Abstract: The main objective of the study is to examine reproductive history and fertility preferences along with respondents’ perceptions about ideal family composition, concept of small and large family. 360 women aged 25-45 years with at least one living child residing in the rural areas of three major districts of the Punjab province Lahore, Rawalpindi and Multan were interviewed. It emerged from the study findings that conceiving more than 6 or 7 times is a normal behavior of women in the selected area. Desire for additional children reflects the existence of a preference for sons in the society. The respondents’ had no clear concept regarding small and large families as promoting by the Government of Pakistan. It is concluded that women’s health is at great risk due to the closely spaced repeated pregnancies, which they deliver, in unsafe environment under the supervision of traditional birth attendants. Attitudinal change regarding family size is a pre-requisite for the effective and efficient implementations of the family planning programme in the country.