Background: Antenatal care (ANC) coverage rates have increased in Pakistan, but little is known about its quality. This study investigated the prevalence and factors associated with the quality of ANC in Pakistan.

Methods: Based on cross-sectional data from Pakistan’s Demographic and Health Survey 2012-13, this study evaluated 5,522 women aged 15-49 years having at least one ANC consultation in their last pregnancy for the receipt of quality antenatal care. It was measured in terms of access and effectiveness (early initiation, four or more ANC visits, care by a skilled provider, and receipt of seven basic components of focused ANC) and was assessed for its association with structural, household, and individual factors. Sampling weights and generalized linear mixed-effects models were used.

Results: ANC coverage was 71% and 38% for one and ≥ 4 visits, respectively. The prevalence of ANC quality was 11%. Higher household wealth and maternal educational level, older maternal age, lower gravidity status, and bad obstetric history significantly increased the odds of receiving quality care, whereas, living in Balochistan and Sindh provinces and attending non-formal care sources was associated with lower odds of getting quality care. Among the basic ANC components, blood pressure measurement was most frequently, whereas, health education was least frequently provided.

Conclusions: Due to suboptimal quality, antenatal care in Pakistan is unlikely to achieve its potential to reduce the maternal and perinatal burden of disease. There is a dire need to address socio-demographic inequality in the receipt of quality ANC and to target the underprivileged.