Abstract
<title>Abstract</title> <p>Background Ghana government introduced and implemented the free maternal healthcare policy to create access to maternal healthcare services. However, after decades of the implementation of this policy a significant number of expectant women still give birth at home. We conducted this study to ascertain the sociocultural architects of women decision to deliver at home in the midst of free maternal healthcare policy Methods A cross sectional study was conducted among mothers who delivered at home from zero to forty eight months (0–48 months) in six sub-districts in the Jirapa municipality in the Upper West Region of Ghana. Results Younger individuals (ages 13–19) are more likely to deliver at compared to older age groups (p = 0.003.). Marital status significantly affects the decision on where to deliver, with married individuals more often influenced by healthcare professionals (p < 0.001). There is a significant association between religion and whether this is the first time delivering at home (p = 0.001). The most important factor for home delivery is significantly influenced by health insurance status (p = 0.000). Conclusions Despite the availability of the free maternal healthcare policy, age, marital status, religion, and health insurance status still influence women to deliver at home. National health insurance must intensified public education so those who are not yet registered will do so.</p>