Abstract
Objective: The present study is a cross district analysis of the effect of health infrastructure, adult literacy, and household characteristics on antenatal care (ANC) use in Punjab (Pakistan).
 Data and Methodology: The unit of analysis is a district. By covering a panel of 35 districts of Punjab, the study has collected the yearly data for the time period 2010 to 2016. The percentage of pregnant women of reproductive age received ANC services in each district is taken as dependent variable. Health physical infrastructure, adult literacy rate, and the percentage of households: having own house, using improved sanitation facilities, and receiving remittances from abroad are taken as explanatory variables. The study used panel Generalized Method of Moments (GMM) to estimate the effects of the explanatory variables on antenatal care. 
 Results: Ranking of the districts on the basis of ANC coverage shows that amongst the 34 districts of Punjab province, Bahawalnagar, Rajan pur, Pakpattan, Kasur, Bahawalpur, and Rahim Yar Khan districts are at the bottom with the lowest use of ANC services by the pregnant mothers. The GMM estimates show that health physical infrastructure, adult literacy rate, and the percentage of households having their own house are positively and significantly affecting the ANC use in Punjab-Pakistan. Hence confirming the healthcare services utilization framework of Andesen and Newman (2005) which explains that formal healthcare system (health physical infrastructure), predisposing factors (adult literacy rate), and enabling factors (households having their own houses) significantly matter in fostering better use of healthcare services.
 Conclusion: The study advocates the need for investment in health physical infrastructure as well as in overall literacy. At the same time, it suggests that for the better coverage of ANC the geographical targeting can result into better outcomes.
Highlights
Many of the stillbirths, infant mortalities, and maternal deaths due to pregnancy-related issues can be prevented through better healthcare during pregnancy and childbirth
The results have shown that health infrastructure and antenatal care use are positive and significantly related to each other
The results show the existence of a positive and very significant relationship between the dependent and independent variables.Health infrastructure is highly significant and positively related to antenatal care, improvements in transportation, rural health centers, hospitals this helps to achieve development goals, improved maternal health care in the case of postnatal care and prenatal care.The result shows that one unit increase in health infrastructure 0.7187193unit increase in maternal health due to the positive relationship between them in districts of Punjab.These findings are similar to results obtained by other studies that found health infrastructure improved maternal health care increases
Summary
Infant mortalities, and maternal deaths due to pregnancy-related issues can be prevented through better healthcare during pregnancy and childbirth. The post-2015 development agenda does not seem to be materialized into reality without adequate use of antenatal care (ANC) services. In Pakistan the percentage of pregnant women receiving antenatal care services was 86.2 in 2018, while maternal mortality ratio was estimated as 140 per 100,000 live births in 2017 (The World Bank, 2019). This ratio is lesser than that of in India and Bangladesh but still remains too high in comparision with the maternal mortality ratio in Sri Lanka (see the table). The situation regarding ANC services use is uneven among various regions of the country
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