This study examines healthcare access for pregnant women in a rural developing country context. Drawing upon institutional theory and Levesque et al’s model of access, the study finds pregnant women face challenges both of a formal and informal nature in accessing healthcare. The findings suggest the need for integrated and collaborative workings across formal and informal institutional networks. Theoretically, the study makes two contributions. First, it adds value to institutional theory by incorporating a dimension of access. Second, it builds upon Levesque et al.’s healthcare access framework by highlighting the role and significance of a third dimension—that is informal institutions, in addition to the current two—formal institutions and individual factors.