J HEALTH POPUL NUTR 2003 Dec;21(4):367-373 © 2003 ICDDR,B: Centre for Health and Population Research ISSN 1606-0997 $ 5.00+0.20 Correspondence and reprint requests should be addressed to: Siri Wood Program for Appropriate Technology in Health 1455 NW Leary Way Seattle, WA 98107 USA Email: swood@path.org Fax: 206-285-6619 Acceptability and Use of Clean Home Delivery Kits in Nepal: A Qualitative Study Monique H. Beun 1 and Siri K. Wood 2 1 Independent Research Consultant based in Kathmandu, Nepal and 2 Program for Appropriate Technology in Health, Seattle, WA 98107, USA ABSTRACT This research was carried out in rural Nepal to explore how different categories of birth attendants at home deliveries accepted and used clean home delivery kit (CHDK) and its contents, including hand-washing practices, during delivery and preparations for birth. In-depth interviews were conducted to collect information from 51 women––both users and non-users of the kit. The respondents were interviewed within one month of their most recent delivery. Results of the interviews showed that the attendants who used the kit perceived it as hygienic and convenient, affordable, and culturally acceptable. The razor blade and thread were the most useful items, and the purpose of the plastic coin was understood. Despite its perceived usefulness, awareness and use of the kit were low, and common reasons for non-use included not knowing about the kit or difficulty in procuring a kit locally. In addition, the kit had limited influence on general hygiene practices. The authors explore the importance of evaluating promotional efforts re-targeted to individuals who hold decision-making power regarding the use of the kit. They recommend that kit promoters emphasize hand-washing and single use of the kit. Key words: Delivery; Safe motherhood; Delivery kit; Traditional birth attendants; Midwifery; Hygiene; Nepal INTRODUCTION Tetanus and sepsis, which result primarily from unhygienic deliveries and lack of clean birth implements, are two of the leading causes of maternal and neonatal deaths and illness in Nepal (1). In Nepal, an estimated 90% of births occur at home and are attended by people with little or no training (1). Due to lack of hygienic precautions during births at home, infants of women delivering alone, or those attended by family members or untrained traditional birth attendants (TBA) are at particular risk of infection. International agencies have identified clean delivery education programmes and the presence of skilled attendants at birth as priorities to improve maternal health worldwide (2). The clean delivery kit is one component of integrated safe motherhood programmes that contributes to a hygienic birthing environment. When introduced as part of maternal and neonatal health programmes, it provides a convenient source of clean birth supplies and may reduce rates of sepsis and cord infection. Kits come in various forms and can be produced locally, nationally, or ordered through United Nations agencies. They are most often used by mothers, TBAs, midwives, and occasional birth attendants such as relatives (2). To address the problem of unhygienic delivery practices and high perinatal infection in Nepal, Maternal and Child Health Products, Ltd. (MCHP) developed a disposable clean delivery kit. Since 1994, MCHP has produced and sold more than 500,000 kits in Nepal. The clean home delivery kit (CHDK), known as Sutkeri Samagri in Nepal, provides materials that ensure a clean delivery surface (plastic sheet), a clean cutting instrument (new razor blade and plastic disc to cut on), clean ties for the cord (cord ties), and clean hands for the birth attendant (soap). The kit is accompanied with a pictorial