Maternal Health and Time Poverty: How Women’s Dual Roles Affect Prenatal Care in South Asia

Abstract

Importance: Maternal health outcomes in South Asia remain among the poorest globally, with preventable maternal morbidity and mortality linked to inequities in access to prenatal care. Women’s dual roles in the productive (income-generating) and reproductive (domestic and caregiving) spheres often generate significant time poverty, constraining their ability to prioritize prenatal health.

Objective: To examine the relationship between women’s dual roles, time poverty, and prenatal care utilization in South Asia, and to identify structural barriers and coping mechanisms shaping maternal health outcomes.

Design, Setting, and Participants: This study employed a mixed-methods approach combining a systematic review of peer-reviewed literature (2015–2024) with secondary data analysis from Demographic and Health Surveys (DHS) in South Asia. A purposive sample of 7,200 women of reproductive age (15–49 years) across Pakistan, India, Nepal, and Bangladesh was analyzed, focusing on prenatal care utilization patterns. Qualitative insights were drawn from thematic synthesis of 38 studies addressing maternal workload, time constraints, and health service access.

Main Outcomes and Measures: The primary outcome was adequate prenatal care utilization (≥4 antenatal visits, WHO recommendation). Predictor variables included women’s employment status, unpaid care workload, and decision-making autonomy. Control variables included education, household income, and rural–urban residence.

Results: Findings revealed that women experiencing high time poverty defined as >10 daily hours spent on unpaid domestic and caregiving work, had 38% lower odds of completing recommended prenatal visits (adjusted odds ratio [aOR] 0.62, 95% CI 0.55–0.70). Employment outside the home did not independently reduce prenatal care, but when combined with heavy domestic responsibilities, it significantly increased time poverty and reduced prenatal care access. Qualitative evidence highlighted cultural expectations of self-sacrifice, limited spousal support, and gendered norms of mobility as major barriers.

Conclusions and Relevance: Women’s dual roles create structural time poverty that undermines maternal health in South Asia. Policy frameworks addressing maternal health must integrate time-use considerations, including labor redistribution, workplace maternity protections, and community-based prenatal outreach, to improve equity in prenatal care access and maternal outcomes.