Intermittent preventive treatment in pregnancy with is a key malaria prevention strategy. We conducted an anthropological study to understand the social context of a community based approach to delivering sulphadoxine pyrimethamine (C-IPTp) through community health workers (CHWs) in four countries (the DRC, Madagascar, Mozambique and Nigeria) to identify key factors influencing the intervention’s acceptability. In-depth interviews, focus group discussions and direct observations were undertaken between 2018 and 2021. The findings provide evidence on the reported acceptability of C-IPTp among a wide range of actors, as well as the barriers and facilitators for delivery and uptake of the intervention. Overall, C-IPTp was accepted by the targeted communities, supporting the public health value of community-based interventions, although the barriers identified should be examined if large-scale implementation of the intervention is considered.