OBJECTIVES: Obstetric referrals constitute an eminent component of emergency care, and key to ensuring safe delivery and reducing maternal and child mortalities. The efficiency of referral systems is however marred by the lack of accessible transportation and socio economic disparities in access to healthcare. This paper assesses incentives to honour maternal health referrals in a setting with inequitable access to healthcare. METHODS: This was a descriptive cross-sectional study, involving 720 randomly sampled pregnant women from five (5) sub districts in the Amansie west district in Ghana, from February to May 2015. Data were collected through structured interviewing and analyzed using STATA 11.0 for windows. A logistic regression models was fitted to determine the influence of socio-demographic characteristics and pregnancy history on obstetric referrals at 95% confident interval. RESULTS: About 21.7% of the women studied had ever been referred by a community health worker to the next level of care. Some of the pregnant women however refused referrals to the next level due to lack of money (58%) and lack of transport (17%). A higher household wealth quintile increased the odds of being referred as compared to those in the lowest wealth quintile.  Women who perceived their disease conditions as an emergency were also more likely to honour referral (OR=2.3; 95% CI=1.3, 3.9). CONCLUSIONS: Clients’ perception and low income remain as barriers to seeking healthcare and disincentives to honour referrals in a setting with inequitable access to healthcare. Implementing social interventions could leap-frog the attainment of maternal health targets in deprived areas.