A cross-sectional descriptive study using qualitative and quantitative methods was carried out in November 2012 to determine the reasons for the very low facility delivery rate in the Imbongu District of the Southern Highlands Province. 300 women of childbearing age (15-45 years) who had delivered either in Imbongu District health facilities or villages within the previous 24 months were interviewed using a structured questionnaire. Two focus groups with women and one focus group with the officers in charge of health facilities were held. The women who delivered at health facilities were more likely to have been educated to primary school level and above, to be less than 36 years of age, to have attended antenatal clinic and to have had the support of their male partner or male relative than the women who delivered in the village. Customary beliefs, run-down health facilities, poor staff attitude and concerns over the possibility of a male birth attendant were major reasons for women avoiding facility delivery. If maternal mortality rates are to fall in the district, urgent attention is needed to make the health facilities more attractive and user-friendly, and to find other ways of persuading mothers to deliver in them.