Background: The quality of health services has been known to be grossly deficient in developing countries, but only few studies were carried out to document the deficiencies in a systematic manner. Objective: To assess the quality of reproductive health services in rural settings with emphasis on the structural aspect. Methods: This is a descriptive cross-sectional study conducted in the peripheral health institutions of two administrative zones in South-Central Ethiopia. Data were collected using an interview questionnaire and observation checklist adopted from the WHO Safe Motherhood Need Assessment and the WHO training modules for EPI and STDs. Findings: Multiple structural deficiencies were identified in all components of reproductive health care. Adequate amounts of the absolute minimum equipment required for maternity and neonatal care were not available in many health institutions. Sterilizers were available in 11(15.3%), essential drugs like iron tablets in 14 (19.4%), and ergometrine injection in 48 (66.7%) of the health institution. In the EPI section, refrigerator was available in 57(79.2%) and steam sterilizer in 43(59.7%) of the institutions. Mix of contraceptives was not available widely. Important laboratory tests like syphilis test, were available in only one (1.4%) health institution. Only 8(11.1%) health institutions had adequate IEC materials on all national reproductive health components. Conclusion: Structural settings for reproductive health services are very poorly organized in the majority of the health institutions. Thus, strong emphasis should be given to strengthen the existing health institutions by correcting structural deficiencies besides building new institution that are needed to expand health services.