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Mauritania introduced in 2002 a pre-payment system for maternal health care: the obstetrical risk insurance scheme. The objective of this study is to find out whether this scheme improves the quality of access and reduces inequalities in the use of obstetric care. Data are from the 2015 MICS-Mauritania household survey. Two methods were used. The first is the concentration index. The second is the decomposition method of inequalities by a recentered influence function, which estimates marginal effects taking into account the characteristics of individuals. The obstetrical risk insurance scheme allows pregnant women to access better quality care and contributes to reducing inequalities in access.