Background: Despite numerous improvements in the health care system of Pakistan in the past few decades, many disparities continue to persist between health care policies and practices in comparison to developed nations, particularly in the area of maternal health. Despite a 181% increase in expenditure, Pakistan did not meet its target to reduce child mortality and improve maternal health by 2015, causing these disparities to further widen. Methods: We sought to investigate the policymaking process of Pakistan by conducting a content analysis of 34 policy documents pertaining to maternal health service delivery. Results: We found a number of gaps, priorities, and determinants for health policymaking. The most commonly discussed themes were the following: Measures of Burden, System and Organizational Capacity, Access and Availability of Health Services, Policy and Planning, Gaps and Needs, and Socioeconomic Factors. Integrated care and opioid use were seldom mentioned in included policy documents. Conclusions: We discuss the reasons that might explain why Pakistan has not observed an improvement in maternal health outcomes despite significant investment. We use path dependency to explain that drawbacks of health care priority-setting processes in Pakistan. We suggest a refocus on identifying and improving health disparities between communities. We also suggest research and policy attention on integrated care and opioid use in Pakistan.