Introduction/Objectives This study assesses the impact of natural disasters on the inequality of quality ANC utilization.

Methods This study uses data from the 2017-18 Bangladesh Demographic and Health Survey and monthly hazard reports from NIRAPAD. Inequalities in maternal healthcare utilization were measured using the Health Opportunity Index, and contributions of socioeconomic factors were decomposed using Shapley decomposition.

Results The results reveal that inequality in the utilization of quality antenatal care is significantly greater in disaster-affected areas (32.72; 95% CI: 16.07, 49.38) compared to disaster-unaffected areas (27.17; 95% CI: 15.95, 38.39). Furthermore, socioeconomic factors such as place of residence, administrative division, maternal employment status, and birth order contribute more to these inequalities in disaster-affected regions than in unaffected areas.

Conclusions The findings illustrate that natural disasters significantly increase the inequality in quality ANC utilization. Geographical location, employment status, and higher parity are key socio-economic factors contributing to the increasing inequality in quality ANC uptake. Therefore, Policymakers must prioritize equitable access to quality antenatal care by focusing on women of rural areas, those not engaged in formal employment, and individuals experiencing high-order pregnancies to mitigate these disaster-induced inequalities effectively.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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In this study secondary data are used which are available in the Demographic and Health Surveys (DHS) Program repository https://dhsprogram.com/data/. Therefore, author required no direct ethical approval for data collection. However, authors adhere to data use ethics of DHS program.

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The datasets analyzed during the current study are available in the Demographic and Health Surveys (DHS) Program repository https://dhsprogram.com/data/. DHS data are publicly available upon request.