Background: Skilled birth attendants (SBAs) provide important services that improve maternal and newborn health and reduce maternal and newborn mortality. Utilization and coverage of SBA services reveal wide disparities between the rural and urban areas of Nepal. Aims: This thesis aimed to identify the barriers to SBA service utilization in Nepal and develop and test a community intervention to address those barriers and increase service utilization. Methods: Mixed-methods research was applied to identify barriers to SBA service utilization, followed by an intervention to address those barriers. Status of SBA service utilization and associated factors were investigated using crosssectional surveys in rural settings of mid- and far-western Nepal and in an urban setting in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur, Nepal. The qualitative study explored perceptions of service users and providers regarding barriers to SBA service utilization and suggestions to overcome those barriers. After identifying such barriers, we designed, implemented, and evaluated a five-component community intervention. The intervention was designed as a cluster-randomized controlled trial involving 36 Village Development Committees.