The Effect of Health Infrastructure, Adult Literacy, and Household Characteristics on Antenatal Care (ANC) Coverage in Punjab (Pakistan)

Objective: The present study is a cross district analysis of the effect of health infrastructure, adult literacy, and household characteristics on antenatal care (ANC) use in Punjab (Pakistan). Data and Methodology: The unit of analysis is a district. By covering a panel of 35 districts of Punjab, the study has collected the yearly data for the time period 2010 to 2016. The percentage of pregnant women of reproductive age received ANC services in each district is taken as dependent variable. Health physical infrastructure, adult literacy rate, and the percentage of households: having own house, using improved sanitation facilities, and receiving remittances from abroad are taken as explanatory variables. The study used panel Generalized Method of Moments (GMM) to estimate the effects of the explanatory variables on antenatal care.   Results: Ranking of the districts on the basis of ANC coverage shows that amongst the 34 districts of Punjab province, Bahawalnagar, Rajan pur, Pakpattan, Kasur, Bahawalpur, and Rahim Yar Khan districts are at the bottom with the lowest use of ANC services by the pregnant mothers. The GMM estimates show that health physical infrastructure, adult literacy rate, and the percentage of households having their own house are positively and significantly affecting the ANC use in Punjab-Pakistan. Hence confirming the healthcare services utilization framework of Andesen and Newman (2005) which explains that formal healthcare system (health physical infrastructure), predisposing factors (adult literacy rate), and enabling factors (households having their own houses) significantly matter in fostering better use of healthcare services. Conclusion: The study advocates the need for investment in health physical infrastructure as well as in overall literacy. At the same time, it suggests that for the better coverage of ANC the geographical targeting can result into better outcomes.