Analysing data from interviews with traditional birth assistants and their clients in rural Nigeria, this paper examines the characteristics and conditions of persons using the services of traditional birth homes. The clients of traditional birth homes mainly comprise women with little or no formal education and in low or no‐income occupations. These persons present at traditional birth homes for child delivery, abortion, family planning, STIs, infertility and a host of other reproductive health‐related conditions. Economic and cultural factors are primary considerations in the uptake of services. Findings highlight the critical role of poverty and culture in mediating access to good quality reproductive healthcare, the burden of unmet needs for good quality neonatal healthcare and reproductive health services among local women, and the critical health role of traditional birth homes in rural Nigeria. Local peoples' access to good quality health services could be improved by integrating traditional birth homes into mainstream healthcare delivery, and making available formal health facilities responsive to the socio‐economic and cultural needs of local peoples and communities.