Maternal healthcare access in Sub-Saharan Africa is influenced by complex socio-cultural factors. In the Republic of Congo, maternal mortality remains a significant concern. This case study examines the gendered dynamics that shape women’s ability to seek and receive obstetric and gynaecological care. This study aimed to analyse the gender-related barriers and facilitators affecting maternal healthcare access in the Republic of Congo. It sought to identify key social, economic, and cultural factors from a gendered perspective to inform more equitable health strategies. A qualitative, instrumental case study design was employed. Data were collected through in-depth, semi-structured interviews with women of reproductive age, healthcare providers, and community stakeholders. Documentary analysis of relevant health policy materials was also conducted. Thematic analysis was used to interpret the data. Findings reveal that gendered power relations within households critically determine access. Male partners or mothers-in-law frequently controlled financial resources and decisions regarding if and when to seek care. A majority of interviewed women reported needing spousal permission to attend antenatal clinics or access emergency obstetric services, which often resulted in delays. Gender dynamics, entrenched in household decision-making and resource control, are a fundamental determinant of maternal healthcare utilisation in this context. Addressing clinical service provision alone is insufficient without confronting these underlying social inequalities. Recommendations include designing community health programmes that actively engage men and extended family in maternal health education. Health policy should promote women’s economic empowerment and integrate gender sensitivity training for healthcare staff to foster a more supportive environment. maternal health, healthcare access, gender, Republic of Congo, case study, qualitative research, obstetric care This case study provides a nuanced, context-specific analysis of how gendered power structures within households directly constrain maternal healthcare access, offering evidence for targeted programme and policy interventions.