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Background: Maternal health care utilization is at the core of global public health provision and an area of focus in the now-concluded Millennium Development Goal agenda. Objective: This study aims to examine trends in maternal health care utilization over the last 15 years in Nepal, focusing on coverage and equity. Methods: This paper used data from the Demographic Health Survey (DHS) 2001, 2006 and 2011 and Multiple Indicator Cluster Survey (MICS), 2014. Coverage rates were calculated and logistic regression models used to examine inequity. Results: Impressive gains were found in antenatal care (ANC) attendance, which increased from nearly half of women attending (49%) in 2001 to 88% in 2014, and the rate of facility delivery increased from just 7–44%. This development did not, however, influence the equity gap in ANC and skilled attendance at birth, as women from low socioeconomic backgrounds were six times more likely to deliver without skilled assistance than those from high socioeconomic backgrounds (AdjOR 6.38 CI 95% 4.57–8.90) in 2014. Conclusion: These persistent equity gaps call for targeted interventions focusing on the most disadvantaged and vulnerable women in order to achieve the new Sustainable Development Goal of universal health coverage. [ABSTRACT FROM PUBLISHER]

Globally, millions of women die during pregnancy and childbirth due to preventable causes. In Nepal, although significant improvements have been made in the availability of routine antenatal care (ANC), the need for effective initiatives still persists. Using the 2011 Nepal Demographic and Health Survey data, we examine the relationship between ecological and socioeconomic variations on the effect of ANC services between three distinct ecological zones in Nepal. We make a case for the consideration of socioecological niches in designing effective policies and programs to achieve positive maternal health outcomes. Most importantly, we demonstrate how sociocultural perspective can be one alternative for examining the cultural and contextual effects on women's health, contributing to the methodological literature on women's health. Since geography and culture are components of human ecology and form the larger socioecological system, we highlight the importance of these contextual effects on women's health in general, and the conditions under which women from diverse backgrounds may experience similar health issues. [ABSTRACT FROM AUTHOR]