Sample characteristics at individual level
Table 1.1 indicated the individual level (socio-demographic and obstetric) characteristics of MWRAs (15–49 years), who gave birth during 5 years preceding the last three waves of PDHSs from 2006 to 2018. Here, wave 2 represents PDHS 2006-07, wave 3 indicates PDHS 2012-13, and wave 4 highlights PDHS 2017-18.
Table 1.1
Individual level characteristics of women of reproductive age 15–49 years, who gave a birth during 5 years preceding PDHSs (2006–2018)
Characteristics | PDHS (2006-07) | PDHS (2012-13) | PDHS (2017-18) |
n = 5,677 | n = 7,446 | n = 6,711 |
f | % | f | % | f | % |
Socio-demographic characteristics |
Maternal Age | | | | | | |
15–24 years | 1,334 | 23.5 | 1,748 | 23.5 | 1,545 | 23 |
25–34 years | 2,952 | 52 | 4,038 | 54.2 | 3,725 | 55.5 |
35 years and above | 1,390 | 24.5 | 1,659 | 22.3 | 1,440 | 21.5 |
Maternal Education status | | | | | | |
No formal schooling | 3,668 | 64.6 | 4,155 | 55.8 | 3,212 | 47.9 |
Up to 5 years of schooling | 854 | 15 | 1,230 | 16.5 | 1,097 | 16.3 |
6–10 years of schooling | 813 | 14.3 | 1,380 | 18.5 | 1,492 | 22.2 |
More than 10 years of schooling | 341 | 6 | 682 | 9.2 | 911 | 13.6 |
Paternal Education status | | | | | | |
No formal schooling | 2,007 | 35.5 | 2,451 | 33 | 1,889 | 28.7 |
Up to 5 years of schooling | 935 | 16.5 | 1,211 | 16.3 | 1,085 | 16.5 |
6–10 years of schooling | 1,904 | 33.7 | 2,547 | 34.3 | 2,316 | 35.2 |
More than 10 years of schooling | 812 | 14.3 | 1,216 | 16.4 | 1,293 | 19.6 |
Maternal Occupation | | | | | |
Not Working /Unemployed | 4,026 | 71 | 5,378 | 72.2 | 5,528 | 82.4 |
Professional/Clerical/Sales & Services | 734 | 12.9 | 658 | 8.8 | 279 | 4.2 |
Agriculture | 728 | 12.8 | 820 | 11 | 403 | 6 |
Manual or Household worker | 185 | 3.3 | 590 | 7.9 | 498 | 7.4 |
Paternal Occupation | | | | | |
Not Working /Unemployed | 174 | 3.1 | 123 | 1.7 | 179 | 2.7 |
Professional/Clerical/Sales & Services | 1,999 | 35.2 | 2,355 | 31.6 | 2,119 | 32.1 |
Agriculture | 1,185 | 20.9 | 1,260 | 16.9 | 1,154 | 17.5 |
Manual or Household worker | 2,316 | 40.8 | 3,707 | 49.8 | 3,142 | 47.7 |
Available Means of Transportation | | | | | |
No Vehicle | 2,523 | 47.9 | 3,292 | 46.7 | 2,256 | 34.8 |
Own vehicle | 2,750 | 52.1 | 3,761 | 53.3 | 4,224 | 65.2 |
Maternal Domestic Decision making Autonomya |
No | - | - | 1,396 | 28.3 | 1,899 | 34 |
Yes | - | - | 3,545 | 71.7 | 3,690 | 66 |
Maternal Emotional Autonomya | | | | | | |
No | - | - | 4,175 | 56.2 | 3,776 | 56.3 |
Yes | - | - | 3,251 | 43.8 | 2,931 | 43.7 |
Wealth Quintile | | | | | | |
Poorest | 1,289 | 22.7 | 1,698 | 22.8 | 1,444 | 21.5 |
Poorer | 1,194 | 21 | 1,544 | 20.7 | 1,299 | 19.4 |
Middle | 1,099 | 19.4 | 1,464 | 19.7 | 1,371 | 20.4 |
Richer | 1,066 | 18.8 | 1,469 | 19.7 | 1,349 | 20.1 |
Richest | 1,029 | 18.1 | 1,272 | 17.1 | 1,248 | 18.6 |
Obstetric Characteristics |
Maternal Age at Marriage | | | | | | |
< 20 years | 4,266 | 75.1 | 5,342 | 71.7 | 4,322 | 64.4 |
20 years and above | 1,411 | 24.9 | 2,104 | 28.3 | 2,389 | 35.5 |
Maternal Age at First Birth | | | | | | |
< 20 years | 3,072 | 54.1 | 3,685 | 49.5 | 3,076 | 45.8 |
20 years and above | 2,605 | 45.9 | 3,761 | 50.5 | 3,635 | 54.2 |
Parity | | | | | | |
1–2 children | 2,000 | 35.2 | 2,885 | 38.7 | 2,749 | 41 |
3–4 children | 1,648 | 29 | 2,249 | 30.2 | 2,183 | 32.5 |
5 children or above | 2,029 | 35.7 | 2,312 | 31.1 | 1,780 | 26.5 |
Number of Living Children | | | | | | |
0 | 100 | 1.8 | 80 | 1.1 | 83 | 1.2 |
1–2 | 2,138 | 37.7 | 3,149 | 42.3 | 2,944 | 43.9 |
3–4 | 1,737 | 30.6 | 2,306 | 31 | 2,222 | 33.1 |
5 or above | 1,702 | 30 | 1,912 | 25.7 | 1,463 | 21.8 |
Antenatal Attendance | | | | | | |
Less than 4 visits or no visit | 3,987 | 71.2 | 4,713 | 63.4 | 2,414 | 41.1 |
At least 4 visits or more | 1,611 | 28.8 | 2,723 | 36.6 | 3,452 | 58.9 |
Birth Order | | | | | | |
1 | 965 | 17 | 1,418 | 19 | 1,337 | 19.9 |
2–3 | 1,917 | 33.8 | 2,710 | 36.4 | 2,571 | 38.3 |
4–5 | 1,389 | 24.5 | 1,735 | 23.3 | 1,739 | 25.9 |
6 or more | 1,406 | 24.8 | 1,583 | 21.3 | 1,064 | 15.9 |
Sex/Gender of Newborn | | | | | | |
Female | 2,606 | 45.9 | 3,583 | 48.1 | 3,308 | 49.3 |
Male | 3,071 | 54.1 | 3,863 | 51.9 | 3,404 | 50.7 |
Size of Newborn at Birth | | | | | | |
Large | 1,272 | 22.6 | 477 | 6.4 | 475 | 7.1 |
Average | 2,526 | 44.8 | 5,421 | 73 | 4,862 | 72.7 |
Small | 1,842 | 32.4 | 1,524 | 20.5 | 1,353 | 20.2 |
a Autonomy related data was not collected during PDHS 2006-07. |
Table 1.1 showed that the majority of the MWRAs were aged between 25–34 years (52%, 54.2%, and 55.5%) and had not attained formal schooling (64.6%, 55.8%, and 47.9%), however, their husbands had completed 6–10 years of schooling, i.e. 33.7%, 34.3%, and 35.2%. in the last three waves respectively. A common trend was seen in terms of employment during the last three waves of PDHS, where a large number of MWRAs were found unemployed (71%, 72.2%, and 82.4%), while their husbands were mostly employed and working as manual/household workers (40.8%, 49.8%, and 47.7%). Further, mostly MWRAs belonged to the poorest wealth quintile (22.7%, 22.8%, and 21.5%), nonetheless, confirmed the availability of own vehicles for transportation (52.1%, 53.3%, and 65.2%).
With regards to autonomy, relevant data was not collected during PDHS 2006-07. Hence, analysis informed that a significant proportion of the MWRAs (71.7% and 66%) had domestic decision-making autonomy, whereas 56.2% and 56.3% MWRAs had no emotional autonomy in waves 3 and 4 of PDHS respectively.
Regarding obstetric characteristics of MWRAs in the last three waves, most of the women were married at a younger age, i.e. <20 years (75.1%, 71.7%, and 64.4%). However, a slight variation was observed in maternal age at first birth, as 54.1% of women gave birth at < 20 years in wave 2, while 20 years and above (50.5% and 54.2%) gave birth in wave 3 and 4. More than one-third of MWRAs had 1–2 children ever born (35.2%, 38.7%, and 41%) and similarly 1–2 living children (37.7%, 42.3%, and 43.9%). Further analysis revealed that most of the women had either availed less than 4 antenatal visits or no visit (71.2% and 63.4%) in wave 2 and wave 3 respectively, nonetheless availed at least 4 visits or more (58.9%) in wave 4, showing an increase in antenatal care utilization over time. Furthermore, the majority of MWRAs had 2–3 birth orders (33.8%, 36.4%, and 38.3%), male newborns (54.1%, 51.9%, and 50.7%) with an average size (44.8%, 73%, and 72.7%) in all three waves of PDHS.
Characteristics at community and institutional level
Table 1.2 indicated community and institutional level characteristics of MWRAs (aged 15–49 years), who gave birth in the last 5 years preceding PDHSs from 2006 to 2018.
Table 1.2
Community and institutional level characteristics of women of reproductive age 15–49 years, who gave a birth during 5 years preceding PDHSs (2006–2018)
Characteristics | PDHS (2006-07) | PDHS (2012-13) | PDHS (2017-18) |
n = 5,677 | n = 7,446 | n = 6,711 |
f | % | f | % | f | % |
Community level Characteristics |
Regions/Provinces | | | | | | |
Punjab | 3,182 | 56.1 | 4,180 | 56.1 | 3,453 | 51.5 |
Sindh | 1,404 | 24.7 | 1,714 | 23 | 1,571 | 23.4 |
Baluchistan | 264 | 4.6 | 348 | 4.7 | 377 | 5.6 |
Khyber Pakhtunkhwaa | 827 | 14.6 | 1,117 | 15 | 1,101 | 16.4 |
Gilgit Baltistan* | - | - | 56 | 0.7 | - | - |
Islamabad* | - | - | 31 | 0.4 | 54 | 0.8 |
FATA* | - | - | - | - | 156 | 2.3 |
Geographical Classification | | | | | | |
Urban | 1,714 | 30.2 | 2,244 | 30.1 | 2,248 | 33.5 |
Rural | 3,962 | 69.8 | 5,202 | 69.9 | 4,463 | 66.5 |
Mass Media Exposure* | | | | | |
No | - | - | 2,184 | 29.4 | 2,454 | 36.6 |
Yes | - | - | 5,241 | 70.6 | 4,254 | 63.4 |
Perceived difficulty of distance to facility* | | | | |
Problem | - | - | 2,982 | 40.1 | 3,024 | 45.1 |
Not a Problem | - | - | 4,451 | 59.9 | 3,683 | 54.9 |
Visit of Field worker (LHWs) | | | | | | |
No | 4,143 | 73 | 2,260 | 43.2 | 2,564 | 38.2 |
Yes | 1,533 | 27 | 2,975 | 56.8 | 4,147 | 61.8 |
Institutional level characteristics |
Mode of Delivery | | | | | | |
Vaginal | 5,193 | 91.5 | 6,268 | 84.3 | 5,094 | 75.9 |
C-Section | 482 | 8.5 | 1,171 | 15.7 | 1,614 | 24.1 |
Place of Delivery | | | | | | |
Home | 3,545 | 62.8 | 3,594 | 48.3 | 2,093 | 31.2 |
Hospital/Facility (Public & Private) | 2,101 | 37.2 | 3,841 | 51.7 | 4,618 | 68.8 |
Skilled Birth Assistance | | | | |
No | 3,280 | 58.1 | 3,312 | 44.6 | 1,879 | 28 |
Yes | 2,365 | 41.9 | 4,112 | 55.4 | 4,833 | 72 |
a Khyber Pakhtunkhwa was formerly known as North-West Frontier Province (NWFP), as reported in PDHS 2006-07 |
* missing information indicates the non-availability of data within PDHS waves, particularly in PDHS 2006-07 for mass media exposure and perceived difficulty of distance to facility |
For community-level characteristics, a higher number of women were found from Punjab (56.1%, 56.1%, and 51.5%), and belonged to rural areas (69.8%, 69.9%, and 66.5%). The majority of the MWRAs had exposure to mass media (70.6% and 63.4%) and reported that distance to health facilities was not a problem (59.9% and 54.9%) from wave 3 and 4 respectively. Further, most of the MWRAs (73%) in wave 2 reported that they were not visited by the field workers, e.g., LHWs, nonetheless, an increase in the number of women attended by LHWs (56.8% and 61.8%) was observed in wave 3 and 4.
Regarding institutional level characteristics, a shift from home-based deliveries to hospital-based deliveries was observed from wave 2 to wave 4. Analysis showed that the majority of MWRAs reported that they had a vaginal delivery (91.5%, 84.3%, and 75.9%), however, mostly delivered at home (62.8%), without any SBA (58.1%) in wave 2. Contrary, a higher number of MWRAs were delivered at health facilities/hospitals (51.7% and 68.8%) by SBA (55.4% and 72%) in wave 3 and 4 respectively.
