Table 4.

Facilitators of and barriers to institutional delivery

Themes	Sub-themes	Facilitators	Barriers
Socio-cultural norms and values	Traditional care during birth and the post-partum period	• Institutional delivery in case of complications	• Childbirth as a normal life event • Care by family members, neighbours and TBAs • Freedom of movement during birth • Warm environment after birth • Food choices and practices
	Family hierarchy and social norms	• Husbands and parents-in-law supportive of institutional delivery	• Shyness • Low caste, poor education, early marriage • Husbands and parents-in-law not supportive of institutional delivery
Access to birthing facilities		• Ambulance available • Birthing centre nearby • Sufficient financial incentives • Material incentives: clothes for mother and baby	• Lack of roads (hill areas) or good roads • Distance from health institution (especially in hill areas) • Ambulance not always available • Insufficient incentives
Perceptions regarding the quality of health services		• 24-h availability of midwives • Friendliness of health workers	• Perceived incompetence of midwives • Young age of midwives • Poor infrastructure and lack of equipment at birthing centres • Low budget allocated to birthing centres

TBA Traditional birth attendant