Abstract Introduction: Almost one-fifth of the world's population constitutes women of reproductive age who are repeatedly exposed to pregnancy and childbearing. Many are often at high risk of illness and mortality during pregnancy and require maternal healthcare services for early detection of complications. More than 0.5 million women die every year worldwide due to pregnancy-related complications. Almost 0.03 million of them are in Pakistan. Maternal healthcare in Pakistan is poor and results in high rates of morbidity and mortality. This paper evaluates the accessibility of antenatal care (ANC) services in primary healthcare settings in the Punjab province of Pakistan during the period June 2010- August 2011. Methods: The paper uses a cross-sectional study including mix methods (qualitative and quantitative).Nine districts were included in the project; one from each administrative tier or division. Nineteen health facilities, including two rural health centres (RHCs) and 17 basic health units (BHUs) were randomly selected from each district. The total sample was 171 health facilities. The qualitative assessment was carried out through focus-group discussions (FGDs) and in- depth interviews with clients, providers, and health managers. Results: The reasons for the gaps in service accessibility were the distant location of facilities, a lack of transport, and inconvenient facility working hours. The issues of service accessibility were further exacerbated by socio- cultural factors such as low levels of client awareness, a lack of decision-making by clients, and the influence of spiritual healers and quacks. Health managers further pointed out weak co-ordination between vertical programmes and routine integrated health services, and a lack of human resources in distantly located facilities. Conclusion: In order to increase the accessibility of ANC services, facility working hours must be extended and adjusted according to the convenience of clients in primary healthcare (PHC) facilities. The utilisation of ANC services can also be increased through client awareness and gender empowerment for ANC decision- making. Keywords: Antenatal, ANC, Punjab, Pakistan, Accessibility, Availability, PHC facilities. Introduction Women of reproductive age, i.e. women aged 15-49 years constitute more than one-fifth of the world's population and are repeatedly exposed to pregnancy and childbearing. 1 Maternal healthcare services utilisation is important for early detection of mothers who are at high risk of illness and mortality during pregnancy as reported by the World Health Organization (WHO). 2 Women have a basic right to be protected when they undertake the risky enterprises of pregnancy and childbirth. 3 One cannot ignore the 600,000 maternal deaths that occur worldwide, every year, due to pregnancy-related complications. 4 Life-threatening complications of pregnancy are generally not preventable or predictable, but when nothing is done to avert maternal death, natural mortality is around 1,000 to 1,500 per 100,000 births. 3 Approximately 30,000 Pakistani women die annually from pregnancy and childbirth-related complications. 5 Maternal and neonatal health are strongly interlinked. For example, 33% of neonates in Pakistan die due to maternal infections and other problems related to pregnancy and delivery. 6 The level of health among Pakistani women is alarmingly poor and contributes to both maternal and child morbidity and mortality. Recent studies estimate that the lifetime risk of maternal death for Pakistani women is one in 93. 7 Antenatal care (ANC) utilisation in developing countries is low (65%) when compared to that of the developed countries, which is 97%. Skilled attendance at delivery is 53% in developing countries and 99% in developed J Pak Med Assoc (Suppl. 3) S-60 Accessibility of Antenatal Services at Primary Healthcare Facilities in Punjab, Pakistan Muhammad Ashraf Majrooh, MBBS, DCH, MPH, FCPS, 1 Seema Hasnain, MBBS, DMCH, FCPS, 1 Javaid Akram, MBBS, MD, MRCP, FRCP, FACP, FACC, 1 Arif Siddiqui, MBBS, MD, MRCP, FRCP, 1 Fatimah Shah, MS, Zahid Ali Memon, MSc MPH 1 Allama Iqbal Medical College, Lahore, Pakistan. Correspondence: Muhammad Ashraf Majrooh. Email: majrooh58@yahoo.com