Maternal mortality remains exceptionally high in Papua New Guinea (PNG) at 733 per 100,000 live births. There has been little, if any, improvement in maternal mortality or maternity services since the 1980s. In 1992-1993 a survey of 550 women in rural coastal areas of Madang Province was undertaken to investigate the prevalence of maternal risk factors and parous women's utilization of and attitudes towards the existing health services. Women were classified as at risk on the basis of previous obstetric complications, parity, stillbirths and neonatal deaths. On this basis 67% of women were classified as being at risk in a future pregnancy. High rates of obstetric complications were reported, with only 42% of women delivering their most recent child in a health facility. There was no statistical difference between those not at risk and those at risk in terms of their use of antenatal care or having been referred for a health centre delivery. The most common reason given for not utilizing the existing health services was lack of access. Most commonly expressed positive perceptions of a health centre delivery were the availability of medical help (59%) and the physical comfort of the health centre (48%). Most common negative views expressed were lack of physical comfort (29%) and the attitudes of staff (11%). Women's opinion on village births was divided. Many (47%) thought that there was nothing good about a village birth and the same percentage cited lack of medical care if problems arose. On the other hand 36% of women thought there was nothing wrong with a village delivery, and 30% cited the care and respect received from relatives as a positive aspect. When asked for suggestions on how services could be improved only a minority of respondents expressed an opinion. Those who did wanted better access, more information on family planning and improved care and respect from staff.