Spatial Analysis of Socioeconomic Inequality of Opportunity in Access to Skilled Birth Attendant in Punjab, Pakistan

Maternal mortality is a critical global public health issue, particularly in developing countries like Pakistan. Interventions to improve mothers’ usage of skilled birth attendant (SBA) may reduce maternal mortality. The aim of this work to conduct the spatial analysis of socioeconomic inequality of opportunity in access to SBA in districts of Punjab, Pakistan and explore the circumstance variables that contribute the most to the socioeconomic inequality. The study is conducted by using Punjab's Multiple Indicator Cluster Survey 2017-18 and the data analyzed are taken from women of 15 to 49 years with a live birth in the last 2 years. The Human Opportunity Index is used to measure the coverage rate, inequality, and universal access of opportunity across the districts of Punjab. Further, Shapley Decomposition is utilized to identify the contribution of the circumstance factors to the inequality. It is noted that most of the southern districts of Punjab have poor coverage rates and low universal access to SBA and northern districts have high coverage and universal access for the SBA. There is also higher inequality in southern districts of Punjab. Further, in decomposition analysis, it is found that household wealth status, ANC, birth order, birth interval, household head education, ethnicity, media access and residence were the most significant factors leading to socioeconomic inequality of opportunity across the districts of Punjab. Based on the findings, it is suggested that the government should prioritize equitable resource allocation, particularly in southern Punjab.