Table 2.

Thematic analysis

Third order	Second order	First order	References
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]