Khotang is located in the Sagarmatha Zone of Northeastern Nepal. This is a hilly region with very limited access to any road or any infrastructure. The district covers an area of 614 sq mi / 1,591 sq km and has a population of 206,312, with 5,000 pregnancies per year. Khotang is part of the area traditionally called Majh Kirat/Kirant, home to indigenous ethnic Kirat Rai peope. Apart from Rais, other ethnic groups and hill castes live in Khotang. The rate of childbirth with a skilled birth attendant, the single most effective intervention to reduce maternal mortality, is less than 25%. Most facilities lack power, running water and are under-staffed. Estimates of maternal and neonatal mortality are twice the national average.