Skin-to-skin contact (STSC) for low birth weight newborns in community settings may greatly improve survival, especially where access to health facilities is limited. Community STSC has been implemented in large-scale trials in Asia and is recommended by WHO and UNICEF. In countries where the practice is entirely new, such as Ghana, STSC may need special educational approaches. OBJECTIVE: The dual aims of this study were to understand the acceptance and barriers to STSC in an African community setting and to use in-depth formative research to contribute to the success of a behavior-based health intervention. DESIGN: A rapid qualitative study with an intentionally small sample. SETTING: Kintampo, Ghana, a predominately rural, agrarian area in the center of the country with diverse ethnic groups in a forest-savannah transition zone. METHOD: Key informants were consulted through in-depth interviews and focus group discussions to develop the pilot. Five mothers participated in pilot instruction (four refused), which included counseling and used a trials-of-improved-practices methodology; data from group discussion with traditional birth attendants were also included. RESULTS: It was difficult to overcome barriers to the practice (post partum pain, fear of harming the umbilicus), and less intractable barriers (traditional carrying practices, fear of causing harm, lack of back support, time constraints, breast feeding issues) were reported. CONCLUSION: Some study participants tried STSC but none did it continuously. As promotion of STSC could be vital for improving newborn survival in low resource settings, tackling perceived barriers may be an important way to increase acceptability of this practice.