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Volume 32, Number 1, March 2006 Maternal mortality in Nepal is estimated to be around 540 deaths per 100,000 births.1 One major factor is low use of maternal health care, despite government efforts to improve services, including an expanded network of rural clinics and the training of auxiliary nurse midwives.2 Fewer than 40% of women receive any antenatal care from a trained provider, and fewer than 10% of births take place in a health facility.3 In seeking to explain these low levels of health care use, most research has focused on the provision and geographic accessibility of services. However, no studies have looked at how sociocultural factors, such as inequitable gender roles and women’s position within the household, have influenced use of services. Earlier work in South Asia has suggested various ways in which gender roles and relations may operate to restrict women’s access to health care during pregnancy and at the time of delivery. These include heightened restrictions on women’s movement because the pregnant state is considered “shameful,” young women’s lack of say within the family and the fact that pregnancy-related knowledge and decision-making authority are commonly vested in older women, young women’s lack of influence over material resources, and the exclusion of men, who are often the primary decision makers in the use of material resources, from the “polluting” event of childbirth.4 In addition, a growing body of literature has explored the links between indicators of women’s household position and contraceptive use in South Asia.5 However, little of this research has examined whether and how dimensions of women’s position are related to their use of maternal health care services. It is widely asserted that increased gender equality is a prerequisite for achieving improvements in maternal health. The Programme of Action adopted at the 1994 International Conference on Population and Development claimed that “improving the status of women also enhances their decision-making capacity at all levels in all spheres of life, especially in the area of sexuality and reproduction.”6 In Nepal, the low social status of women has been identified as a hindrance to progress toward national health and population policy targets.7 Although it seems reasonable to assume that greater equality within the household leads to higher use of maternal health care services, this factor has not been explored for Nepal. We know little about how intrahousehold relations constrain or facilitate access to health care, or about the dimensions of women’s position that are most critical for achieving increased use. In this study, we examine the influence of four indicators of women’s household position on the receipt of skilled antenatal and delivery care: their involvement in decision making about their own health care and about large houseWomen’s Position Within the Household as a Determinant Of Maternal Health Care Use in Nepal