Skip to main content

Mapping out regional disparities of reproductive health care services (RHCS) across Pakistan: an exploratory spatial approach


Although Pakistan has reduced maternal mortality ratio by 57% over the last 2 decades, Millennium Development Goals (MDGs) unmet maternal mortality targets are a matter of concern to achieve the Sustainable Development Goals (SDGs) by 2030. Provincial level maternal mortality data suggested large disparities and inequalities within the country. Therefore, the primary objective of this study was to identify the national- and provincial-level spatial inequalities regarding access to reproductive health care services. Exploratory Spatial Data Analysis (ESDA) was used to leverage the information of spatial clusters and outliers based on the Reproductive Healthcare Services (RHCS) index of 2004 and 2014. Growing high–high clusters were only found in the North-east Punjab Province and neighboring Khyber Pakhtun Khawa Province. Conversely, low–low clusters increased in North Baluchistan and neighboring districts south of Khyber Pakhtun Khawa and southwest of Punjab. The present study is one of the first attempt to investigate the national- and provincial-level variations for access to reproductive healthcare services across Pakistan. The findings provide valuable insights for the government and policymakers regarding the dimensions of clusters to address reproductive healthcare issues in vulnerable districts. These results also revealed many questions that need further investigation to uncover the determinants of these geographical clusters and outliers in reproductive healthcare services.

This is a preview of subscription content, access via your institution.

Fig. 1

Source: Author

Fig. 2

Source: Author

Fig. 3

Source: Author

Fig. 4

Source: Author

Fig. 5

Source: Author

Fig. 6

Source: Author

Fig. 7

Source: Author

Fig. 8

Source: Author

Availability of data and materials

The datasets for the present study are taken from the Pakistan social and living standards measurement surveys as well as the Multiple Indicators Custer Surveys (MICS) that are available online on the website of Pakistan Bureau of Statistics (PBS) as well as Data for Pakistan website.


  1. BHUs are the basic health units with small number of medical personnel who provide basic healthcare services. Each BHU must have one medical doctor who serves as the main head of the BHU and is supported by lady health workers who move around the communities to provide essential nutrition information and vaccines to newborns and pregnant women.


Download references


The author would like to thank Professor Carlos Mendez, for his tremendous support motivation and immense knowledge. Moreover, I express my gratitude to the two anonymous referees and the members of Quarcs-lab for their valuable comments and suggestions during the writing phase of this article. Finally, I would like to acknowledge my family, for their priceless support.


The author has received no funding or grant to conduct this research.

Author information

Authors and Affiliations



The author read and approve the final manuscripts.

Corresponding author

Correspondence to Aiza Sarwar.

Ethics declarations

Competing interests

The author declares no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.



See Tables 4, 5 and Fig. 9.

Table 4 List of districts (118) used for spatial analysis
Table 5 High–high and low–low districts of initial (2004) & final (2014) year (macro-level LISA analysis)
Fig. 9
figure 9

Source: Author

Local indicator of spatial autocorrelation maps for ANC and SBAs 2004 & 2014. Notes: Code and district names are listed in Appendix Table 4.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sarwar, A. Mapping out regional disparities of reproductive health care services (RHCS) across Pakistan: an exploratory spatial approach. Asia-Pac J Reg Sci 5, 825–849 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Maternal mortality
  • Reproductive healthcare services
  • Provincial spatial inequality
  • Spatial analysis