Maternal mortality is a major public health concern in Ghana as women continue to die from avoidable pregnancy and childbirth complications. The Eastern Region, Ghana has one of the highest maternal mortality rates in the country. While the number of women using health facility birthing services has increased, it has not led to a significant decrease in maternal deaths. The thesis examines how travel time and the quality of birthing services drives utilisation The study analyses routine birth records of women attending health facilities to give birth. Through a three paper thesis format, the first study develops health service areas from birthing care utilisation patterns derived from routine health data. The second paper assesses the quality of emergency obstetric and newborn care services in health facilities providing birthing. The final paper determines how the quality of maternal health services and travel time to health facilities are associated with health facility birthing service utilisation in Eastern region, Ghana. The thesis delineated 11 health service areas from the flows of women giving birth. Because the newly delineated boundaries are more “natural” and sensitive to observed flow patterns, areal indicator estimates showed a marked improvement over the existing administrative boundaries. The overall quality in hospitals was better than health centres and other primary level health facilities. Most districts did not have the required number of functioning emergency obstetric and newborn care health facilities. Also, most women travelling via mechanised transport were within two hours of any birthing service. In contrast, majority of women were beyond the two-hour threshold of critical comprehensive emergency obstetric and newborn care services. Higher travel time to health facilities decreased utilisation while increasing quality care promoted birthing care utilisation. The effect of quality is more profound than proximity. At similar quality, shorter travel times were associated with better use. To increase birthing service utilisation in Ghana, higher quality health facilities should be sited closer to women, particularly in rural areas. Beyond Ghana, routinely collected birth records could be used to analyse spatial patterns of birthing service use. In addition, data-driven geographic boundaries derived from public health events will improve areal health indicator estimates, planning and interventions.