MCur / Department of Advanced Nursing Science / Background: Perinatal and neonatal mortality rates remain high in South Africa especially in rural areas and townships where the majority of poor people live. With regard to perinatal and neonatal mortality, South Africa like many other developing countries has failed to achieve MDG 4 and 5 by 2015 regardless of many efforts by the governments. To achieve the SDG which replaced MDGs for child health, it is necessary for the South African public and private health care to reduce substantially perinatal and new born deaths, particularly in rural areas. There are many factors that contribute to a high perinatal mortality rate in public hospitals in rural areas. To understand these factors, a study was conducted with midwives from selected public hospitals in Limpopo, Vhembe district which experiences the highest perinatal mortality rates in South Africa. Purpose and methodology: The purpose of this research study was to assess factors contributing to high perinatal mortality rates in the selected public hospitals in Vhembe district. A quantitative, descriptive, exploratory and cross-sectional design was used to collect data from the sampled hospitals in the Vhembe district. Hospitals were purposively sampled based on the statistics of monthly deliveries. The target population consisted of all registered midwives who had been working in the maternity units for at least two years. Cochrane's formula was used to determine the sample from the target population for each hospital. A random sample of 110 respondents was selected upon which a questionnaire was administered to each by the researcher. Responses from the close-ended and open-ended questions was grouped and analysed quantitatively by means of Statistical Package for Social Sciences 23.0 (SPSS). Results and findings: Results were presented in frequency tables and graphs revealed that most of the midwives lacked knowledge and skills in a number of key areas needed for them to operate efficiently in the maternity wards. There was also high staff turnover which led to a few midwives being overworked. The utilisation of guidelines and protocols in maternity was left to individual midwives as the hospitals did not evaluate the use of it. Conclusions: Lack of key skills in assisting women in labour, and poor use of guidelines and understaffing were the main contributing factors to high perinatal mortality rates in the selected public hospitals of Vhembe district. Midwife attitudes were not a contributory factor. / NRF