Background <p>Access to health facility delivery services is critical for reducing the persistently high rates of maternal mortality worldwide. However, sociodemographic and regional disparities continue to limit women’s ability to access these services. This study addresses a gap in the literature by analyzing and comparing how these disparities vary across regions and change over time.</p> Methods <p>This study presents an analysis of maternal health facility deliveries across time, regions, and a range of sociodemographic variables, with a focus on the combined effects of household wealth and urban-rural residence. We analyzed Demographic and Health Surveys (DHS) data from 52 countries collected between 2000 and 2023 (<i>N</i> = 1,929,073). Mixed-effects logistic regression models were used to estimate the odds of delivering in a health facility, adjusting for key sociodemographic factors.</p> Results <p>Despite overall increases in facility-based childbirths, significant inequalities in access to maternal health services persist. Rural poor women, in particular, face substantial disadvantages, with urban rich women having nearly four times the odds of delivering in a health facility. This disparity remains consistent across regions.</p> Conclusion <p>This study contributes to existing research by examining trends in health facility deliveries over time, across regions, and by key demographic factors. The findings offer insights for future policy interventions aimed at reducing maternal and infant mortality, including improvements in transportation support, affordability, and maternal health education, particularly among disadvantaged populations such as rural poor women.</p>