The attitudes of a sample of 800 urban and 400 rural women towards pregnancy services and delivery care in Sindh province, Pakistan, were surveyed. The sample consisted of predominantly poor and illiterate women of reproductive age. Generally little access to quality institutional care services existed in the rural areas. Most rural women delivered at home using the services of the traditional midwife, the dai. Concern for costs and convenience was found to be coupled with a high degree of trust in the services of the dai. In the urban setting preference for the dais' services was likewise expressed, but the hospital was considered the safest place for delivery by the majority of respondents. The quality of the services rendered by all occupational groups was considered highly, in particular those of the traditional dais. The absence of trained doctors in the rural areas is noted and changes to increase their availability and services are proposed.
PIP: The attitudes of 800 urban women and 400 rural women towards pregnancy services and delivery care in Sindh province, Pakistan, were surveyed in an effort to improve the knowledge base for decision making in maternal health policy. The participants were largely poor, illiterate, and of reproductive age. In the rural context of only minimal access to quality institutional care services, most rural women delivered at home with the aid of traditional birth attendants (TBA). The decision to deliver at home was reached by a combination of women's high degree of trust in the services of TBAs and their concern about costs and convenience. There was also a preference for the TBAs' services in urban areas, but the hospital was considered the safest place for delivery by the majority of respondents. Quality of care was a major concern among study participants. The absence of trained doctors in rural areas is noted and changes to increase their availability and services are proposed.