Women who proceed with an unapproved pregnancy are known to be reluctant to use antenatal and obstetric services because they fear they will face pressure to have an abortion or fines for violating the one-child policy. Many deliveries of babies that have not been officially sanctioned occur at home without trained personnel, a practice that is associated with the risk of maternal or neonatal mortality. A study carried out in rural Sichuan province in 1990 reported a doubling of maternal deaths for unapproved pregnancies as compared with those receiving government sanction.