Background: Maternal, newborn and child health (MNCH) status in tea garden communities of Bangladesh is neglected and poor compared to many other areas in Bangladesh. Community health need assessments of maternal and neonatal health (MNH) services are important to identify the necessary interventions to improve MNH services in a community. Identifying and prioritizing health needs are two of the most essential community-centric activities where each community can set their own priorities and areas of focus. Objectives: The current need assessment is designed to identify all needs and gaps along with assessing program effort in increasing the quality, coverage, and utilization of MNH services as well as insuring there is a critical support system placed at each of the referral levels. Methods: A qualitative study was conducted in the Moulvibazar district of Bangladesh. 20 in-depth interviews (IDIs) were conducted among different groups of people including civil surgeons, the Deputy Commissioner of Moulvibazar, the General Secretary of the Bangladesh Tea Labour Union of Sreemangal, the Finance Secretary of the Bangladesh Tea Estate Staff Association of Sreemangal, the Coordinator of the Bangladesh Tea Board of Sreemangal, community leaders, pregnant mothers, Panchayat committee members, traditional birth attendants and health care providers of the selected tea gardens. Results: Tea garden communities have lack knowledge and awareness of MNCH issues as well as a gap in utilizing related services. Reasons for not seeking proper health care services were lower socio-economic status, traditional myth and superstitions, dependency on traditional birth attendants and negligence on seeking appropriate MNH services. Policy makers need to place more emphasis on MNH related interventions in marginalized communities, specifically in tea garden areas.