This paper presents findings from the application of a framework for assessing the quality of care of institutional maternity services in an urban slum in India. The framework divides quality into two parts: the quality of users' experience of care and the quality of the provision of care. Data from public and private hospitals were collected via observation, exit interviews, provider interviews, review of hospital records, the mystery client approach and a household survey of 650 women in the immediate vicinity of the case study hospitals. Findings provide evidence that quality is far from optimal in both public and private facilities. Problems identified included a lack of essential drugs, women being left unsupported, evidence of physical and verbal abuse, and births occurring in hospitals without a health professional in attendance. The paper concludes that while many governments have explicit targets to increase institutional deliveries, many do not have explicit targets or even a commitment to assess and improve the quality of institutional services for childbirth.