With a national maternal mortality rate of 401 per 100,000 live births, it is clear that becoming a mother in Togo carries significant risk. In order to inform the scale-up of maternal health services, this qualitative baseline evaluation explored barriers to maternal and reproductive health in the Kozah district of northern Togo through semi-structured interviews with 21 community stake-holders and focus group discussions with four groups of six mothers. Inter-related factors including financial means, distance from health posts, gender roles, cultural beliefs, and patient-provider relations all influence women's care-seeking behavior. Lack of financial means renders the cost of crucial maternal health services prohibitive, and husbands' resistance to family planning and health-care financing compounds the challenges women face meeting essential maternal health needs. Our findings suggest that waiving user fees, providing facility-based delivery free of cost, improving transportation options, and fostering trust in and access to health centers could significantly improve maternal health in the Kozah district.