Nearly 600,000 women die each year due to pregnancy-related causes. Over 99 percent of these women live in developing countries (WHO and UNICEF, 1996). An additional 50 million women in developing countries experience a pregnancy-related complication each year (NRC, 1997). These numbers reflect huge differences in maternal morbidity and mortality between developing and industrialized countries, with rates in the former countries reaching values 100 times as large as those in the latter (Walsh et al., 1993). Leedham (1985) estimates that between 60 and 80 percent of births in developing countries are attended by midwives or traditional birth attendants, who are frequently the primary or sole providers of maternal health care (Levitt and Minden, 1995). More recent estimates indicate that about half of births in the developing world are attended by a person with no formal or professional training (WHO, 1997). Most women in these countries do not have access to and cannot afford obstetrical care. The purpose of this report is to describe and evaluate pregnancy-related care in Guatemala.% Guatemala has among the highest maternal and infant mortality rates in Latin America. According to the most recent estimates, the infant mortality rate in Guatemala is 43 deaths per 1,000 live births and the maternal mortality rate is 190 deaths per 100,000 live births (World Bank, 1999). Postpartum hemorrhage is the most common cause of maternal mortality (24%), followed by retained placenta (15%) and septicemia (11%) (OPS-OMS, forthcoming). Rates are even higher in the rural areas, where the majority of the population lives. For example, estimates from the 1996 Demographic Health Survey reveal an infant mortality rate of 56 per 1000 in rural areas compared to only 41 per 1000 in urban areas, for the first half of the 1990s (INE et al., 1996)