Impact of Gender Inequality on Maternal Health Outcomes: Mediating Role of Women’s Healthcare Utilization and Moderating Role of Cultural Attitudes

Abstract

This study investigates the impact of gender inequality on maternal health outcomes, examining the mediating role of women’s healthcare utilization and the moderating influence of cultural attitudes within a South Asian context. Grounded in social determinants of health and gender-inequality frameworks, this research adopts a cross-sectional quantitative design using data collected from 220 women of reproductive age (15–49 years) in District Bhakkar, Punjab, Pakistan. For accurate and validated results, this research study employed well-established and standardized measurement scales to ensure the reliability, validity, and accuracy of the findings. Data were analyzed using SPSS and AMOS, applying mediation and moderation analyses with bootstrapping method to ensure robustness. Findings reveal that gender inequality exerts a significant negative effect on maternal health outcomes (β = –0.29, p < .001). Women’s healthcare utilization partially mediates this relationship (indirect effect β = –0.24, 95% CI [–0.35, –0.14]), indicating that reduced service use transmits the adverse influence of inequality. Moreover, cultural attitudes significantly moderate the association between healthcare utilization and maternal outcomes (interaction β = 0.16, p = .002), suggesting that egalitarian cultural norms amplify the positive effects of healthcare utilization. These results advance theoretical understanding by integrating structural, behavioral, and cultural dimensions into a moderated mediation framework. Policy implications highlight the need for gender-transformative and culturally adaptive interventions that simultaneously address structural inequities, enhance women’s healthcare utilization, and promote progressive cultural attitudes to achieve sustainable improvements in maternal health.

Keywords: Gender Inequality, Maternal Health, Healthcare Utilization, Cultural Attitudes