In low-medium-income countries, maternal mortality continues to be major public health problem. Maternal mortality rates (MMR) in Kenya declined from 362/100,000 live births in 2014 to 353/100,000 live births in 2021. One of Kenya's three counties with the lowest use of skilled delivery services is Marsabit County, which despite the nation's decline has a high MMR of 1,127/100,000 live births. In the North Horr sub-county in 2018, just 26% of expectant women had skilled births. We estimated coverage for skilled delivery and identified factors associated with the utilization of skilled birth attendant services in North Horr.