In this study the changes in attitude of midwives towards their work following completion of the Maternal Care Manual of the Perinatal Education Programme (PEP), were determined. A prospective, controlled trial was performed in a study, and two control towns in a region where PEP had not previously been used. All midwives caring for pregnant women in the three towns were included in the study. First the attitude of these midwives was determined by means of a questionnaire. Subsequent to this, the Maternal Care Manual was introduced and studied by the midwives in the study town. Following the completion of the Manual after 12 months, the attitude of all midwives was again evaluated using the same questionnaire. A total of 40 midwives in the study town and 53 in the two control towns were included in the study. There were no differences on comparing the ages of the midwives in the study town to those in the control towns. The attitude of the midwives in the study town improved significantly (p < 0.001). The mean result in the study town improved by 6.1 (24.4%) marks from 14.5 (58.0%) to 20.6 (82.4%). A significant shift also occurred in the range of the marks from 0-25 to 13-25. No changes were observed in the control towns. Most studies that have evaluated educational programmes measured improvement in health services, and did not evaluate changes in attitude. This study found that the attitude of midwives improved significantly in the study town. This positive attitude of midwives towards their work and their ability to perform their daily tasks must be an important component of any programme to improve the quality of care rendered to women during pregnancy, labour and the puerperium.