Maternal and newborn PNC related characteristics
Table 2 highlighted respondents’ characteristics related to maternal and newborn PNC utilization within the first 2 months from 2006 to 2018. Analysis reveals that the trend of maternal and newborn PNC utilization has changed over time from 2006 to 2018, as exhibited in Fig. 3.
Table 2
Maternal and newborn postnatal care related characteristics of the women of reproductive age 15–49 years, who gave a birth during 5 years preceding PDHSs (2006–2018)
Characteristics | PDHS (2006-07) | PDHS (2012-13) | PDHS (2017-18) |
n = 5,677 | n = 7,446 | n = 6,711 |
f | % | f | % | f | % |
Maternal PNC Utilization | | | | | | |
No | 3,181 | 56.5 | 2,946 | 39.7 | 2,442 | 36.4 |
Yes | 2,446 | 43.5 | 4,473 | 60.3 | 4,269 | 63.6 |
Timing for PNC check-up | | | | | | |
Within first 24 hours | 2,148 | 90.1 | 2,992 | 81.5 | 2,510 | 59.1 |
Within 2–6 days | 177 | 7.4 | 391 | 10.7 | 117 | 2.8 |
Within 7–42 days | 59 | 2.5 | 289 | 7.9 | 1,620 | 38.2 |
Newborn PNC Utilization within first 2 months | | | | |
No | 2,837 | 79.4 | 3,652 | 49.5 | 4,631 | 69.3 |
Yes | 738 | 20.6 | 3,724 | 50.5 | 2,056 | 30.7 |
PNC Utilization by Skilled Birth Attendants | | | | | |
No | 927 | 37.9 | 747 | 20 | 400 | 9.4 |
Yes | 1,518 | 62.1 | 2,977 | 80 | 3,869 | 90.6 |
Place of 1st PNC check-up | | | | | | |
Home | 980 | 91.3 | 800 | 21.5 | 508 | 21 |
Hospital/Facility (Public & Private) | 94 | 8.7 | 2,924 | 78.5 | 1,913 | 79 |
The majority of respondents informed that they had not availed both maternal PNC (56.5%) and newborn PNC (79.4%) in wave 2, nevertheless, a gradual increase in the proportions of maternal PNC utilization (60.3% and 63.6%) was recorded in wave 3 and 4 respectively, showing an upward trend in maternal PNC utilization. In the case of newborn PNC utilization, a dip was observed, where more than half of the respondents reported that their newborns were checked (50.5%) in wave 3, while 69.3% were not checked after delivery in wave 4, highlighting a downward trend in newborn PNC.
Further, amongst those who availed PNC utilization, the majority availed PNC within the first 24 hours (90.1%, 81.5%, and 59.1%), by skilled birth attendants (62.1%, 80%, and 90.6%). Furthermore, a large number of the women reported that their first PNC checkup took place at home (91.3%) in wave 2, nevertheless mostly visited a health facility for their first PNC checkup (78.5% and 79%) during wave 3 and 4 of PDHS.
Relationship of maternal PNC utilization with individual-level characteristics
Table 3.1 indicated an association between maternal PNC utilization and individual-level characteristics of MWARs aged 15–49 years, who gave birth in the last 5 years preceding PDHSs (2006–2018).
Table 3.1
Relationship of maternal PNC utilization with individual level characteristics of women of reproductive age 15–49 years, who gave a birth during 5 years preceding PDHSs (2006–2018)
Characteristics | PDHS (2006-07) | PDHS (2012-13) | PDHS (2017-18) |
n = 5,677 | n = 7,446 | n = 6,711 |
Yes | No | p-value* | Yes | No | p-value* | Yes | No | p-value* |
Individual Characteristics |
Socio-demographic characteristics |
Maternal Age | | | | | | | | | |
15–24 years | 45.3 | 54.7 | < 0.01 | 63.1 | 36.9 | < 0.01 | 62.7 | 37.3 | < 0.01 |
25–34 years | 46.4 | 53.6 | 60.2 | 39.8 | 66.1 | 33.9 |
35 years and above | 35.5 | 64.5 | 57.5 | 42.5 | 58.2 | 41.8 |
Maternal Education status | | | | | | | | | |
No formal schooling | 35.1 | 64.9 | < 0.01 | 50.2 | 49.8 | < 0.01 | 50.3 | 49.7 | < 0.01 |
Up to 5 years of schooling | 49.4 | 50.6 | 60.6 | 39.4 | 65.7 | 34.3 |
6–10 years of schooling | 61.6 | 38.4 | 75.6 | 24.4 | 76.1 | 23.9 |
More than 10 years of schooling | 74.5 | 25.5 | 90.5 | 9.5 | 87.3 | 12.7 |
Paternal Education status | | | | | | | | | |
No formal schooling | 32.5 | 67.5 | < 0.01 | 49.6 | 50.4 | < 0.01 | 50.7 | 49.3 | < 0.01 |
Up to 5 years of schooling | 38.9 | 61.2 | 57.4 | 42.6 | 57.6 | 42.4 |
6–10 years of schooling | 49.1 | 50.9 | 63.6 | 36.4 | 68.6 | 31.4 |
More than 10 years of schooling | 62.7 | 37.3 | 77.6 | 22.4 | 79.4 | 20.6 |
Maternal Occupation | | | | | | | | |
Not Working /Unemployed | 44.2 | 55.8 | < 0.01 | 62.7 | 37.3 | < 0.01 | 64.1 | 35.9 | < 0.01 |
Professional/Clerical/Sales & Services | 48.4 | 51.6 | 67.5 | 32.5 | 75.3 | 24.7 |
Agriculture | 34.8 | 65.2 | 45.3 | 54.7 | 46.9 | 53.1 |
Manual or Household worker | 43.6 | 56.4 | 51.4 | 48.6 | 64.8 | 35.2 |
Paternal Occupation | | | | | | |
Not Working /Unemployed | 38.2 | 61.8 | < 0.01 | 50.8 | 49.2 | < 0.01 | 59.2 | 40.8 | < 0.01 |
Professional/Clerical/Sales & Services | 51.6 | 48.4 | 69.1 | 30.9 | 72.7 | 27.3 |
Agriculture | 36.1 | 63.9 | 54.7 | 45.3 | 52.9 | 47.1 |
Manual or Household worker | 40.6 | 59.4 | 56.9 | 43.1 | 61.7 | 38.3 |
Available Means of Transportation | | | | | | | | |
No Vehicle | 39.0 | 61.0 | < 0.01 | 52.0 | 48.0 | < 0.01 | 56.3 | 43.7 | < 0.01 |
Own vehicle | 46.9 | 53.1 | 66.9 | 33.1 | 66.6 | 33.4 |
Maternal Decision making Autonomy | | | | | | | | |
No | - | - | - | 50.9 | 49.1 | < 0.01 | 51.3 | 48.7 | < 0.01 |
Yes | - | - | 60.3 | 39.7 | 70.6 | 29.4 |
Maternal Emotional Autonomy | | | | | | | | | |
No | - | - | - | 67.3 | 32.7 | < 0.01 | 72.0 | 28.0 | < 0.01 |
Yes | - | - | 51.3 | 48.7 | 53.0 | 47.0 |
Wealth Quintile | | | | | | | | | |
Poorest | 31.7 | 68.3 | < 0.01 | 43.0 | 57.0 | < 0.01 | 47.1 | 52.9 | < 0.01 |
Poorer | 31.1 | 68.9 | 50.3 | 49.7 | 49.7 | 50.3 |
Middle | 41.0 | 59.0 | 59.1 | 40.9 | 63.1 | 36.9 |
Richer | 52.1 | 47.9 | 71.7 | 28.3 | 73.7 | 26.3 |
Richest | 66.1 | 33.9 | 83.8 | 16.2 | 86.9 | 13.1 |
Obstetric Characteristics |
Maternal Age at Marriage | | | | | | | | | |
< 20 years | 41.2 | 58.8 | < 0.01 | 55.9 | 44.1 | < 0.01 | 57.8 | 42.2 | < 0.01 |
20 years and above | 50.4 | 49.6 | 71.5 | 28.5 | 74.2 | 25.8 |
Maternal Age at First Birth | | | | | | | | | |
< 20 years | 40.3 | 59.7 | < 0.01 | 54 | 46 | < 0.01 | 56.4 | 43.6 | < 0.01 |
20 years and above | 47.2 | 52.8 | 66.4 | 33.6 | 69.7 | 30.3 |
Parity | | | | | | | | | |
1–2 children | 49 | 51 | < 0.01 | 69 | 31 | < 0.01 | 70.9 | 29.1 | < 0.01 |
3–4 children | 45.7 | 54.3 | 59.4 | 40.6 | 65.5 | 34.5 |
5 children or above | 36.2 | 63.8 | 50.2 | 49.8 | 50 | 50 |
Number of living children | | | | | | | | | |
0 | 49.5 | 50.5 | < 0.01 | 75.3 | 24.7 | < 0.01 | 66.3 | 33.7 | < 0.01 |
1–2 | 48.3 | 51.7 | 68.3 | 31.7 | 70.2 | 29.8 |
3–4 | 46 | 54 | 58.3 | 41.7 | 64.2 | 35.8 |
5 or above | 34.5 | 65.5 | 48.9 | 51.1 | 49.2 | 50.8 |
Antenatal Attendance | | | | | | | | | |
Less than 4 visits or no visit | 33.7 | 66.3 | < 0.01 | 48.5 | 51.5 | < 0.01 | 54.5 | 45.5 | < 0.01 |
At least 4 visits or more | 66.9 | 33.1 | 80.8 | 19.2 | 78.8 | 21.2 |
Birth Order | | | | | | | | | |
1 | 49.7 | 50.3 | < 0.01 | 72 | 28 | < 0.01 | 72.6 | 27.4 | < 0.01 |
2–3 | 47.9 | 52.1 | 64.3 | 35.7 | 68.8 | 31.2 |
4–5 | 42.5 | 57.5 | 54.9 | 45.1 | 58.7 | 41.3 |
6 or more | 34.2 | 65.8 | 48.8 | 51.2 | 47.9 | 52.1 |
Sex/Gender of Newborn | | | | | | | | | |
Female | 42.5 | 57.5 | 0.18 | 59.1 | 40.9 | 0.04 | 63.3 | 36.7 | 0.64 |
Male | 44.3 | 55.7 | 61.4 | 38.6 | 63.9 | 36.1 |
Size of Newborn at Birth | | | | | | | | | |
Large | 46.5 | 53.5 | 0.04 | 63.2 | 36.8 | < 0.01 | 68.5 | 31.5 | < 0.01 |
Average | 42.9 | 57.1 | 62.2 | 37.8 | 65.3 | 34.7 |
Small | 42.1 | 57.9 | 52.5 | 47.5 | 56.3 | 43.7 |
* Chi-square test was applied to determine p-value |
The results of chi-square showed a statistically significant association between maternal PNC utilization and key characteristics, including maternal age, maternal and paternal education status, maternal and paternal occupations, available means of transportation, and wealth quintile in the last three waves of PDHS (2006–2018). Further, a strong statistical relationship between maternal PNC utilization and domestic decision-making, and emotional autonomy was also seen during 3 and 4 waves of PDHS.
The overall findings highlighted an upward trend of maternal PNC utilization and a strong association with individual-level women characteristics. For instance, maternal PNC utilization was found high among women aged between 25–34 years (46.4%, 60.2%, and 66.1%), who attended more than 10 years of schooling (74.5%, 90.5%, and 87.3%), worked for the category of professional/clerical/sales & services (48.4%, 67.5%, and 75.3%), owned vehicle for transportation (46.9%, 66.9%, and 66.6%) and belonged to richest wealth quintile (66.1%, 83.8%, and 86.9%) in the last three waves of PDHS. Further, more than 60% and 70% of women having maternal domestic decision-making autonomy also received maternal PNC utilization during 3rd and 4th waves of PDHS. Contrary, the majority of the women, who had no emotional autonomy (67.3% and 72%) also utilized PNC services in waves 3 and 4 respectively.
With reference to obstetric characteristics, the results of chi-square expressed a statistically significant association of maternal PNC utilization with maternal age at marriage and first birth, parity, number of living children, antenatal attendance, birth order, sex/gender of newborn, and size of the newborn at birth in last three waves of PDHS (2006–2018).
Findings also informed that maternal PNC utilization was high among those women, who had an age of 20 years and above at marriage (50.4%, 71.5%, and 74.2%), and also at the time of first birth (47.2%, 66.4%, and 69.7%), had 3–4 living children ( 45.7%, 59.4%, and 65.5%), attended at least 4 or more antenatal visits (66.9%, 80.8%, and 78.8%), within their first birth order ( 49.7%, 72%, and 72.6%) and had male newborn (44.3%, 61.4%, and 63.9%) with large size (46.5%, 63.2%, and 68.5%) in all last three waves of PDHS.
