Background. Nepal has made significant progress against the Millennium Development Goals for maternal and child health over
the past two decades. However, disparities in use of maternal health services persist along geographic, economic, and sociocultural
lines. Methods. Trends and inequalities in the use of maternal health services in Nepal between 1994 and 2011 were examined using
four Nepal Demographic and Health Surveys (NDHS), nationally representative cross-sectional surveys conducted by interviewing
women who gave birth 3–5 years prior to the survey. Sociodemographic disparities in maternal health service utilization were
measured. Rate difference, rate ratios, and concentration index were calculated to measure income inequalities. Findings. The
percentage of mothers that received four antenatal care (ANC) consultations increased from 9% to 54%, the institutional delivery
rate increased from 6% to 47%, and the cesarean section (C-section) rate increased from 1% in 1994 to 6% in 2011. The ratio of
the richest and the poorest quintile mothers for use of four ANC, institutional delivery, and C-section delivery were 5.08 (95% CI:
3.82–6.76), 9.00 (95% CI: 6.55–12.37), and 9.37 (95% CI: 4.22–20.83), respectively. However, inequality is reducing over time; for the
use of four ANC services, the concentration index fell from 0.60 (95% CI: 0.56–0.64) in 1994–1996 to 0.31 (95% CI: 0.29–0.33) in
2009–2011. For institutional delivery, the concentration index fell from 0.65 (95% CI: 0.62–0.70) to 0.40 (95% CI: 0.38–0.40) between
1994–1996 and 2009–2011. For C-section deliveries, an increase in concentration index was observed, 0.64 (95% CI: 0.51–0.77); 0.76
(95% CI: 0.64–0.88); 0.77 (95% CI: 0.71–0.84); and 0.66 (95% CI: 0.60–0.72) in the periods 1994–1996, 1999–2001, 2004–2006, and
2009–2011, respectively.