Social Determinants of Health and Inequities in Maternal Healthcare Access

Abstract

Maternal healthcare access remains uneven across populations globally. Persistent inequities rooted in social determinants of health such as socioeconomic status, education, geographic location, and cultural norms result in disproportionate maternal morbidity and mortality. This thesis examines how core social determinants influence maternal healthcare access and outcomes, proposing a conceptual model that identifies pathways through which structural and individual factors generate inequities. To investigate relationships among socioeconomic status, educational attainment, geographic location, health system responsiveness, and maternal healthcare utilization; and to quantify these relationships using structural equation modeling with SmartPLS. A cross-sectional survey of 600 women of reproductive age (18–49 years) was conducted across urban and rural districts. Latent constructs measured included Socioeconomic Status, Health System Responsiveness, Education Level, Geographic Accessibility, and Maternal Healthcare Utilization. Data were analyzed using SmartPLS 4 to assess measurement reliability and structural relationships, including direct, indirect, and moderated effects. Measurement model assessments demonstrated strong reliability (CR > .80) and validity (AVE > .50) for all constructs. Structural paths were statistically significant (p < .001) demonstrating that socioeconomic status and education positively predicted utilization of maternal healthcare services, while geographic barriers negatively affected access. Health system responsiveness mediated the link between social determinants and utilization. Interaction terms suggested that educational level moderated the effect of health system responsiveness on maternal care uptake. Social determinants significantly influence maternal healthcare access. Evidence supports that improvements in socioeconomic conditions and educational attainment can increase utilization, particularly when health systems are responsive and accessible. Geographic inequities remain a barrier, especially in rural settings. Policy interventions must address structural inequities and strengthen health services responsiveness to achieve equitable maternal healthcare access