Relationship of maternal PNC utilization with community and institutional level characteristics
Table 3.2 specified the association of maternal PNC utilization with community and institutional level characteristics of women of reproductive age 15–49 years, who gave birth in the last 5 years preceding PDHSs (2006–2018).
Table 3.2
Relationship of Maternal PNC Utilization with Community and Institutional level Characteristics of women of reproductive age 15–49 years, who gave a birth during 5 years preceding PDHSs (2006–2018)
Characteristics | PDHS (2006-07) | PDHS (2012-13) | PDHS (2017-18) |
n = 5,677 | n = 7,446 | n = 6,711 |
Yes | No | p-value* | Yes | No | p-value* | Yes | No | p-value* |
Community level Characteristics |
Regions/Provinces | | | | | | | | | |
Punjab | 40.3 | 59.7 | < 0.01 | 65.5 | 34.5 | < 0.01 | 68.5 | 31.5 | < 0.01 |
Sindh | 60.6 | 39.4 | 67.6 | 32.4 | 75.6 | 24.4 |
Baluchistan | 40.8 | 59.2 | 39.7 | 60.3 | 38.7 | 61.3 |
Khyber Pakhtunkhwa | 27.5 | 72.5 | 37.4 | 62.6 | 43.9 | 56.1 |
Gilgit Baltistan | - | - | 21.8 | 78.2 | - | - |
Islamabad | - | - | 80.6 | 19.4 | 79.2 | 20.8 |
FATA | - | - | - | - | 30.1 | 69.9 |
Geographical Classification | | | | | | | | |
Urban | 57.8 | 42.2 | < 0.01 | 74.4 | 25.6 | < 0.01 | 76.8 | 23.2 | < 0.01 |
Rural | 37.3 | 62.7 | 54.2 | 45.8 | 57.0 | 43.0 |
Mass Media Exposure | | | | | | | |
No | - | - | - | 42.8 | 57.2 | < 0.01 | 48.4 | 51.6 | < 0.01 |
Yes | - | - | 67.6 | 32.4 | 72.4 | 27.6 |
Perceived difficulty of distance to facility | | | | | |
Problem | - | - | - | 49.2 | 50.8 | < 0.01 | 54.5 | 45.5 | < 0.01 |
Not a Problem | - | - | 67.7 | 32.3 | 71.1 | 28.9 |
Visit of Field worker (LHWs) | | | | | | | |
No | 42.0 | 58.0 | < 0.01 | 62.1 | 37.9 | 0.02 | 56.4 | 43.6 | < 0.01 |
Yes | 47.5 | 52.5 | 65.2 | 34.8 | 68.1 | 31.9 |
Institutional level Characteristics |
Mode of Delivery | | | | | | | | | |
Vaginal | 39.2 | 60.8 | < 0.01 | 53.2 | 46.8 | < 0.01 | 52.5 | 47.5 | < 0.01 |
C-Section | 89.0 | 11.0 | 98.0 | 2.0 | 98.9 | 1.1 |
Place of Delivery | | | | | | | | | |
Home | 28.7 | 71.3 | < 0.01 | 31.6 | 68.4 | < 0.01 | 24.7 | 75.3 | < 0.01 |
Hospital/Facility (Public & Private) | 68.3 | 31.7 | 87.1 | 12.9 | 81.3 | 18.7 |
Skilled Birth Assistance | | | | | | | |
No | 28.5 | 71.5 | < 0.01 | 30.0 | 70.0 | < 0.01 | 23.3 | 76.7 | < 0.01 |
Yes | 64.2 | 35.8 | 84.8 | 15.2 | 79.3 | 20.7 |
* Chi-square test was applied to determine p-value |
Results showed a statistically significant relationship (p ≤ 0.05) of maternal PNC utilization with regions/provinces, geographical classification, mass media exposure, perceived difficulty of distance to facility, visit of field worker (LHWs), mode of delivery, place of delivery and skilled birth assistance during last three waves of PDHS.
Findings informed that majority of the women from Sindh (60.6%, 67.6%, and 75.6%), residing in urban areas (57.8%, 74.4%, and 76.8%) and visited by LHWs (47.5%, 65.2%, and 68.1%) availed maternal PNC utilization. Further, those women, who had exposure to mass media (67.6% and 72.4%) and had not faced any difficulty accessing the facility (67.7% and 71.1%) also utilized maternal PNC during wave 3 and 4 of PDHS. Furthermore, results also highlighted that majority of the women, who had caesarean sections (89%, 98%, and 98.9%) and delivered at health facilities (68.3%, 87.1%, and 81.3%) by skilled birth attendants (64.2%, 84.8%, and 79.3%) were more likely to avail maternal PNC utilization across last three waves of PDHS.
Relationship of newborn PNC utilization with individual-level characteristics
Table 3.3 expressed the association of newborn PNC utilization with individual-level characteristics of MWRAs, who gave birth in the last 5 years preceding PDHSs (2006–2018).
Table 3.3
Relationship of Newborn PNC Utilization with Individual level Characteristics of women of reproductive age 15–49 years, who gave a birth during 5 years preceding PDHSs (2006–2018)
Characteristics | PDHS (2006-07) | PDHS (2012-13) | PDHS (2017-18) |
n = 5,677 | n = 7,446 | n = 6,711 |
Yes | No | p-value* | Yes | No | p-value* | Yes | No | p-value* |
Individual Characteristics |
Socio-demographic Characteristics |
Maternal Age | | | | | | | | | |
15–24 years | 23.1 | 76.9 | < 0.01 | 50.3 | 49.7 | 0.79 | 29.5 | 70.5 | 0.13 |
25–34 years | 21.8 | 78.2 | 50.8 | 49.2 | 31.8 | 68.2 |
35 years and above | 16.3 | 83.7 | 49.9 | 50.1 | 29.5 | 70.5 |
Maternal Education status | | | | | | | | | |
No formal schooling | 18.3 | 81.7 | < 0.01 | 41.3 | 58.7 | < 0.01 | 25.9 | 74.1 | < 0.01 |
Up to 5 years of schooling | 26.1 | 73.9 | 56.5 | 43.5 | 33.8 | 66.2 |
6–10 years of schooling | 31.8 | 68.2 | 61.1 | 38.9 | 32.8 | 67.2 |
More than 10 years of schooling | 29.5 | 70.5 | 74.4 | 25.6 | 40.7 | 59.3 |
Paternal Education status | | | | | | | | | |
No formal schooling | 15.7 | 84.3 | < 0.01 | 41.3 | 58.7 | < 0.01 | 27.5 | 72.5 | < 0.01 |
Up to 5 years of schooling | 20.6 | 79.4 | 50.3 | 49.7 | 29.6 | 70.4 |
6–10 years of schooling | 24.3 | 75.7 | 52.6 | 47.4 | 31.8 | 68.2 |
More than 10 years of schooling | 32.0 | 68.0 | 64.7 | 35.3 | 35.1 | 64.9 |
Maternal Occupation | | | | | | | | |
Not Working /Unemployed | 20.7 | 79.3 | < 0.01 | 51.5 | 48.5 | < 0.01 | 29.7 | 70.3 | < 0.01 |
Professional/Clerical/Sales & Services | 23.1 | 76.9 | 59.0 | 41.0 | 38.5 | 61.5 |
Agriculture | 16.3 | 83.7 | 44.6 | 55.4 | 30.8 | 69.2 |
Manual or Household worker | 29.8 | 70.2 | 40.2 | 59.8 | 37.6 | 62.4 |
Paternal Occupation | | | | | | | |
Not Working /Unemployed | 14.0 | 86.0 | < 0.01 | 38.5 | 61.5 | < 0.01 | 34.8 | 65.2 | 0.42 |
Professional/Clerical/Sales & Services | 23.1 | 76.9 | 59.3 | 40.7 | 31.5 | 68.5 |
Agriculture | 17.0 | 83.0 | 50.6 | 49.4 | 31.0 | 69.0 |
Manual or Household worker | 21.4 | 78.6 | 45.3 | 54.7 | 30.0 | 70.0 |
Available Means of Transportation | | | | | | | |
No Vehicle | 20.1 | 79.9 | 0.49 | 43.4 | 56.6 | < 0.01 | 28.8 | 71.2 | 0.05 |
Own vehicle | 21.1 | 78.9 | 56.1 | 43.9 | 31.2 | 68.8 |
Maternal Decision making Autonomy | | | | | | | |
No | - | - | - | 42.6 | 57.4 | < 0.01 | 22.1 | 77.9 | < 0.01 |
Yes | - | - | 51.7 | 48.3 | 35.2 | 64.8 |
Maternal Emotional Autonomy | | | | | | | | |
No | - | - | - | 54.6 | 45.4 | < 0.01 | 33.3 | 66.7 | < 0.01 |
Yes | - | - | 45.2 | 54.8 | 27.4 | 72.6 |
Wealth Quintile | | | | | | | | | |
Poorest | 17.2 | 82.8 | < 0.01 | 36.6 | 63.4 | < 0.01 | 27.5 | 72.5 | < 0.01 |
Poorer | 17.9 | 82.1 | 44.4 | 55.6 | 27.6 | 72.4 |
Middle | 20.5 | 79.5 | 50.3 | 49.7 | 28.3 | 71.7 |
Richer | 26.2 | 73.8 | 58.8 | 41.2 | 32.0 | 68.0 |
Richest | 32.9 | 67.1 | 67.5 | 32.5 | 39.0 | 61.0 |
Obstetric Characteristics |
Maternal Age at Marriage | | | | | | | | | |
< 20 years | 21.5 | 78.5 | 0.01 | 46.6 | 53.4 | < 0.01 | 28.7 | 71.3 | < 0.01 |
20 years and above | 17.2 | 82.8 | 60.6 | 39.4 | 34.5 | 65.5 |
Maternal Age at First Birth | | | | | | | | | |
< 20 years | 21.6 | 78.4 | 0.08 | 46 | 54 | < 0.01 | 27.9 | 72.1 | < 0.01 |
20 years and above | 19.2 | 80.8 | 54.9 | 45.1 | 33.2 | 66.8 |
Parity | | | | | | | | | |
1–2 children | 21.9 | 78.1 | 0.01 | 55.5 | 44.5 | < 0.01 | 34.8 | 65.2 | < 0.01 |
3–4 children | 22.8 | 77.2 | 49.5 | 50.5 | 29.3 | 70.7 |
5 children or above | 18.2 | 81.8 | 45.2 | 54.8 | 26.2 | 73.8 |
Number of living children | | | | | | | | | |
0 | 31.5 | 68.5 | 0.01 | 53.4 | 46.6 | < 0.01 | 29.3 | 70.7 | < 0.01 |
1–2 | 22.3 | 77.7 | 55.5 | 44.5 | 35 | 65 |
3–4 | 21.5 | 78.5 | 48.4 | 51.6 | 29.6 | 70.4 |
5 or above | 17.9 | 82.1 | 44.7 | 55.3 | 24 | 76 |
Antenatal Attendance | | | | | | | | | |
Less than 4 visits or no visit | 18.3 | 81.7 | < 0.01 | 43.3 | 56.7 | < 0.01 | 28.7 | 71.3 | < 0.01 |
At least 4 visits or more | 34 | 66 | 63.1 | 36.9 | 36 | 64 |
Birth Order | | | | | | | | | |
1 | 24.1 | 75.9 | 0.01 | 57 | 43 | < 0.01 | 35.2 | 64.8 | < 0.01 |
2–3 | 21.3 | 78.7 | 52.6 | 47.4 | 31.8 | 68.2 |
4–5 | 21.9 | 78.1 | 48.2 | 51.8 | 28.9 | 71.1 |
6 or more | 17.3 | 82.7 | 43.7 | 56.3 | 25.5 | 74.5 |
Sex/Gender of Newborn | | | | | | | | | |
Female | 18 | 82 | < 0.01 | 50.3 | 49.7 | 0.72 | 28.8 | 71.2 | < 0.01 |
Male | 22.9 | 77.1 | 50.7 | 49.3 | 32.6 | 67.4 |
Size of Newborn at Birth | | | | | | | | | |
Large | 23.1 | 76.9 | < 0.01 | 52.4 | 47.6 | 0.17 | 32.6 | 67.4 | 0.30 |
Average | 17.6 | 82.4 | 50.9 | 49.1 | 30.3 | 69.7 |
Small | 23.1 | 76.9 | 48.5 | 51.5 | 32.1 | 67.9 |
* Chi-square test was applied to determine p-value |
Results showed a statistically significant relationship (p ≤ 0.05) of newborn PNC utilization with maternal and paternal education status, maternal occupation, and wealth quintile in the last three waves of PDHS. Further, findings also revealed a strong statistical relationship between newborn PNC utilization and maternal domestic decision-making autonomy, emotional autonomy, and available means of transportation in wave 3 and 4 respectively. However, results found a significant association of newborn PNC with maternal age during wave 2, and with paternal occupation in waves 2 and 3 of PDHS.
