A community based cross sectional study was conducted from October to December 2004 in Ayssaita and Dubti towns in Afar Regional state to assess factors affecting utilization of maternal health care services among women during their third trimester of pregnancy and with in 12 months post delivery preceding the survey. Data were collected using a pre-tested and standardized questionnaire in 642 eligible women from four kebeles by clustered random sampling technique. Analysis revealed that close to 80% of the women had at least one prenatal visit during their recent pregnancy. Most of the antenatal care (ANC) attendants made their first visit during their second trimester of pregnancy. Among ANC users 53% of had less than four antenatal care contacts. Majority of deliveries took place at home, of which 93.7% were attended by TBAs. Absences of a health problem, lack of awareness, work overload and distant health service were the main reasons for no ANC attendance. Presence of relatives nearby, more trust on TBAs, lack of privacy, and male professionals assistance during labor at health facilities, were the main reasons cited for resorting to home delivery. Of the total, 45% of the women had knowledge on danger signals of pregnancy and childbirth related health problems. The majorities were able to name the danger signs of pregnancy related health problems. Most of the women neither perceived pregnancy related morbidity nor experienced illness in the recent pregnancy. Bivariant and multivariate analysis showed significant association between ANC attendance and maternal age, occupation, wanted pregnancies, illness experience and perceived susceptibility to dangerous health problems related to pregnancy and childbirth. Education (OR=5.26,95% viii CI=3.12,8.92), religion (OR=2.77,95% CI=1.80,4.27), income (OR=2.59,95% CI=1.55,5.00) and ANC attendance (OR=0.21,95% CI=0.13, 0.35) were associated with choice of delivery site. Orders of pregnancy and husbands’ attitude were found to be strong predictor of both antenatal care and skilled attendance at birth. In conclusion, the study revealed low maternal health care utilization in the area. Demographic and socio cultural factors were found to be barriers to utilization of maternal health care services. Increasing maternal health service coverage and promotion of IEC in the community are recommended. Key words: Maternal health care, antenatal care, preferred place of delivery, Afar Region.