A community based cross sectional study was conducted from October to December 2004 inrnAyssaita and Dubti towns in Afar Regional state to assess factors affecting utilization of maternalrnhealth care services among women during their third trimester of pregnancy and with in 12rnmonths post delivery preceding the survey. Data were collected using a pre-tested andrnstandardized questionnaire in 642 eligible women from four kebeles by clustered randomrnsampling technique.rnAnalysis revealed that close to 80% of the women had at least one prenatal visit during theirrnrecent pregnancy. Most of the antenatal care (ANC) attendants made their first visit during theirrnsecond trimester of pregnancy. Among ANC users 53% of had less than four antenatal carerncontacts. Majority of deliveries took place at home, of which 93.7% were attended by TBAs.rnAbsences of a health problem, lack of awareness, work overload and distant health service werernthe main reasons for no ANC attendance. Presence of relatives nearby, more trust on TBAs, lackrnof privacy, and male professionals assistance during labor at health facilities, were the mainrnreasons cited for resorting to home delivery. Of the total, 45% of the women had knowledge onrndanger signals of pregnancy and childbirth related health problems. The majorities were able tornname the danger signs of pregnancy related health problems. Most of the women neitherrnperceived pregnancy related morbidity nor experienced illness in the recent pregnancy.rnBivariant and multivariate analysis showed significant association between ANC attendance andrnmaternal age, occupation, wanted pregnancies, illness experience and perceived susceptibility torndangerous health problems related to pregnancy and childbirth. Education (OR=5.26,95%rnviiirnCI=3.12,8.92), religion (OR=2.77,95% CI=1.80,4.27), income (OR=2.59,95% CI=1.55,5.00) andrnANC attendance (OR=0.21,95% CI=0.13, 0.35) were associated with choice of delivery site.rnOrders of pregnancy and husbandsâ€™ attitude were found to be strong predictor of both antenatalrncare and skilled attendance at birth.rnIn conclusion, the study revealed low maternal health care utilization in the area. Demographicrnand socio cultural factors were found to be barriers to utilization of maternal health care services.rnIncreasing maternal health service coverage and promotion of IEC in the community arernrecommended.rnKey words: Maternal health care, antenatal care, preferred place of delivery, Afar Region.