The findings informed that newborn PNC utilization was found higher among those women, who attended more than 10 years of schooling (74.4% and 40.7%) in 3 and 4 waves, and their husbands also had more than 10 years of schooling during the last three waves (32%, 64.7%, and 35.1%). However, a substantial difference in patterns of newborn PNC utilization was observed with maternal autonomy and occupation. For instance, those women who belonged to the category of professional/clerical/sales & services (59% and 38.5%) in waves 3 and 4, while engaged in manual and household work (29.8%) in wave 2 were more likely to utilize newborn PNC services.
With reference to obstetric characteristics, the results highlighted a statistically significant association (p ≤ 0.05) of newborn PNC utilization with maternal age at marriage, parity, number of living children, antenatal attendance, and birth order in the last three waves of PDHS. Nonetheless, a significant relationship between newborn PNC utilization and sex/gender of the newborn was seen during waves 2 and 4, as well as with the size of the newborn in wave 2 and maternal age at first birth in waves 3 and 4 of PDHS.
Relationship of newborn PNC utilization with community and institutional level characteristics
Table 3.4 showed the association of newborn PNC utilization with community and institutional level characteristics of women of reproductive age 15–49 years, who gave birth during 5 years preceding PDHSs (2006–2018).
Table 3.4
Relationship of Newborn PNC Utilization with Community and Institutional level Characteristics of women of reproductive age 15–49 years, who gave a birth during 5 years preceding PDHSs (2006–2018)
Characteristics | PDHS (2006-07) | PDHS (2012-13) | PDHS (2017-18) |
n = 5,677 | n = 7,446 | n = 6,711 |
Yes | No | p-value* | Yes | No | p-value* | Yes | No | p-value* |
Community level Characteristics |
Regions/Provinces | | | | | | | | | |
Punjab | 17.5 | 82.5 | < 0.01 | 58.1 | 41.9 | < 0.01 | 33.3 | 66.7 | < 0.01 |
Sindh | 34.2 | 65.8 | 50.6 | 49.4 | 40.4 | 59.6 |
Baluchistan | 10.7 | 89.3 | 18.0 | 82.0 | 15.3 | 84.7 |
Khyber Pakhtunkhwa | 17.1 | 82.9 | 33.4 | 66.6 | 17.4 | 82.6 |
Gilgit Baltistan | - | - | 16.1 | 83.9 | - | - |
Islamabad | - | - | 64.5 | 35.5 | 38.9 | 61.1 |
FATA | - | - | - | - | 5.1 | 94.9 |
Geographical Classification | | | | | | | | | |
Urban | 26.4 | 73.6 | < 0.01 | 58.3 | 41.7 | < 0.01 | 36.9 | 63.1 | < 0.01 |
Rural | 19.2 | 80.8 | 47.1 | 52.9 | 27.6 | 72.4 |
Mass Media Exposure | | | | | | | | | |
No | - | - | - | 37.4 | 62.6 | < 0.01 | 22.7 | 77.3 | < 0.01 |
Yes | - | - | 56.1 | 43.9 | 35.4 | 64.6 |
Perceived difficulty of distance to facility | | | | | | | |
Problem | - | - | - | 40.8 | 59.2 | < 0.01 | 26.9 | 73.1 | < 0.01 |
Not a Problem | - | - | 57.0 | 43.0 | 33.9 | 66.1 |
Visit of Field worker (LHWs) | | | | | | | | | |
No | 19.6 | 80.4 | 0.01 | 48.0 | 52.0 | < 0.01 | 25.8 | 74.2 | < 0.01 |
Yes | 23.8 | 76.2 | 58.0 | 42.0 | 33.8 | 66.2 |
Institutional level Characteristics |
Mode of Delivery | | | | | | | | | |
Vaginal | 20.6 | 79.4 | 0.44 | 45.6 | 54.4 | < 0.01 | 26.7 | 73.3 | < 0.01 |
C-Section | 33.3 | 66.7 | 77.0 | 23.0 | 43.5 | 56.5 |
Place of Delivery | | | | | | | | | |
Home | 20.3 | 79.7 | < 0.01 | 35.2 | 64.8 | < 0.01 | 30.7 | 69.3 | 0.91 |
Hospital/Facility (Public & Private) | 40.0 | 60.0 | 65.0 | 35.0 | 30.8 | 69.2 |
Skilled Birth Assistance | | | | | | | |
No | 19.9 | 80.1 | < 0.01 | 33.6 | 66.4 | < 0.01 | 29.2 | 70.8 | 0.09 |
Yes | 27.0 | 73.0 | 64.3 | 35.7 | 31.3 | 68.7 |
* Chi-square test was applied to determine p-value |
Results showed a statistically significant association (p ≤ 0.05) between newborn PNC utilization and various community-level characteristics, such as regions/provinces, geographical classification, and visits of field workers (LHWs) during the last three waves of PDHS. Further, a strong association with mass media exposure and perceived difficulty of distance to the facility was also seen during waves-3 and 4. Nevertheless, with reference to institutional level characteristics, a significant relationship of newborn PNC was observed with the mode of delivery in waves 3 and 4, as well as with place of delivery and skilled birth assistance in waves 2 and 3 of PDHS.
Regarding community-level characteristics, findings indicated that the majority of the women from Sindh province (34.2% and 40.4%) availed newborn PNC services in waves 2 and 4, while from Punjab province (58.1%) in wave 3. Also, those women who availed newborn PNC utilization were living in an urban area (26.4%, 58.3%, and 36.9%) during the last three waves of PDHS. Further, those women who had exposure to mass media (56.1% and 35.4%) and reported no problem in accessing distant facilities (57% and 33.9%) were more likely to availed newborn PNC in waves 3 and 4 of PDHS.
Regarding institutional level characteristics, the majority of the women, who had caesarean sections (77% and 43.5%) availed newborn PNC in waves-3 and 4. Moreover, those women, who delivered at health facilities (40% and 65%) through skilled birth attendants (27% and 64.3%) also had a strong statistical association with newborn PNC utilization during waves 2 and 3.
Bivariate logistic regression of maternal PNC utilization with multi-level determinants
Tables 4.1 and 4.2 showed the bivariate analysis of maternal PNC utilization with multi-level determinants at the individual, community, and institutional levels of women of reproductive age 15–49 years, who gave birth during 5 years preceding PDHSs (2006–2018).
Table 4.1
Bivariate Logistic Regression of Maternal PNC Utilization with Individual level Characteristics of women of reproductive age 15–49 years, who gave a birth during 5 years preceding PDHSs (2006–2018)
Characteristics | PDHS (2006-07) | PDHS (2012-13) | PDHS (2017-18) |
n = 5,677 | n = 7,446 | n = 6,711 |
OR | CI (95%) | p-value | OR | CI (95%) | p-value | OR | CI (95%) | p-value |
Individual Characteristics |
Socio-demographic Characteristics |
Maternal age | | | | | | | | | |
15–24 years | 1 | | | 1 | | | 1 | | |
25–34 years | 1.04 | 0.92–1.19 | 0.50 | 0.88* | 0.79–0.99 | 0.04 | 1.16* | 1.03–1.31 | 0.02 |
35 years and above | 0.66* | 0.57–0.77 | < 0.01 | 0.79* | 0.69–0.91 | < 0.01 | 0.83* | 0.72–0.96 | 0.01 |
Maternal Education status | | | | | | | | | |
No formal schooling | 1 | | | 1 | | | 1 | | |
Up to 5 years of schooling | 1.80* | 1.55–2.09 | < 0.01 | 1.52* | 1.34–1.74 | < 0.01 | 1.89* | 1.64–2.18 | < 0.01 |
6–10 years of schooling | 2.97* | 2.53–3.47 | < 0.01 | 3.06* | 2.67–3.52 | < 0.01 | 3.15* | 2.74–3.61 | < 0.01 |
More than 10 years of schooling | 5.39* | 4.19–6.95 | < 0.01 | 9.42* | 7.23–12.26 | < 0.01 | 6.78* | 5.51–8.34 | < 0.01 |
Paternal Education status | | | | | | | | | |
No formal schooling | 1 | | | 1 | | | 1 | | |
Up to 5 years of schooling | 1.32* | 1.12–1.55 | < 0.01 | 1.37* | 1.19–1.57 | < 0.01 | 1.32* | 1.13–1.53 | < 0.01 |
6–10 years of schooling | 2.00* | 1.76–2.28 | < 0.01 | 1.77* | 1.58–1.98 | < 0.01 | 2.12* | 1.87–2.40 | < 0.01 |
More than 10 years of schooling | 3.50* | 2.95–4.15 | < 0.01 | 3.51* | 3.01–4.11 | < 0.01 | 3.74* | 3.18–4.40 | < 0.01 |
Maternal Occupation | | | | | | | | |
Not Working /Unemployed | 1 | | | 1 | | | 1 | | |
Professional/Clerical/Sales & Services | 1.18* | 1.01–1.38 | 0.03 | 1.24* | 1.04–1.47 | 0.01 | 1.69* | 1.28–2.23 | < 0.01 |
Agriculture | 0.67* | 0.57–0.79 | < 0.01 | 0.49* | 0.42–0.57 | < 0.01 | 0.49* | 0.40–0.60 | < 0.01 |
Manual or Household worker | 0.98 | 0.72–1.32 | 0.88 | 0.63* | 0.53–0.75 | < 0.01 | 1.03 | 0.85–1.25 | 0.76 |
Paternal Occupation | | | | | | | | | |
Not Working /Unemployed | 1 | | | 1 | | | 1 | | |
Professional/Clerical/Sales & Services | 1.73* | 1.25–2.38 | < 0.01 | 2.16* | 1.50–3.11 | < 0.01 | 1.83* | 1.34–2.51 | < 0.01 |
Agriculture | 0.91 | 0.66–1.27 | 0.59 | 1.17 | 0.81–1.69 | 0.40 | 0.77 | 0.56–1.06 | 0.12 |
Manual or Household worker | 1.11 | 0.81–1.52 | 0.53 | 1.28 | 0.89–1.83 | 0.18 | 1.11 | 0.82–1.51 | 0.50 |
Available Means of Transportation | | | | | | | | | |
No Vehicle | 1 | | | 1 | | | 1 | | |
Own vehicle | 1.38* | 1.23–1.54 | < 0.01 | 1.86* | 1.69–2.05 | < 0.01 | 1.55* | 1.39–1.72 | < 0.01 |
Maternal Decision making Autonomy | | | | | | | | | |
No | - | - | - | 1 | | | 1 | | |
Yes | - | - | 1.47* | 1.29–1.66 | < 0.01 | 2.27* | 2.03–2.55 | < 0.01 |
Maternal Emotional Autonomy | | | | | | | | | |
No | - | - | - | 1 | | | 1 | | |
Yes | - | - | 0.51* | 0.46–0.56 | < 0.01 | 0.44* | 0.39–0.48 | < 0.01 |
Wealth Quintile | | | | | | | | | |
Poorest | 1 | | | 1 | | | 1 | | |
Poorer | 0.97 | 0.82–1.15 | 0.73 | 1.34* | 1.17–1.54 | < 0.01 | 1.11 | 0.95–1.28 | 0.18 |
Middle | 1.49* | 1.26–1.77 | < 0.01 | 1.92* | 1.67–2.21 | < 0.01 | 1.92* | 1.65–2.25 | < 0.01 |
Richer | 2.33* | 1.97–2.76 | < 0.01 | 3.37* | 2.90–3.91 | < 0.01 | 3.15* | 2.69–3.70 | < 0.01 |
Richest | 4.18* | 3.51–4.98 | < 0.01 | 6.86* | 5.75–8.19 | < 0.01 | 7.42* | 6.11–9.01 | < 0.01 |
Obstetric Characteristics |
Maternal Age at Marriage | | | | | | | | | |
< 20 years | 1 | | | 1 | | | 1 | | |
20 years and above | 1.45* | 1.28–1.64 | < 0.01 | 1.99* | 1.78–2.22 | < 0.01 | 2.10* | 1.89–2.35 | < 0.01 |
Maternal Age at First Birth | | | | | | | | | |
< 20 years | 1 | | | 1 | | | 1 | | |
20 years and above | 1.32* | 1.18–1.47 | < 0.01 | 1.69* | 1.53–1.85 | < 0.01 | 1.77* | 1.60–1.96 | < 0.01 |
Parity | | | | | | | | | |
5 children or above | 1 | | | 1 | | | 1 | | |
3–4 children | 1.48* | 1.29–1.69 | < 0.01 | 1.45* | 1.29–1.63 | < 0.01 | 1.90* | 1.67–2.16 | < 0.01 |
1–2 children | 1.69* | 1.49–1.92 | < 0.01 | 2.20* | 1.97–2.47 | < 0.01 | 2.43* | 2.15–2.76 | < 0.01 |
Number of living children | | | | | | | | | |
5 or above | 1 | | | 1 | | | 1 | | |
3–4 | 1.62* | 1.41–1.86 | < 0.01 | 1.46* | 1.29–1.65 | < 0.01 | 1.85* | 1.62–2.12 | < 0.01 |
1–2 | 1.77* | 1.56–2.02 | < 0.01 | 2.25* | 2.00-2.53 | < 0.01 | 2.43* | 2.14–2.77 | < 0.01 |
0 | 1.86* | 1.24–2.80 | < 0.01 | 3.13* | 1.86–5.27 | < 0.01 | 2.02* | 1.27–3.23 | < 0.01 |
Antenatal Attendance | | | | | | | | | |
Less than 4 visits or no visit | 1 | | | 1 | | | 1 | | |
At least 4 visits or more | 3.98* | 3.52–4.50 | < 0.01 | 4.46* | 3.99–4.99 | < 0.01 | 3.11* | 2.77–3.48 | < 0.01 |
Birth Order | | | | | | | | | |
6 or more | 1 | | | 1 | | | 1 | | |
4–5 | 1.90* | 1.61–2.25 | < 0.01 | 1.28* | 1.11–1.46 | < 0.01 | 1.54* | 1.32–1.80 | < 0.01 |
2–3 | 1.77* | 1.53–2.04 | < 0.01 | 1.89* | 1.67–2.15 | < 0.01 | 2.40* | 2.07–2.78 | < 0.01 |
1 | 1.42* | 1.22–1.66 | < 0.01 | 2.71* | 2.32–3.15 | < 0.01 | 2.88* | 2.43–3.41 | < 0.01 |
Sex/Gender of Newborn | | | | | | | | | |
Female | 1 | | | | | | 1 | | |
Male | 1.07 | 0.97–1.19 | 0.18 | 1.10* | 1.00-1.21 | 0.04 | 1.02 | 0.93–1.13 | 0.64 |
Size of Newborn at Birth | | | | | | | | | |
Small | 1 | | | 1 | | | 1 | | |
Average | 1.03 | 0.92–1.17 | 0.59 | 1.49* | 1.33–1.67 | < 0.01 | 1.46* | 1.29–1.65 | < 0.01 |
Large | 1.19* | 1.04–1.38 | 0.01 | 1.55* | 1.26–1.92 | < 0.01 | 1.69* | 1.35–2.10 | < 0.01 |
* p-value = < 0.01 & ≥0.05 |
Overall, the findings (Table 4.1) showed that women aged 35 years and above, who attained more than 10 years of schooling, belonged to professional/clerical/sales & services, and their husbands also had more than 10 years of schooling and were employed as professional/clerical/ sales & services, owned vehicle for transportation and belonged to the richest wealth quintile were more likely to avail maternal PNC services in all three waves of PDHS. Further, those women, who had maternal domestic decision-making and emotional autonomy also had more probability of maternal PNC utilization during waves 3 and 4.
