This paper investigates the interplay between structural and behavioral barriers that discourage pregnant women from accessing institutional care in Haiti, where despite some improvements in the past decades, maternal mortality remains a significant challenge. The analysis complements household survey data with data on service provision and qualitative data on beliefs, perceptions, and attitudes toward maternal health care. Using a mixed-methods approach, the paper confirms that transportation and poverty are important barriers that decrease the likelihood of attending maternal health care services. At the same time, the findings show that women suffer from optimism bias and are uncomfortable with the current model of received care. These barriers discourage women from seeking, reaching, and receiving maternal health care services at health institutions. Tackling structural barriers while finding ways to encourage women to shift their beliefs, perceptions, and attitudes are key recommendations to improve maternal health in Haiti.