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Introduction: A minority of births in sub-Saharan African regions are conducted with the supervision of skilled birth attendants. With among the highest world-wide maternal mortality ratios and the majority of the deaths being associated with a lack of trained supervision at delivery, changing delivery practices is a major priority in this world region. This study identified attitudes to and beliefs about the uptake of hospital services for birthing. Methods: Data were gathered using a combination of individual interviews and group discussions. Twelve discussion groups were held with participants who included hospital staff and general community members (36 males and 54 females). In addition, individual interviews were carried out with 26 mothers who chose not to deliver their babies in hospital. Results: Qualitative analysis identified a number of barriers to seeking skilled attendants at birth including: lack of resources (monetary, transport and access), customer care (lack of partnership between mother and health professional), and knowledge and beliefs (lack of knowledge about pregnancy and maternal health). Conclusions: The community must be better informed about the costs and benefits of hospital deliveries, while medical services must be more sensitive to community needs and preferences. These findings prompted the initiation of consultation groups on health and maternal issues between health service providers and community organisations. [ABSTRACT FROM AUTHOR]