More specifically, Table 4.1 showed that maternal PNC utilization increased with the increase in age (OR: 0.66, 0.79, and 0.83) with a higher level of education (OR: 5.39, 9.42, and 6.78), in the category of professional/clerical/sales & services (OR: 1.73, 2.16, and 1.83) and with the increase in wealth quintile (OR: 4.18, 6.86, and 7.42) in all three waves.
With reference to obstetric characteristics, results also revealed that maternal PNC utilization was found associated with maternal age at marriage and first birth, number of living children, antenatal attendance, birth order, sex/gender of newborn, and size of the newborn at birth. Further data suggested that PNC utilization was higher among women having 1–2 children (OR: 1.69, 2.20, and 2.43) and large size of newborns at birth (OR: 1.19, 1.55, and 1.69) in the last three waves of PDHS.
Furthermore, Table 4.2 revealed that women from Sindh were more likely to avail PNC utilization as compared to other provinces (OR: 2.24, 3.16, and 4.91) in all three waves. Also, an increased PNC utilization was found in all three waves amongst women residing in urban areas (OR: 2.30, 2.46, and 2.50), visited by LHWs (OR: 1.25, 1.14, and 1.65), who had caesarean section (OR: 12.47, 41.51, and 85.09), delivered at hospital/facility (OR: 5.35, 14.66, and 13.26), and availed skilled birth assistance (OR: 4.50, 12.99, and 12.61).
Table 4.2
Bivariate Logistic Regression of Maternal PNC Utilization with Community and Institutional level Characteristics of women of reproductive age 15–49 years who gave a birth during 5 years preceding PDHSs (2006–2018)
Characteristics | PDHS (2006-07) | PDHS (2012-13) | PDHS (2017-18) |
n = 5,677 | n = 7,446 | n = 6,711 |
OR | CI (95%) | p-value | OR | CI (95%) | p-value | OR | CI (95%) | p-value |
Community level Characteristics |
Regions/Provinces | | | | | | | | | |
Baluchistan | 1 | | | 1 | | | 1 | | |
Punjab | 0.98 | 0.76–1.27 | 0.89 | 2.88* | 2.30–3.61 | < 0.01 | 3.44* | 2.77–4.29 | < 0.01 |
Sindh | 2.24* | 1.72–2.94 | < 0.01 | 3.16* | 2.49–4.01 | < 0.01 | 4.91* | 3.87–6.22 | < 0.01 |
Khyber Pakhtunkhwa | 0.55* | 0.41-.0.74 | < 0.01 | 0.91 | 0.71–1.16 | 0.44 | 1.24 | 0.98–1.58 | 0.07 |
Gilgit Baltistan | - | - | - | 0.42* | 0.21–0.82 | 0.01 | - | - | - |
Islamabad | - | - | - | 6.63* | 2.62–16.76 | < 0.01 | 5.88* | 2.97–11.66 | < 0.01 |
FATA | - | - | - | - | - | - | 0.68* | 0.45–1.01 | 0.05 |
Geographical Classification | | | | | | | | | |
Rural | 1 | | | 1 | | | 1 | | |
Urban | 2.30* | 2.05–2.59 | < 0.01 | 2.46* | 2.20–2.74 | < 0.01 | 2.50* | 2.23–2.80 | < 0.01 |
Mass Media Exposure | | | | | | | | | |
No | - | - | - | 1 | | | 1 | | |
Yes | - | - | - | 2.79* | 2.52–3.03 | < 0.01 | 2.78* | 2.51–3.09 | < 0.01 |
Perceived difficulty of distance to facility | | | | | | | |
Problem | - | - | - | 1 | | | 1 | | |
Not a Problem | - | - | - | 2.16* | 1.96–2.37 | < 0.01 | 2.05* | 1.85–2.27 | < 0.01 |
Visit of Field worker (LHWs) | | | | | | | | | |
No | 1 | | | 1 | | | 1 | | |
Yes | 1.25* | 1.11–1.41 | < 0.01 | 1.14* | 1.02–1.28 | 0.02 | 1.65* | 1.45–1.83 | < 0.01 |
Institutional level Characteristics |
Mode of Delivery | | | | | | | | | |
Vaginal | 1 | | | 1 | | | 1 | | |
C-Section | 12.47* | 9.33–16.66 | < 0.01 | 41.51* | 27.68–62.25 | < 0.01 | 85.09* | 52.61-137.65 | < 0.01 |
Place of Delivery | | | | | | | | | |
Home | 1 | | | 1 | | | 1 | | |
Hospital/Facility (Public & Private) | 5.35* | 4.76–6.02 | < 0.01 | 14.66* | 13.03–16.49 | < 0.01 | 13.26* | 11.72–15.01 | < 0.01 |
Skilled Birth Assistance | | | | | | | |
No | 1 | | | 1 | | | 1 | | |
Yes | 4.50* | 4.02–5.04 | < 0.01 | 12.99* | 11.61–14.55 | < 0.01 | 12.61* | 11.10-14.33 | < 0.01 |
* p-value = < 0.01 & ≥0.05 |
Bivariate logistic regression of newborn PNC utilization with multi-level determinants
Tables 4.3 and 4.4 highlighted the bivariate analysis of newborn PNC utilization with multi-level determinants at individual, community and institutional levels of respondents from the last three waves of PDHSs (2006–2018).
Table 4.3
Bivariate Logistic Regression of Newborn PNC Utilization with Individual level Characteristics of women of reproductive age 15–49 years, who gave a birth during 5 years preceding PDHSs (2006–2018)
Characteristics | PDHS (2006-07) | PDHS (2012-13) | PDHS (2017-18) |
n = 5,677 | n = 7,446 | n = 6,711 |
OR | CI (95%) | p-value | OR | CI (95%) | p-value | OR | CI (95%) | p-value |
Individual Characteristics |
Socio-demographic characteristics |
Maternal age | | | | | | | | | |
15–24 years | 1 | | | 1 | | | 1 | | |
25–34 years | 0.93 | 0.76–1.13 | 0.47 | 1.02 | 0.91–1.14 | 0.72 | 1.11 | 0.97–1.26 | 0.11 |
35 years and above | 0.65* | 0.51–0.82 | < 0.01 | 0.98 | 0.86–1.12 | 0.81 | 0.99 | 0.85–1.17 | 0.96 |
Maternal Education status | | | | | | | | | |
No formal schooling | 1 | | | 1 | | | 1 | | |
Up to 5 years of schooling | 1.56* | 1.25–1.96 | < 0.01 | 1.85* | 1.62–2.10 | < 0.01 | 1.46* | 1.26–1.69 | < 0.01 |
6–10 years of schooling | 2.07* | 1.58–2.71 | < 0.01 | 2.23* | 1.97–2.53 | < 0.01 | 1.39* | 1.22–1.59 | < 0.01 |
More than 10 years of schooling | 1.87* | 1.07–3.26 | 0.03 | 4.13* | 3.43–4.97 | < 0.01 | 1.97* | 1.68–2.29 | < 0.01 |
Paternal Education status | | | | | | | | | |
No formal schooling | 1 | | | 1 | | | 1 | | |
Up to 5 years of schooling | 1.39* | 1.10–1.76 | < 0.01 | 1.44* | 1.25–1.65 | < 0.01 | 1.11 | 0.94–1.31 | 0.21 |
6–10 years of schooling | 1.72* | 1.41–2.09 | < 0.01 | 1.57* | 1.41–1.76 | < 0.01 | 1.23* | 1.08–1.41 | < 0.01 |
More than 10 years of schooling | 2.53* | 1.92–3.33 | < 0.01 | 2.61* | 2.26–3.01 | < 0.01 | 1.43* | 1.23–1.67 | < 0.01 |
Maternal Occupation | | | | | | | | |
Not Working /Unemployed | 1 | | | 1 | | | 1 | | |
Professional/Clerical/Sales & Services | 1.15 | 0.90–1.46 | 0.25 | 1.35* | 1.14–1.59 | < 0.01 | 1.47* | 1.15–1.89 | < 0.01 |
Agriculture | 0.75* | 0.59–0.95 | 0.01 | 0.76* | 0.66–0.88 | < 0.01 | 1.05 | 0.85–1.31 | 0.63 |
Manual or Household worker | 1.62* | 1.09–2.38 | 0.01 | 0.63* | 0.53–0.75 | < 0.01 | 1.42* | 1.18–1.72 | < 0.01 |
Paternal Occupation | | | | | | | | | |
Not Working /Unemployed | 1 | | | 1 | | | 1 | | |
Professional/Clerical/Sales & Services | 1.89* | 1.05–3.41 | 0.03 | 2.31* | 1.59–3.36 | < 0.01 | 0.86* | 0.62–1.19 | < 0.01 |
Agriculture | 1.29 | 0.71–2.35 | 0.40 | 1.63* | 1.11–2.39 | 0.01 | 0.84* | 0.60–1.17 | < 0.01 |
Manual or Household worker | 1.71 | 0.95–3.07 | 0.07 | 1.32 | 0.91–1.91 | 0.14 | 0.80* | 0.58–1.10 | < 0.01 |
Available Means of Transportation | | | | | | | | | |
No Vehicle | 1 | | | 1 | | | 1 | | |
Own vehicle | 1.06 | 0.89–1.25 | 0.50 | 1.67* | 1.52–1.83 | < 0.01 | 1.12* | 1.00-1.25 | 0.05 |
Maternal Decision making Autonomy | | | | | | | | |
No | - | - | - | 1 | | | 1 | | |
Yes | - | - | - | 1.44* | 1.27–1.63 | < 0.01 | 1.91* | 1.68–2.17 | < 0.01 |
Maternal Emotional Autonomy | | | | | | | | | |
No | - | - | - | 1 | | | 1 | | |
Yes | - | - | - | 0.68* | 0.62–0.75 | < 0.01 | 0.75* | 0.68–0.84 | < 0.01 |
Wealth Quintile | | | | | | | | | |
Poorest | 1 | | | 1 | | | 1 | | |
