Abstract
<jats:p>Background Obstetric ultrasound is an essential tool for assessing fetal growth and wellbeing. While evidence-based recommendations advise one routine scan before 24-weeks of gestation, research suggests its use in low- and middle-income countries often extends beyond medical necessity. This study examined how ultrasound technology has become integrated into antenatal practices in rural Pakistan and how cultural, economic, and institutional factors shape its use. Methods Drawing on data from two qualitative and one mixed-method studies conducted across six rural districts of Punjab, we used a pragmatic mixed-methods approach integrating latent content analysis of interviews, focus group discussions and observations with quantitative survey data. Results Ultrasound use is common, with nearly 80-percent of women reported having at least one ultrasound and many undergoing three to six scans. For some participants, ultrasound had become synonymous with antenatal care, overtaking basic tests such as blood and urine analysis. The technology was widely perceived as both diagnostic and therapeutic, with some women believing it could cure health problems. Providers, particularly in the private sector, promoted frequent scans to meet patient expectations and financial targets, while women’s demand was driven by reassurance, perceived modernity, and son preference. This dynamic created a self-reinforcing supply–demand cycle in which clinical need played a secondary role. Conclusions In rural Pakistan, obstetric ultrasound has evolved into a central socio-technical feature of pregnancy care that extends far beyond its clinical purpose. These findings highlight the interplay of technology, culture, and market forces in shaping maternal health behaviors and underscore the need for context-sensitive policy responses that align ultrasound use with evidence-based care while engaging with the social realities that sustain its widespread adoption.</jats:p>