Post-socialist economic declines have included declines in women's use of maternal health care. This paper examines the use of maternal health care in Tajikistan, where such declines have occurred. The findings support previous evidence that women's use of services depends on women's education, household income, and proximity of services. Previous models have not specified who makes the care decision. Using education as a proxy for preferences, the findings show that women share decisionmaking with their spouse and the eldest female in the household. However, the data provides limited evidence that traditional proxies for bargaining power affect outcomes. The authors conclude that measures of bargaining power require tailoring to local conditions. Surveys evaluating the value of women's assets and their services in the home, as well as questions about decision-making, will allow researchers to more effectively measure bargaining power across contexts. The paper concludes with policy recommendations.