Poorer | 1.05 | 0.83–1.32 | 0.66 | 1.39* | 1.21–1.59 | < 0.01 | 1.01 | 0.75–1.19 | 0.96 |
Middle | 1.25 | 0.98–1.58 | 0.07 | 1.75* | 1.52–2.02 | < 0.01 | 1.04 | 0.88–1.22 | 0.66 |
Richer | 1.72* | 1.34–2.19 | < 0.01 | 2.47* | 2.14–2.86 | < 0.01 | 1.24* | 1.05–1.45 | 0.01 |
Richest | 2.35* | 1.74–3.16 | < 0.01 | 3.59* | 3.08–4.19 | < 0.01 | 1.68* | 1.43–1.97 | < 0.01 |
Obstetric Characteristics |
Maternal Age at Marriage | | | | | | | | | |
< 20 years | 1 | | | 1 | | | 1 | | |
20 years and above | 0.76* | 0.61–0.94 | 0.01 | 1.76* | 1.59–1.96 | < 0.01 | 1.31* | 1.18–1.46 | < 0.01 |
Maternal Age at First Birth | | | | | | | | | |
< 20 years | 1 | | | 1 | | | 1 | | |
20 years and above | 0.86 | 0.73–1.02 | 0.08 | 1.43* | 1.31–1.57 | < 0.01 | 1.29* | 1.16–1.43 | < 0.01 |
Parity | | | | | | | | | |
5 children or above | 1 | | | 1 | | | 1 | | |
3–4 children | 1.32* | 1.08–1.61 | < 0.01 | 1.19* | 1.06–1.34 | < 0.01 | 1.17* | 1.01–1.34 | 0.03 |
1–2 children | 1.26* | 1.03–1.53 | 0.02 | 1.52* | 1.36–1.69 | < 0.01 | 1.51* | 1.32–1.72 | < 0.01 |
Number of living children | | | | | | | | | |
5 or above | 1 | | | 1 | | | 1 | | |
3–4 | 1.25* | 1.02–1.53 | 0.03 | 1.16* | 1.03–1.31 | 0.01 | 1.33* | 1.15–1.55 | < 0.01 |
1–2 | 1.31* | 1.07–1.60 | < 0.01 | 1.54* | 1.37–1.72 | < 0.01 | 1.71* | 1.45–1.97 | < 0.01 |
0 | 2.10* | 1.16–3.80 | 0.01 | 1.40 | 0.88–2.24 | 0.15 | 1.32 | 0.81–2.15 | 0.26 |
Antenatal Attendance | | | | | | | | | |
Less than 4 visits or no visit | 1 | | | 1 | | | 1 | | |
At least 4 visits or more | 2.30* | 1.88–2.83 | < 0.01 | 2.24* | 2.03–2.46 | < 0.01 | 1.39* | 1.25–1.56 | < 0.01 |
Birth Order | | | | | | | | | |
6 or more | 1 | | | 1 | | | 1 | | |
4–5 | 1.34* | 1.08–1.68 | 0.01 | 1.20* | 1.05–1.38 | < 0.01 | 1.18* | 0.99–1.40 | 0.05 |
2–3 | 1.30* | 1.05–1.61 | 0.02 | 1.43* | 1.26–1.62 | < 0.01 | 1.36* | 1.16–1.59 | < 0.01 |
1 | 1.52* | 1.17–1.98 | < 0.01 | 1.71* | 1.47–1.97 | < 0.01 | 1.58* | 1.32–1.89 | < 0.01 |
Sex/Gender of Newborn | | | | | | | | | |
Female | 1 | | | 1 | | | 1 | | |
Male | 1.34* | 1.14–1.59 | < 0.01 | 1.02 | 0.93–1.11 | 0.72 | 1.19* | 1.07–1.33 | < 0.01 |
Size of Newborn at Birth | | | | | | | | | |
Small | 1 | | | 1 | | | 1 | | |
Average | 0.71 | 0.59–0.85 | 0.98 | 1.10 | 0.98–1.23 | 0.09 | 0.97 | 0.78–1.22 | 0.81 |
Large | 0.99* | 0.91–1.23 | < 0.01 | 1.17 | 0.95–1.44 | 0.13 | 0.89 | 0.73–1.09 | 0.28 |
* p-value = < 0.01 & ≥0.05 |
Table 4.3 informed that newborn PNC utilization increased with the increase in maternal age (OR: 0.65), who had 6–10 years of schooling (OR: 2.07) in wave 2, while, those women who had more than 10 years of schooling in wave 3 and 4 were more likely to utilize newborn PNC (OR: 4.13, and 1.97). Regarding paternal education in all three waves, the women whose husbands had more than 10 years of schooling had a higher probability to avail newborn PNC services (OR: 2.53, 2.61, and 1.43). Further, the odds of newborn PNC utilization were found higher amongst women serving as professional/clerical/sales & services (OR: 1.35 and 1.47) in waves 3 and 4., as well as their husbands belonged to the category of professional/clerical/sales & services (OR: 1.89, 2.31, and 0.86) and belonged to richest wealth quintile (OR: 2.35, 3.59, and 1.68) in all three waves of PDHS.
With reference to obstetric characteristics, results (Table 4.3) informed that newborn PNC utilization was associated with maternal age at marriage, the number of living children, antenatal attendance, and birth order. Further data highlighted that odds of newborn PNC utilization were higher among women having 1–2 children (OR: 1.31, 1.54, and 1.71) in all three waves of PDHS.
Table 4.4 revealed that women from Sindh province (OR: 4.28, 4.66, and 3.73), living in urban areas (OR: 1.51, 1.57, and 1.53) and visited by LHWs (OR: 1.28, 1.49, and 1.47) availed highest newborn PNC utilization. Moreover, those women were more likely to avail newborn PNC services, who had caesarean sections (OR: 3.99 and 2.12) in waves 3 and 4, and were delivered at hospitals/facilities (OR: 2.62 and 3.41) by skilled birth attendants (OR: 1.48 and 3.57) during waves 2 and 3 of PDHS.
Table 4.4
Bivariate Logistic Regression of Newborn PNC Utilization with Community and Institutional level Characteristics of women of reproductive age 15–49 years, who gave a birth during 5 years preceding PDHSs (2006–2018)
Characteristics | PDHS (2006-07) | PDHS (2012-13) | PDHS (2017-18) |
n = 5,677 | n = 7,446 | n = 6,711 |
OR | CI (95%) | p-value | OR | CI (95%) | p-value | OR | CI (95%) | p-value |
Community level Characteristics |
Regions/Provinces | | | | | | | | | |
Baluchistan | 1 | | | 1 | | | 1 | | |
Punjab | 1.74* | 1.12–2.72 | 0.01 | 6.29* | 4.75–8.34 | < 0.01 | 2.75* | 2.06–3.68 | < 0.01 |
Sindh | 4.28* | 2.72–6.76 | < 0.01 | 4.66* | 3.48–6.22 | < 0.01 | 3.73* | 2.77–5.03 | < 0.01 |
Khyber Pakhtunkhwa | 1.70* | 1.05–2.76 | 0.03 | 2.28* | 1.68–3.08 | < 0.01 | 1.16 | 0.84–1.59 | 0.37 |
Gilgit Baltistan | - | - | - | 0.83 | 0.38–1.81 | 0.64 | - | - | - |
Islamabad | - | - | - | 8.73* | 3.96–19.24 | < 0.01 | 3.52* | 1.90–6.52 | < 0.01 |
FATA | - | - | - | - | - | - | 0.28* | 0.13–0.61 | 0.03 |
Geographical Classification | | | | | | | | | |
Rural | 1 | | | 1 | | | 1 | | |
Urban | 1.51* | 1.25–1.83 | < 0.01 | 1.57* | 1.42–1.74 | < 0.01 | 1.53* | 1.07–1.70 | < 0.01 |
Mass Media Exposure | | | | | | | | | |
No | - | - | - | 1 | | | 1 | | |
Yes | - | - | - | 2.14* | 1.93–2.37 | < 0.01 | 1.86* | 1.65–2.08 | < 0.01 |
Perceived difficulty of distance to facility | | | | | | | |
Problem | - | - | - | 1 | | | 1 | | |
Not a Problem | - | - | - | 1.93* | 1.75–2.12 | < 0.01 | 1.39* | 1.25–1.54 | < 0.01 |
Visit of Field worker (LHWs) | | | | | | | | | |
No | 1 | | | 1 | | | 1 | | |
Yes | 1.28* | 1.07–1.53 | < 0.01 | 1.49* | 1.33–1.66 | < 0.01 | 1.47* | 1.31–1.64 | < 0.01 |
Institutional level Characteristics |
Mode of Delivery | | | | | | | | | |
Vaginal | 1 | | | 1 | | | 1 | | |
C-Section | 1.71 | 0.29–10.29 | 0.55 | 3.99* | 3.45–4.62 | < 0.01 | 2.12* | 1.88–2.38 | < 0.01 |
Place of Delivery | | | | | | | | | |
Home | 1 | | | 1 | | | 1 | | |
Hospital/Facility (Public & Private) | 2.62* | 1.55–4.41 | < 0.01 | 3.41* | 3.10–3.76 | < 0.01 | 1.01 | 0.90–1.13 | 0.91 |
Skilled Birth Assistance | | | | | | | |
No | 1 | | | 1 | | | 1 | | |
Yes | 1.48* | 1.16–1.90 | < 0.01 | 3.57* | 3.24–3.93 | < 0.01 | 1.10 | 0.98–1.24 | 0.09 |
* p-value = < 0.01 & ≥0.05 |
Multivariate logistic regression of maternal PNC utilization with individual, community, and institutional level characteristics
Table 5.1 exhibited multivariate logistic regression of maternal PNC utilization with individual, community, and institutional level characteristics of women of reproductive age 15–49 years, who gave birth during 5 years preceding PDHSs (2006–2018). While interpreting the results of multivariate logistic regression, one may consider that multivariate analysis was conducted to obtain AOR after controlling for visits of field workers (LHWs). Further, VIF was calculated before multivariate regression to assess multicollinearity, which was found > 10.
