Previous studies have demonstrated large disparities in use of skilled birth attendants (SBAs) by
socioeconomic status (SES), but little empirical evidence addresses the factors underlying these
disparities. This is likely because current models do not provide clear pathways for how distal
factors like SES may affect maternal health-seeking behaviors. We propose the Disparities in
Skilled Birth Attendance (DiSBA) framework. We posit that three proximal factors directly
affect use of SBAs: perceived need, perceived accessibility of maternal health services, and
perceived quality of care. Distal factors like SES affect use of SBAs indirectly through these
proximal factors. We test the assumptions of the DiSBA framework using data from the Ghana
Maternal Health Survey. The proximal factors are worthy of increased attention as they are more
amenable to change than the distal factors. Their effects are also likely context specific, thus
sufficient understanding in different contexts is essential to developing appropriate interventions.