Table 2 Thematic analysis

Perceptions of pregnancy and delivery

Traditional influences

Barrier: Tradition supports an external locus of control

[16–20]

Barrier: Traditional understandings of disease etiology

[16, 19–23]

Medicalization of childbirth

Barrier: Facilities deemed unnecessary for the “natural event” of birth

[18, 19, 24–37]

Facilitator: Facility delivery valued for obstetric complications

[18, 19, 26, 29–38]

Barrier: Unfamiliar and undesirable birth practices in facilities

[18, 19, 22, 24, 26, 29–31, 36, 39, 40]

Barrier: Lack of privacy in a facility

[24, 26, 27, 31, 39, 41, 42]

Barrier: Lack of supportive attendance during facility delivery

[23, 24, 29, 34, 36, 39, 41, 43]

Barrier: Fear of cutting

[19, 22–24, 36, 43–45]

Facilitator: Desire for modernity

[16, 18, 20, 24, 25]

Barrier: Making logistical plans for childbirth is rare

[18, 19, 25, 29, 31, 32]

Influence of sociocultural context and care experiences

Influence of ANC

Barrier: Belief that ANC diminishes the likelihood of a complicated delivery

[19, 30, 46]

Barrier: ANC providers do not universally promote facility delivery

[19, 29, 35, 45]

Barrier: Lack of ANC attendance inhibits facility delivery

[27, 28, 31]

Previous birth experiences

Facilitator/barrier: Effects of previous birth experiences on subsequent delivery locations

[17, 20, 21, 24, 25, 30, 32, 34, 36, 39, 44, 46, 47]

Influence of others on delivery location

Barrier: Too many people involved in the decision-making process leads to delays in seeking care

[16, 18, 23, 24, 26, 29, 32, 33, 36, 40, 45, 47]

Barrier: Intergenerational continuity and the role of elder women

[16–19, 21, 34, 39, 43, 45]

Facilitator/barrier: The role of husbands

[16–22, 24, 25, 28, 29, 31, 39, 41, 47]

Facilitator: Personal links to healthcare facilities

[20, 25, 32, 44]

Ease of home birth

Barrier: Facility births less convenient than home births

[18, 33, 35, 42, 46]

Barrier: Unable to maintain household or family demands during facility delivery

[18, 19, 21, 32, 33, 45]

Effects of policies

Facilitator/barrier: Health insurance schemes, national population policies, and national policies aimed to shift deliveries from the home to a facility

[21, 23, 31, 33, 34, 46, 48]

Resource availability and access

Transportation

Barrier: Poor proximity and access to a facility

[18, 20, 25–27, 29, 32–36, 39, 41, 45, 46, 49]

Barrier: Lack of accessible and reliable transportation

[25–27, 32, 36, 39, 41, 45, 47]

Barrier: Inaccessibility of transportation and facilities during off-hours

[33, 39, 41, 43, 45, 46]

Barrier: Delays in accessing referral services

[17, 29, 34, 45, 49]

Cost of childbirth

Barrier: Perceived high cost of facility birth compared to home birth

[17, 20, 23, 24, 26, 28, 30, 32–37, 39, 41, 42, 46, 48, 49]

Barrier: Lack of access to funds in an emergency

[28, 32–34, 37, 41, 48, 49]

Barrier: Indirect and hidden costs associated with facility delivery

[16, 19, 20, 24, 25, 30, 31, 34, 41, 43–45, 47–49]

Perceptions of quality of care

Perceived quality of care from TBAs

Barrier: Utilization of TBAs as first-line providers

[18, 23, 24, 30, 32, 33, 37, 39, 40, 43–46]

Facilitator: TBAs perceived as providing low quality care

[20, 30, 33, 39, 43, 45]

Barrier: TBAs perceived as providing high quality care

[18, 19, 21, 22, 30, 33, 35, 40, 45]

Perceived quality of care at facilities

Facilitator: Facilities perceived as providing high quality care

[16–19, 21, 24, 29, 30, 33–35, 39, 41, 45, 47]

Barrier: Facilities perceived as providing low quality of care

[17–19, 23, 26, 29–31, 36, 39]

Barrier: Mistreatment and abuse by health workers

[17–21, 24, 28, 34, 36, 37, 41, 42, 45–48]

Barrier: Neglect and delays in receiving care at the facility

[17, 24, 31, 36, 39, 41, 45, 46, 48]

Barrier: Inadequate health facility staffing and infrastructure

[17, 18, 24, 34, 35, 37, 39, 41, 45–47]

Stigma

Barrier: Fear of compulsory HIV testing during delivery services

[28, 30, 36, 38]

Barrier: Fear of HIV-status disclosure in health facilities

[28, 36, 38]

Barrier: Fear of treatment disparities among HIV-positive women

[28, 38]

Barrier: Stigmatization of unwed, pregnant women

[17, 21, 41]