Table 5.1
Multivariate Logistic Regression of Maternal PNC Utilization with Individual, Community and Institutional level Characteristics of women of reproductive age 15–49 years, who gave a birth during 5 years preceding PDHSs (2006–2018)
Characteristics | PDHS (2006-07) | PDHS (2012-13) | PDHS (2017-18) |
n = 5,677 | n = 7,446 | n = 6,711 |
AOR | CI (95%) | p-value* | AOR | CI (95%) | p-value* | AOR | CI (95%) | p-value* |
Individual Characteristics |
Socio-demographic characteristics |
Maternal age | | | | | | | | | |
15–24 years | 1 | | | 1 | | | 1 | | |
25–34 years | 0.77 | 0.51–1.16 | 0.22 | 0.85 | 0.64–1.11 | 0.23 | 1.37 | 0.99–1.89 | 0.05 |
35 years and above | 0.46* | 0.26–0.82 | 0.01 | 1.25 | 0.88–1.78 | 0.20 | 1.08 | 0.69–1.69 | 0.73 |
Maternal Education status | | | | | | | | | |
No formal schooling | 1 | | | 1 | | | 1 | | |
Up to 5 years of schooling | 1.38* | 1.00-1.94 | 0.05 | 0.70* | 0.55–0.88 | < 0.01 | 0.87 | 0.66–1.15 | 0.34 |
6–10 years of schooling | 1.19 | 0.79–1.79 | 0.38 | 0.79 | 0.59–1.04 | 0.09 | 0.91 | 0.67–1.24 | 0.55 |
More than 10 years of schooling | 1.53 | 0.76–3.09 | 0.23 | 1.52 | 0.91–2.53 | 0.11 | 0.71 | 0.45–1.12 | 0.14 |
Paternal Education status | | | | | | | | | |
No formal schooling | 1 | | | 1 | | | 1 | | |
Up to 5 years of schooling | 0.89 | 0.60–1.30 | 0.54 | 1.08 | 0.86–1.34 | 0.52 | 1.04 | 0.78–1.39 | 0.77 |
6–10 years of schooling | 0.99 | 0.71–1.38 | 0.96 | 0.98 | 0.79–1.19 | 0.81 | 1.17 | 0.89–1.53 | 0.27 |
More than 10 years of schooling | 1.09 | 0.68–1.75 | 0.72 | 1.29 | 0.95–1.76 | 0.10 | 1.19 | 0.83–1.71 | 0.35 |
Maternal Occupation | | | | | | | | | |
Not Working /Unemployed | 1 | | | 1 | | | 1 | | |
Professional/Clerical/Sales & Services | 0.92 | 0.64–1.34 | 0.67 | 1.08 | 0.82–1.42 | 0.57 | 0.81 | 0.51–1.29 | 0.38 |
Agriculture | 1.21 | 0.81–1.82 | 0.35 | 0.79* | 0.62-1.00 | 0.05 | 0.78 | 0.51–1.19 | 0.25 |
Manual or Household worker | 0.43 | 0.18–1.04 | 0.06 | 0.76* | 0.59–0.98 | 0.03 | 1.00 | 0.71–1.41 | 0.98 |
Paternal Occupation | | | | | | | | | |
Not Working /Unemployed | 1 | | | 1 | | | 1 | | |
Professional/Clerical/Sales & Services | 1.15 | 0.50–2.63 | 0.74 | 1.22 | 0.56–2.59 | 0.61 | 4.57* | 1.23–16.99 | 0.02 |
Agriculture | 0.87 | 0.37–2.03 | 0.75 | 1.12 | 0.51–2.47 | 0.78 | 2.79 | 0.75–10.40 | 0.13 |
Manual or Household worker | 0.99 | 0.44–2.25 | 0.98 | 1.07 | 0.49–2.33 | 0.86 | 3.95* | 1.07–14.57 | 0.04 |
Available Means of Transportation | | | | | | | | | |
No Vehicle | 1 | | | 1 | | | 1 | | |
Own vehicle | 1.48* | 1.13–1.94 | < 0.01 | 1.14 | 0.97–1.34 | 0.12 | 1.28* | 1.03–1.61 | 0.03 |
Maternal Decision making Autonomy | | | | | | | | | |
No | - | | | 1 | | | 1 | | |
Yes | - | - | - | 0.79* | 0.66–0.95 | 0.01 | 1.28* | 1.02–1.61 | 0.03 |
Maternal Emotional Autonomy | | | | | | | | | |
No | - | | | 1 | | | 1 | | |
Yes | - | - | - | 1.13 | 0.96–1.32 | 0.16 | 0.77* | 0.62–0.95 | 0.01 |
Wealth Quintile | | | | | | | | | |
Poorest | 1 | | | 1 | | | 1 | | |
Poorer | 0.97 | 0.63–1.49 | 0.87 | 1.2 | 0.96–1.50 | 0.11 | 0.74 | 0.53–1.03 | 0.07 |
Middle | 1.05 | 0.67–1.63 | 0.84 | 1.02 | 0.78–1.33 | 0.91 | 0.79 | 0.55–1.15 | 0.22 |
Richer | 1.17 | 0.71–1.92 | 0.54 | 0.86 | 0.61–1.19 | 0.36 | 0.59 | 0.38–0.91 | 0.02 |
Richest | 1.18 | 0.63–2.18 | 0.61 | 1.13 | 0.73–1.76 | 0.59 | 1.69* | 1.08–2.92 | 0.05 |
Obstetric Characteristics |
Maternal Age at Marriage | | | | | | | | | |
< 20 years | 1 | | | 1 | | | 1 | | |
20 years and above | 0.69 | 0.47–1.01 | 0.06 | 0.83 | 0.66–1.06 | 0.14 | 1.14 | 0.86–1.52 | 0.36 |
Maternal Age at First Birth | | | | | | | | | |
< 20 years | 1 | | | 1 | | | 1 | | |
20 years and above | 1.19 | 0.86–1.67 | 0.28 | 1.00 | 0.82–1.22 | 0.98 | 0.96 | 0.73–1.27 | 0.78 |
Parity | | | | | | | | | |
5 children or above | 1 | | | 1 | | | 1 | | |
3–4 children | 0.63 | 0.34–1.15 | 0.13 | 0.86 | 0.61–1.21 | 0.39 | 2.24* | 1.39–3.59 | < 0.01 |
1–2 children | 0.57 | 0.23–1.46 | 0.24 | 0.68 | 0.39–1.18 | 0.17 | 4.38* | 2.07–9.26 | < 0.01 |
Number of living children | | | | | | | | | |
5 or above | 1 | | | 1 | | | 1 | | |
3–4 | 1.39 | 0.78–2.46 | 0.26 | 1.45* | 1.06–1.99 | 0.02 | 0.69 | 0.44–1.11 | 0.13 |
1–2 | 1.35 | 0.58–3.15 | 0.48 | 1.94* | 1.18–3.19 | 0.01 | 0.32* | 0.16–0.64 | < 0.01 |
0 | 2.72 | 0.65–11.26 | 0.17 | 2.37 | 0.69–8.08 | 0.17 | 1.31 | 0.32–5.35 | 0.71 |
Antenatal Attendance | | | | | | | | | |
Less than 4 visits or no visit | 1 | | | 1 | | | 1 | | |
At least 4 visits or more | 2.23* | 1.63–3.03 | < 0.01 | 1.69* | 1.39–2.05 | < 0.01 | 1.23* | 1.00-1.52 | 0.05 |
Birth Order | | | | | | | | | |
6 or more | 1 | | | 1 | | | 1 | | |
4–5 | 0.95 | 0.59–1.51 | 0.83 | 0.99 | 0.76–1.31 | 0.99 | 0.80 | 0.55–1.18 | 0.26 |
2–3 | 0.88 | 0.45–1.73 | 0.72 | 0.89 | 0.59–1.33 | 0.57 | 0.69 | 0.41–1.18 | 0.18 |
1 | 0.71 | 0.31–1.62 | 0.41 | 1.24 | 0.73–2.08 | 0.42 | 0.68 | 0.36–1.29 | 0.24 |
Sex/Gender of Newborn | | | | | | | | | |
Female | 1 | | | 1 | | | 1 | | |
Male | 0.99 | 0.77–1.27 | 0.95 | 0.97 | 0.84–1.13 | 0.99 | 0.86 | 0.71–1.05 | 0.13 |
Size of Newborn at Birth | | | | | | | | | |
Small | 1 | | | 1 | | | 1 | | |
Average | 1.03 | 0.77–1.37 | 0.85 | 1.41* | 1.17–1.70 | < 0.01 | 1.69* | 1.32–2.16 | < 0.01 |
Large | 1.19 | 0.86–1.66 | 0.29 | 0.92 | 0.64–1.32 | 0.66 | 1.37 | 0.89–2.11 | 0.15 |
Community level Characteristics |
Regions/Provinces | | | | | | | | | |
Baluchistan | 1 | | | 1 | | | 1 | | |
Punjab | 0.35* | 0.16–0.74 | 0.01 | 1.45* | 1.04–2.04 | 0.03 | 1.51 | 0.75–3.03 | 0.25 |
Sindh | 0.99 | 0.45–2.15 | 0.97 | 1.00 | 0.71–1.42 | 0.98 | 3.24* | 1.56–6.74 | < 0.01 |
Khyber Pakhtunkhwa | 0.22* | 0.10–0.50 | < 0.01 | 0.31* | 0.21–0.46 | < 0.01 | 1.3 | 0.62–2.74 | 0.49 |
Gilgit Baltistan | - | - | - | 0.08* | 0.03–0.25 | < 0.01 | - | - | - |
Islamabad | - | - | - | 0.64 | 0.17–2.46 | 0.52 | 4.44 | 0.59–33.40 | 0.15 |
FATA | - | - | - | - | - | - | 0.73 | 0.11–4.92 | 0.75 |
Geographical classification | | | | | | | | | |
Rural | 1 | | | 1 | | | 1 | | |
Urban | 1.34 | 0.96–1.85 | 0.08 | 1.00 | 0.79–1.26 | 0.99 | 0.91 | 0.70–1.17 | 0.46 |
Mass Media Exposure | | | | | | | | | |
No | - | | | 1 | | | 1 | | |
Yes | - | - | - | 1.10 | 0.92–1.33 | 0.29 | 1.08 | 0.86–1.37 | 0.51 |
Perceived difficulty of distance to facility | | | | | | | | |
Problem | - | | | 1 | | | 1 | | |
Not a Problem | - | - | - | 1.33* | 1.12–1.59 | < 0.01 | 0.87 | 0.70–1.07 | 0.18 |
Institutional level Characteristics |
Mode of Delivery | | | | | | | | | |
Vaginal | 1 | | | 1 | | | 1 | | |
C-Section | 4.43* | 2.32–8.45 | < 0.01 | 5.33* | 3.20–8.89 | < 0.01 | 24.39* | 13.29–44.75 | < 0.01 |
Place of Delivery | | | | | | | | | |
Home | 1 | | | 1 | | | 1 | | |
Hospital/Facility (Public & Private) | 1.39 | 0.83–2.37 | 0.21 | 3.63* | 2.61–5.06 | < 0.01 | 3.28* | 2.17–4.95 | < 0.01 |
Skilled Birth Assistance | | | | | | | | | |
No | 1 | | | 1 | | | 1 | | |
Yes | 2.29* | 1.38–3.80 | < 0.01 | 3.22* | 2.34–4.42 | < 0.01 | 1.60* | 1.04–2.47 | 0.03 |
* p-value = < 0.01 & ≥0.05 |
Multivariable logistic regression analysis was carried out to obtain the AOR after controlling for visit of field worker (LHWs). |
VIF was calculated before Multivariate regression to assess Multicollinearity, which was found > 10 |
Results (Table 5.1) informed a significant association of maternal PNC utilization with maternal age of 35 years and above (AOR = 0.46, 95% CI: 0.26–0.82) in wave 2, who attained education up to 5 years of schooling (AOR = 1.38, 95% CI: 1.00-1.94; AOR = 0.70, 95% CI: 0.55–0.88) in waves 2 and 3 respectively, and were employed in agriculture (AOR = 0.79, 95% CI: 0.62-1.00) and manual/household jobs (AOR = 0.76, 95% CI: 0.59–0.98) in wave 3, and their husbands employed as professional/clerical/sales & services (AOR = 4.57, 95% CI: 1.23–16.99) and manual/household jobs (AOR = 3.95, 95% CI: 1.07–14.57) in wave 4. Further, a higher likelihood of maternal PNC was found with availability of own vehicle for transportation (AOR = 0.79, 95% CI: 0.66–0.95; AOR = 1.28, 95% CI: 1.02–1.61) in waves 3 and 4, and richest wealth quintile in wave 4 (AOR = 1.69, 95% CI: 1.08–2.92). Maternal decision-making autonomy (AOR = 0.79, 95% CI: 0.66–0.95; AOR = 1.28, 95% CI: 1.02–1.61) in waves 3 and 4, and emotional autonomy jobs (AOR = 0.77, 95% CI: 0.62–0.95) in wave 4 was also significantly associated with maternal PNC utilization.
Multivariate analysis revealed that maternal PNC utilization showed a strong association with the obstetric characteristics in some waves, such as parity in wave 4, number of living children in waves 3 and 4, and the average size of the newborn at birth in waves 3 and 4. Only the antenatal attendance was found significant with maternal PNC utilization (AOR = 2.23, 95% CI: 1.63–3.03; AOR = 1.69, 95% CI: 1.39–2.05; AOR = 1.23, 95% CI: 1.00-1.52) across all waves of PDHS.
At the community level characteristics, regions/provinces, and perceived difficulty to access the distant health facility highlighted a significant association with maternal PNC utilization during multivariate analysis. More specifically, perceived difficulty was found significant in wave 3, while some of the regions/provinces had a strong association across all waves of PDHS. Further, nearly all characteristics of the institutional level (e.g., mode of delivery, skilled birth assistance) significantly predicted the maternal PNC utilization across waves of PDHS, except for a place of delivery.
Multivariate logistic regression of newborn PNC utilization with individual, community, and institutional level characteristics
Table 5.2 informed multivariate logistic regression findings of newborn PNC utilization with individual, community, and institutional level characteristics of women of reproductive age 15–49 years, who gave birth during 5 years preceding PDHSs (2006–2018), after adjusting the visits of field workers (LHWs).
