<p>Spatial inequality in maternal healthcare access remains a persistent challenge where complex terrain, uneven infrastructure, and dispersed settlements constrain service delivery. This study evaluates maternal healthcare accessibility in Goalpara district, Assam, by analysing the combined influence and interaction of physical, infrastructural, and demographic determinants through an integrated decision-support framework. The methodology applied the Fuzzy Analytic Hierarchy Process to quantify the relative importance of accessibility indicators, Fuzzy Decision-Making Trial and Evaluation Laboratory (DEMATEL) to identify dominant causal drivers and dependent factors, and Total Interpretive Structural Modelling (TISM) to organise these relationships into a hierarchical structure, clarifying how upstream drivers shape downstream accessibility constraints. The results identify Distance from Built-up Areas, Distance from Major Roads, Hospital Density, and Elevation as the most influential determinants of maternal healthcare accessibility. Fuzzy DEMATEL classifies these variables as primary causal drivers, while TISM places them at the highest hierarchical level, indicating their system-wide influence on downstream constraints such as distance from hospitals, Slope, land-use patterns, and Distance from Waterbodies. Spatial patterns reveal high accessibility around Goalpara town and major transport corridors, contrasted by very low accessibility in the Brahmaputra charlands, western rural pockets, and the foothills of the Meghalaya Plateau. The integrated model shows strong predictive performance, with an AUC value of 0.903. By providing spatially explicit and causally grounded insights, this study emphasizes the need for targeted infrastructure planning and presents an approach applicable to evaluating maternal healthcare accessibility in other geographically constrained regions.</p>