OBJECTIVES: To conduct an holistic economic evaluation of an Aboriginal community (Daruk)-controlled midwifery service in Western Sydney. METHODS: The study estimated direct programme costs and downstream savings to the health sector. Measures of antenatal attendance and perinatal outcome were compared between Aboriginal women with and without experiences of the antenatal programme through examination of antenatal clinic records and the New South Wales Midwives Data Collection for the period 1991-1996. Qualitative outcomes were analysed through interviews and focus groups. RESULTS: The net cost to the health sector was estimated to be $A1200 per client. Compared with Aboriginal women who received antenatal care in two conventional settings, there were no statistically significant differences in birthweight and perinatal survival. Gestational age at first visit was lower (17.2 vs 21.2 and 19.9 weeks), mean number of antenatal visits was higher (10.5 vs 5.5 and 9.5) and attendance for routine antenatal tests was better (94% vs 71% and 84%). Aboriginal clients were strongly positive about their experience of the Daruk service in terms of relationship and trust, accessibility, flexibility, provision of clear and appropriate information, continuity of care, empowerment and family-centred care. CONCLUSIONS: Net per client costs to the health service were modest. Quantitative evidence of improved antenatal outcomes was limited, but qualitative evaluation suggested the service was strongly valued. The outcomes examined in this study were broader than those used in conventional forms of economic evaluation and this enabled identification and analysis of more diverse sources of value from this programme.