Pakistan: consumer satisfaction and dissatisfaction with maternal and child health services.

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.