Digital access and maternal healthcare inequalities in Pakistan, 2024-2025: a population-based cross-sectional study.
- 1Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmacy, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates.
- 2Faculty of Pharmacy, Near East University, Nicosia, Türkiye.
Abstract
Background
Digital access may influence how women obtain health information, communicate, and navigate healthcare, but it is also strongly shaped by socioeconomic and geographic disadvantage. We examined associations between recent digital access and maternal healthcare utilization among women in Pakistan and assessed whether these associations differed by socioeconomic position.Methods
We analyzed 2024-25 Household Integrated Economic Survey data from 10,723 ever-married women aged 15-49 years who reported a live birth during the preceding three years in Pakistan's four provinces. Recent digital access during the three months before interview was classified into four mutually exclusive nominal categories: fully disconnected, offline device use, Internet use without any of 11 specified ICT activities, and Internet use with ≥1 recorded ICT activity. Primary outcomes were ≥4 antenatal-care contacts (ANC ≥4), facility delivery, and maternal postnatal care (PNC) within six weeks. Survey-weighted modified Poisson models estimated adjusted prevalence ratios (aPRs), with maternal age modeled using linear and quadratic terms and lifetime live births continuously. Marginal standardization estimated adjusted prevalences and absolute differences.Results
Fully disconnected women had lower adjusted prevalence of ANC ≥4 than women reporting Internet use with ≥1 recorded ICT activity (aPR 0.75, 95% CI 0.67-0.85), corresponding to standardized prevalences of 47.2% and 58.6%, respectively (difference -11.4 percentage points, 95% CI -13.9 to -8.9). The association with ANC differed across household consumption quintiles (interaction P = 0.004). Among women in the poorest quintile, 19.2% reported Internet use with ≥1 recorded ICT activity, compared with 84.2% among women in the richest quintile. Associations were smaller for facility delivery (aPR 0.94, 95% CI 0.89-1.00) and maternal PNC (0.87, 0.76-0.99) and were less consistent across sensitivity analyses. The ANC association remained evident after additional social-context, temporal, missing-data, and finer-geographic analyses.Conclusions
Complete digital disconnection was consistently associated with lower antenatal-care utilization and was concentrated among socioeconomically disadvantaged women. Associations with facility delivery and maternal PNC were weaker and more context-sensitive, indicating that recent digital access does not relate uniformly to all stages of maternal care. Because digital status was measured near the survey interview and may have changed after the index pregnancy, these findings are associational and do not establish a causal effect of digital access on maternal healthcare use.
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BibTeX
@article{shah2026digital,
title = {{Digital access and maternal healthcare inequalities in Pakistan, 2024-2025: a population-based cross-sectional study.}},
author = {Syed Sikandar Shah and Aftab Alam and Junaid Asghar},
journal = {Frontiers in reproductive health},
year = {2026},
month = oct,
doi = {10.3389/frph.2026.1976275},
url = {https://europepmc.org/article/MED/42921251},
note = {CC BY},
}
RIS
TY - JOUR
TI - Digital access and maternal healthcare inequalities in Pakistan, 2024-2025: a population-based cross-sectional study.
AU - Syed Sikandar Shah
AU - Aftab Alam
AU - Junaid Asghar
PY - 2026
DA - 2026/10/09
JO - Frontiers in reproductive health
DO - 10.3389/frph.2026.1976275
UR - https://europepmc.org/article/MED/42921251
AB - Background Digital access may influence how women obtain health information, communicate, and navigate healthcare, but it is also strongly shaped by socioeconomic and geographic disadvantage. We examined associations between recent digital access and maternal healthcare utilization among women in Pakistan and assessed whether these associations differed by socioeconomic position.Methods We analyzed 2024-25 Household Integrated Economic Survey data from 10,723 ever-married women aged 15-49 years who reported a live birth during the preceding three years in Pakistan's four provinces. Recent digital access during the three months before interview was classified into four mutually exclusive nominal categories: fully disconnected, offline device use, Internet use without any of 11 specified ICT activities, and Internet use with ≥1 recorded ICT activity. Primary outcomes were ≥4 antenatal-care contacts (ANC ≥4), facility delivery, and maternal postnatal care (PNC) within six weeks. Survey-weighted modified Poisson models estimated adjusted prevalence ratios (aPRs), with maternal age modeled using linear and quadratic terms and lifetime live births continuously. Marginal standardization estimated adjusted prevalences and absolute differences.Results Fully disconnected women had lower adjusted prevalence of ANC ≥4 than women reporting Internet use with ≥1 recorded ICT activity (aPR 0.75, 95% CI 0.67-0.85), corresponding to standardized prevalences of 47.2% and 58.6%, respectively (difference -11.4 percentage points, 95% CI -13.9 to -8.9). The association with ANC differed across household consumption quintiles (interaction P = 0.004). Among women in the poorest quintile, 19.2% reported Internet use with ≥1 recorded ICT activity, compared with 84.2% among women in the richest quintile. Associations were smaller for facility delivery (aPR 0.94, 95% CI 0.89-1.00) and maternal PNC (0.87, 0.76-0.99) and were less consistent across sensitivity analyses. The ANC association remained evident after additional social-context, temporal, missing-data, and finer-geographic analyses.Conclusions Complete digital disconnection was consistently associated with lower antenatal-care utilization and was concentrated among socioeconomically disadvantaged women. Associations with facility delivery and maternal PNC were weaker and more context-sensitive, indicating that recent digital access does not relate uniformly to all stages of maternal care. Because digital status was measured near the survey interview and may have changed after the index pregnancy, these findings are associational and do not establish a causal effect of digital access on maternal healthcare use.
SN - 2673-3153
ER -