Table 5.2
Multivariate Logistic Regression of Newborn PNC Utilization with Individual, Community and Institutional level Characteristics of women of reproductive age 15–49 years, who gave a birth during 5 years preceding PDHSs (2006–2018)
Characteristics | PDHS (2006-07) | PDHS (2012-13) | PDHS (2017-18) |
n = 5,677 | n = 7,446 | n = 6,711 |
AOR | CI (95%) | p-value* | AOR | CI (95%) | p-value* | AOR | CI (95%) | p-value* |
Individual Characteristics |
Socio-demographic Characteristics |
Maternal age | | | | | | | | | |
15–24 years | 1 | | | 1 | | | 1 | | |
25–34 years | 1.71 | 0.97–2.99 | 0.06 | 1.43 | 0.97–2.09 | 0.06 | 1.28 | 0.99–1.67 | 0.06 |
35 years and above | 1.35 | 0.61–2.95 | 0.45 | 1.84* | 1.14–2.97 | 0.01 | 1.32 | 0.92–1.89 | 0.13 |
Maternal Education status | | | | | | | | | |
No formal schooling | 1 | | | 1 | | | 1 | | |
Up to 5 years of schooling | 1.22 | 0.78–1.92 | 0.38 | 1.12 | 0.83–1.52 | 0.44 | 0.95 | 0.75–1.21 | 0.69 |
6–10 years of schooling | 1.07 | 0.59–1.94 | 0.83 | 1.21 | 0.85–1.73 | 0.28 | 0.76* | 0.59–0.99 | 0.04 |
More than 10 years of schooling | 2.17 | 0.69–6.81 | 0.18 | 1.14 | 0.64–2.01 | 0.66 | 0.91 | 0.62–1.27 | 0.59 |
Paternal Education status | | | | | | | | | |
No formal schooling | 1 | | | 1 | | | 1 | | |
Up to 5 years of schooling | 1.11 | 0.66–1.88 | 0.69 | 1.19 | 0.89–1.62 | 0.24 | 0.97 | 0.75–1.25 | 0.81 |
6–10 years of schooling | 1.41 | 0.89–2.22 | 0.13 | 0.86 | 0.65–1.14 | 0.30 | 0.99 | 0.79–1.27 | 0.99 |
More than 10 years of schooling | 1.62 | 0.84–3.11 | 0.15 | 1.47 | 0.97–2.24 | 0.06 | 1.32 | 0.98–1.78 | 0.06 |
Maternal Occupation | | | | | | | | | |
Not Working /Unemployed | 1 | | | 1 | | | 1 | | |
Professional/Clerical/Sales & Services | 0.89 | 0.53–1.49 | 0.66 | 1.67* | 1.19–2.37 | < 0.01 | 1.08 | 0.75–1.54 | 0.68 |
Agriculture | 0.73 | 0.40–1.30 | 0.29 | 0.86 | 0.61–1.21 | 0.38 | 0.77 | 0.52–1.12 | 0.17 |
Manual or Household worker | 0.81 | 0.28–2.38 | 0.71 | 0.74 | 0.52–1.05 | 0.09 | 1.55* | 1.16–2.06 | < 0.01 |
Paternal Occupation | | | | | | | | | |
Not Working /Unemployed | 1 | | | 1 | | | 1 | | |
Professional/Clerical/Sales & Services | 2.93 | 0.60-14.25 | 0.18 | 0.62 | 0.11–3.45 | 0.59 | 0.55 | 0.18–1.64 | 0.28 |
Agriculture | 2.65 | 0.53–13.36 | 0.24 | 0.94 | 0.17–5.33 | 0.95 | 0.70 | 0.23–2.11 | 0.53 |
Manual or Household worker | 4.09 | 0.84–1.81 | 0.08 | 0.57 | 0.10–3.16 | 0.52 | 0.57 | 0.19–1.69 | 0.31 |
Available Means of Transportation | | | | | | | | | |
No Vehicle | 1 | | | 1 | | | 1 | | |
Own vehicle | 1.25 | 0.86–1.81 | 0.24 | 0.89 | 0.72–1.12 | 0.34 | 0.95 | 0.78–1.15 | 0.60 |
Maternal Decision making Autonomy | | | | | | | | | |
No | - | | | 1 | | | 1 | | |
Yes | - | - | - | 0.78 | 0.59–1.02 | 0.06 | 1.56* | 1.28–1.90 | < 0.01 |
Maternal Emotional Autonomy | | | | | | | | | |
No | - | | | 1 | | | 1 | | |
Yes | - | - | - | 1.17 | 0.93–1.47 | 0.18 | 1.23* | 1.03–1.47 | 0.02 |
Wealth Quintile | | | | | | | | | |
Poorest | 1 | | | 1 | | | 1 | | |
Poorer | 1.24 | 0.72–2.16 | 0.44 | 0.94 | 0.68–1.29 | 0.66 | 0.94 | 0.70–1.26 | 0.67 |
Middle | 1.01 | 0.55–1.84 | 0.98 | 0.69* | 0.48-1.00 | 0.05 | 0.83 | 0.60–1.15 | 0.27 |
Richer | 1.50 | 0.78–2.90 | 0.22 | 0.75 | 0.47–1.17 | 0.20 | 0.99 | 0.69–1.44 | 0.99 |
Richest | 1.44 | 0.60–3.46 | 0.41 | 0.61 | 0.34–1.07 | 0.08 | 1.02 | 0.66–1.56 | 0.94 |
Obstetric Characteristics |
Maternal Age at Marriage | | | | | | | | | |
< 20 years | 1 | | | 1 | | | 1 | | |
20 years and above | 0.78 | 0.43–1.40 | 0.40 | 0.89 | 0.65–1.23 | 0.49 | 1.17 | 0.93–1.47 | 0.19 |
Maternal Age at First Birth | | | | | | | | | |
< 20 years | 1 | | | 1 | | | 1 | | |
20 years and above | 0.55* | 0.35–0.88 | 0.01 | 1.14 | 0.87-.1.49 | 0.35 | 1.00 | 0.79–1.27 | 0.99 |
Parity | | | | | | | | | |
5 children or above | 1 | | | 1 | | | 1 | | |
3–4 children | 0.98 | 0.41–2.39 | 0.97 | 0.67 | 0.40–1.12 | 0.13 | 0.82 | 0.44–1.51 | 0.24 |
1–2 children | 1.44 | 0.42–4.93 | 0.56 | 0.55 | 0.25–1.23 | 0.15 | 0.79 | 0.53–1.17 | 0.52 |
Number of living children | | | | | | | | | |
5 or above | 1 | | | 1 | | | 1 | | |
3–4 | 0.72 | 0.32–1.62 | 0.42 | 1.01 | 0.63–1.61 | 0.97 | 1.57* | 1.05–2.34 | 0.03 |
1–2 | 0.83 | 0.28–2.48 | 0.74 | 1.17 | 0.58–2.37 | 0.65 | 2.06* | 1.15–3.67 | 0.01 |
0 | 0.55 | 0.08–3.95 | 0.55 | 1.02 | 0.90–1.98 | 0.98 | 2.67* | 1.07–7.34 | 0.05 |
Antenatal Attendance | | | | | | | | | |
Less than 4 visits or no visit | 1 | | | 1 | | | 1 | | |
At least 4 visits or more | 1.73* | 1.09–2.74 | 0.02 | 1.09 | 0.84–1.40 | 0.51 | 1.19* | 1.09–1.44 | 0.05 |
Birth Order | | | | | | | | | |
6 or more | 1 | | | 1 | | | 1 | | |
4–5 | 1.25 | 0.68–2.29 | 0.47 | 1.36 | 0.93–1.99 | 0.11 | 1.13 | 0.79–1.59 | 0.49 |
2–3 | 1.55 | 0.63–3.84 | 0.34 | 1.64 | 0.95–2.82 | 0.07 | 0.97 | 0.62–1.52 | 0.89 |
1 | 1.34 | 0.42–4.26 | 0.62 | 1.89 | 0.91–3.92 | 0.08 | 0.99 | 0.58–1.68 | 0.97 |
Sex/Gender of Newborn | | | | | | | | | |
Female | 1 | | | 1 | | | 1 | | |
Male | 1.28 | 0.91–1.80 | 0.16 | 1.17 | 0.96–1.44 | 0.12 | 1.28* | 1.09–1.49 | < 0.01 |
Size of Newborn at Birth | | | | | | | | | |
Small | 1 | | | 1 | | | 1 | | |
Average | 0.77 | 0.51–1.15 | 0.19 | 1.07 | 0.83–1.39 | 0.61 | 0.91 | 0.74–1.11 | 0.36 |
Large | 1.04 | 0.66–1.62 | 0.87 | 0.59* | 0.38–0.91 | 0.01 | 0.90 | 0.64–1.28 | 0.57 |
Community level Characteristics |
Regions/Provinces | | | | | | | | | |
Baluchistan | 1 | | | 1 | | | 1 | | |
Punjab | 1.57 | 0.48–5.07 | 0.45 | 4.28* | 1.33–13.77 | 0.01 | 2.30* | 1.09–5.35 | 0.05 |
Sindh | 4.81* | 1.47–15.70 | 0.01 | 5.28* | 1.61–17.29 | < 0.01 | 3.61* | 1.53–8.51 | < 0.01 |
Khyber Pakhtunkhwa | 1.93 | 0.57–6.51 | 0.29 | 1.98 | 0.59–6.64 | 0.27 | 1.91 | 0.79–4.62 | 0.15 |
Gilgit Baltistan | - | - | - | 0.67 | 0.12–3.84 | 0.65 | - | - | - |
Islamabad | - | - | - | 4.79 | 0.54–42.19 | 0.16 | 3.54 | 0.88–14.31 | 0.07 |
FATA | - | - | - | - | - | - | 0.30 | 0.01–19.62 | 0.57 |
Geographical classification | | | | | | | | | |
Rural | 1 | | | 1 | | | 1 | | |
Urban | 1.22 | 0.77–1.92 | 0.40 | 0.77 | 0.57–1.03 | 0.08 | 1.09 | 0.89–1.35 | 0.36 |
Mass Media Exposure | | | | | | | | | |
No | - | | | 1 | | | 1 | | |
Yes | - | - | - | 1.03 | 0.79–1.34 | 0.85 | 1.29* | 1.05–1.59 | 0.01 |
Perceived difficulty of distance to facility | | | | | | | | |
Problem | - | | | 1 | | | 1 | | |
Not a Problem | - | - | - | 1.29* | 1.01–1.66 | 0.04 | 1.11 | 0.93–1.33 | 0.24 |
Institutional level Characteristics |
Mode of Delivery | | | | | | | | | |
Vaginal | 1 | | | 1 | | | 1 | | |
C-Section | 0.70 | 0.97–1.69 | 0.79 | 2.55* | 1.71–3.81 | < 0.01 | 2.23* | 1.83–2.72 | < 0.01 |
Place of Delivery | | | | | | | | | |
Home | 1 | | | 1 | | | 1 | | |
Hospital/Facility (Public & Private) | 0.82 | 0.16–4.08 | 0.81 | 1.26 | 0.73–2.19 | 0.40 | 0.27* | 0.18–0.40 | < 0.01 |
Skilled Birth Assistance | | | | | | | | | |
No | 1 | | | 1 | | | 1 | | |
Yes | 1.76* | 1.09–3.32 | 0.05 | 2.39* | 1.39–4.09 | < 0.01 | 1.39 | 0.91–2.14 | 0.13 |
* p-value = < 0.01 & ≥0.05 |
Multivariable logistic regression analysis was carried out to obtain the AOR after controlling for visit of field worker (LHWs) |
VIF was calculated before Multivariate regression to assess Multicollinearity, which was found > 10 |
Findings of multivariate analysis revealed that those mother, who aged 35 years and above (AOR = 1.84, 95% CI: 1.14–2.97) in wave 3, attained 6–10 years of schooling (AOR = 0.76, 95% CI: 0.59–0.99) in wave 4, serving as professional/clerical/sales & services (AOR = 1.67, 95% CI: 1.19–2.37) in wave 3 and manual/households jobs (AOR = 1.55, 95% CI: 1.16–2.06) in wave 4, belonged to middle wealth quintile (AOR = 0.69, 95% CI: 0.48-1.00) in wave 3 and had both decision-making (AOR = 1.56, 95% CI: 1.28–1.90) and emotional autonomy (AOR = 1.23, 95% CI: 1.03–1.47) in wave 4 are more likely to avail newborn PNC utilization in Pakistan.
Regarding obstetric characteristics, the multivariate analysis highlighted that the mothers gave first birth at the age of 20 years and above (AOR = 0.55, 95% CI: 0.35–0.88) in wave 3, having living children in wave 4, had male newborns (AOR = 1.28, 95% CI: 1.09–1.49) in wave 4 with large size (AOR = 0.59, 95% CI: 0.38–0.91) in wave 3 had more probability to avail newborn PNC services. Findings showed that antenatal attendance with at least 4 visits or more had a strong association with newborn PNC utilization (AOR = 1.73, 95% CI: 1.09–2.74; AOR = 1,19, 95% CI: 1.09–1.44) in waves 2 and 4 respectively.
With reference to community-level characteristics, results showed that women from Sindh province across all three waves of PDHS (AOR 4.81, 95% CI: 1.47–15.70; AOR 5.28, 95% CI: 1.61–17.29; AOR 3.61, 95% CI: 1.53–8.51), while Punjab in last two waves, i.e. wave 3 and 4 (AOR = 4.28, 95% CI: 1.33–13.77) (AOR = 2.30, 95% CI: 1.09–5.35) had higher newborn PNC utilization. Further, those mothers, who had exposure to mass media (AOR = 1.29, 95% CI: 1.05–1.59) in wave 4 and had no perceived difficulty in accessing distant healthcare facilities (AOR = 1.29, 95% CI: 1.01–1.66) in wave 3 are more likely to avail newborn PNC utilization.
Lastly, multivariate analysis with institutional level characteristics informed that newborn PNC utilization had a strong association with mode of delivery (AOR = 2.55, 95% CI: 1.71–3.81; AOR = 2.23, 95% CI:1.83–2.72) in waves 3 and 4, skilled birth assistance (AOR = 1.76, 95% CI: 1.09–3.32; AOR = 2.39, 95% CI: 1.39–4.09) in wave 2 and 3, and place of delivery (AOR = 0.27, 95% CI: 0.18–0.40) in wave 4 of PDHS.