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BACKGROUND	Nepal is on track to achieve MDG 5 but there is a huge sub-national disparity with existing high maternal mortality in western and hilly regions .
BACKGROUND	The national priority is to reduce this disparity to achieve the goal at sub-national level .
BACKGROUND	Evidences from developing countries show that increasing utilization of skilled attendant at birth is an important indicator for reducing maternal death .
BACKGROUND	Further , there is a very low utilization during childbirth in western and hilly regions of Nepal which clearly depicts the barriers in utilization of skilled birth attendants .
BACKGROUND	So , there is a need to overcome the identified barriers to increase the utilization thereby decreasing the maternal mortality .
BACKGROUND	The hypothesis of this study is that through a package of interventions the utilization of skilled birth attendants will be increased and hence improve maternal health in Nepal .
METHODS	This study involves a cluster randomized controlled trial involving approximately 5000 pregnant women in 36 clusters .
METHODS	The 18 intervention clusters will receive the following interventions : i ) mobilization of family support for pregnant women to reach the health facility , ii ) availability of emergency funds for institutional childbirth , iii ) availability of transport options to reach a health facility for childbirth , iv ) training to health workers on communication skills , v ) security provisions for SBAs to reach services 24/24 through community mobilization ; 18 control clusters will not receive the intervention package .
METHODS	The final evaluation of the intervention is planned to be completed by October 2014 .
METHODS	Primary study output of this study is utilization of SBA services .
METHODS	Secondary study outputs measure the uptake of antenatal care , post natal checkup for mother and baby , availability of transportation for childbirth , operation of emergency fund , improved reception of women at health services , and improved physical security of SBAs .
CONCLUSIONS	The intervention package is designed to increase the utilization of skilled birth attendants by overcoming the barriers related to awareness , finance , transport , security etc. .
CONCLUSIONS	If proven effective , the Ministry of Health has committed to scale up the intervention package throughout the country .
BACKGROUND	ISRCTN78892490 .

