One way of reducing maternal mortality in developing countries is to ensure that women have a referral
system at the local level that includes access to emergency obstetric care. Using a 13-month ethnographic
study from 2003 to 2005 of women’s social positions and maternal health in a semi-urban
community of Hindu-caste women in the Kathmandu Valley, this paper identifies impediments to
receiving obstetric care in a context where the infrastructure and services are in place. As birth in Nepal
predominantly takes place at home, this paper identifies the following areas for potential improvement
in order to avoid the loss of women’s lives during childbirth: the frequency of giving birth unaided,
minimal planning for birth or obstetric complications, and delayed responses at the household level to
obstetric emergencies. Focusing particularly on the last item, this study concludes that women do not
have the power to demand biomedical services or emergency care, and men still viewed birth as the
domain of women and remained mostly uninvolved in the process. As the cultural construction of birth
shifts from a “natural” phenomenon that did not require human regulation toward one that is located
within the domain of biomedical expertise and control, local acceptance of a biomedical model does not
necessarily lead to the utilization of services if neither women nor men are in a culturally-defined
position to act.