Background: Mozambique has one of the highest maternal mortality rates in sub-Saharan Africa. While some progress has been made, further efforts are required to ensure that women in Mozambique have access to high-quality healthcare. A key strategy for reducing maternal and child mortality is to promote adequate access to and utilisation of maternal healthcare services.

Methods: We used the population-based, nationwide, cross-sectional Mozambique Demographic and Health Survey 2022-2023 data (n=3808). The survey employed a two-stage stratified sampling design that yielded a nationally representative sample at the household level. Four essential maternal healthcare services outcomes were defined: adequate (at least four visits) antenatal care by a skilled provider, lab-based test services (blood, urine and ultrasound), births with a skilled birth attendant and postnatal care by a skilled provider.

Results: Overall, 18.6% of women received all four maternal healthcare services. Maternal healthcare utilisation showed significant inequalities favouring wealthier and more empowered women. Regression model suggests that women who were classified in the highest quintile for empowerment index (adjusted OR (aOR)=2.17, 95% CI=1.41 to 3.33), women in the two highest quintiles for wealth index (richer: aOR=2.37, 95% CI=1.41 to 3.98; richest: aOR=2.60, 95% CI=1.41 to 4.79) and women residing in urban area (aOR=1.35, 95% CI=0.99 to 1.83) were significantly associated with the utilisation of all four healthcare services. Other factors like exposure to media (television/radio/newspaper), husband's educational status, distance to the nearest health facility and province/region of residence also determined maternal healthcare services utilisation.

Conclusion: Our findings highlight the need for targeted interventions such as improving women's education, healthcare infrastructure and distance barriers and promoting gender equality to ensure greater service utilisation. These findings could help advance further development and implementation of Mozambique's national strategies, and development assistance, for community-based primary healthcare and women-centred care as they provide the latest evidence on this topic.

Keywords: Cross-sectional survey; Global Health; Health Services Accessibility; Maternal health; Obstetrics.

© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

背景: 莫桑比克是撒哈拉以南非洲地区孕产妇死亡率最高的国家之一。虽然已经取得了一些进展，但仍需进一步努力确保莫桑比克女性能够获得高质量的医疗服务。减少孕产妇和儿童死亡的关键策略之一是促进对产前保健服务的充分获取和利用。

方法: 我们使用了基于人口、全国范围内的横断面莫桑比克人口与健康调查2022-2023年数据（n=3808）。该调查采用两阶段分层抽样设计，获得了家庭层面的全国代表性样本。定义了四个基本的产前保健服务结果：由熟练提供者进行至少四次访问的产前护理、基于实验室的服务（血液、尿液和超声波）、有技能接生员在场的分娩以及由熟练提供者提供的产后护理。

结果: 总体而言，18.6% 的女性接受了所有四项产前保健服务。孕产妇医疗服务利用显示了显著的不平等现象，有利于较富裕和赋权程度较高的妇女。回归模型表明，在赋权指数（调整后的比值比 (aOR)=2.17, 95% CI=1.41 至 3.33）最高的五分位数中的女性、财富指数（富人：aOR=2.37, 95% CI=1.41 至 3.98；最富有：aOR=2.60, 95% CI=1.41 至 4.79）最高的两个五分位数中的女性以及居住在城市地区的女性（aOR=1.35, 95% CI=0.99 至 1.83），与所有四项医疗服务的利用有显著关联。其他因素如接触媒体（电视/广播/报纸）、丈夫受教育状况、到最近医疗设施的距离和居住省份也影响了孕产妇保健服务的使用。

结论: 我们的研究结果强调了需要有针对性的干预措施，例如提高女性教育水平、改善卫生基础设施并消除距离障碍以及促进性别平等，以确保更大程度的服务利用。这些发现可以帮助推进莫桑比克国家策略的发展和实施，并为社区基础的一级医疗保健和以妇女为中心的护理提供最新的证据。

关键词: 横断面调查；全球卫生；医疗服务可及性；孕产妇健康；妇产科。