The fifth Millennium Development Goal (MDG-5) is to improve maternal health by targeting a reduction in maternal mortality ratios by 75% between 1990 and 2015, and increasing the proportion of all births assisted by skilled attendants to at least 90% globally by 2015. Progress towards these targets seems to have slowed down and even stagnated in many parts of Sub-Saharan Africa where many women continue to deliver at home without skilled assistance. The Ghana Demographic Health Survey (GDHS) 1988- 2003 reports for instance show that for over two decades, the percentage gain in skilled assistance was just six points, rising from 41% in 1988 to 47 % in 2003. The Offinso District which lies in the Ashanti region of Ghana has observed rising trends in its maternal mortality ratio (MMR) figures over the past three years with a steady decline in the proportion of ANC attendants who deliver in health facilities and thus receive skilled assistance. Marternal Mortality Ratio has risen from 140/100 000 in 2004 to 210/100 000 in 2006 and skilled attendance has declined from 92% to 81% over the same period. To determine the factors influencing the utilization of skilled delivery services in the Offinso district of Ghana and identify the barriers that pregnant women encounter in their bid to access delivery. A descriptive cross sectional study was done between September and October 2008 by administering a structured questionnaire to 400 women between the ages of 15-49 years who had delivered within 12months prior to the survey. Socio-demographic, household level, community, pregnancy care and delivery related factors were collected and analysed. A majority, (97%) of respondents attended ANC at least once, and another 80% of them attended four times or more. Only 63% had skilled assistance at delivery with the rest delivering at home. Barriers cited include transportation (27%); money (23%); short labour (22%) and socio-cultural (11%). Urban residency, (contrast rural) odds ratio (OR)=4.32 (2.82-6.63); women with more than basic formal education, (contrast less) OR=3.55 (2.33-5.40); women living in proximity to a health facility, (contrast living afar) OR=3.60 (1.90-6.72); with relatively higher income (compared to lesser) OR=7.10 (3.7- 13.7) and respondents who paid four or more ANC visits during pregnancy (in contrast to those who paid fewer) OR=8.52 (4.8-15.1) all showed statistical association with the utilization of skilled assistance during labour. ANC coverage is high but delivery care coverage has stagnated at 61% since 2003 GDHS. There are still significant rural urban disparities, and women with lower education, lower monthly earnings and living far from health facilities face challenges accessing skilled care and hence deliver at home. Transportation, money and socio cultural barriers need to be overcome to improve delivery care coverage in district.