Antenatal care is now universally accepted as an essential part of obstetric care and most health authorities in developing countries are trying to offer this service to their populations. This study, part of the Nairobi Birth Survey, looks into the pattern and distribution of antenatal care in the City of Nairobi, particularly to assess the quality and appropriateness of the service. 96.4% of women attended antenatal clinic at least once, the majority (74.7%) being looked after at health center level. There was an overrepresentation of young, single, primigravidae who had received little formal education in the group that received no antenatal care. The quality of care varied from clinic to clinic but on the whole there was a tendency either not to do certain important investigations or failure to obtain the results in the cases where the tests were requested. Nearly 60% of the antenatal women had height between 155 cm and 164 cm, 2.7% had positive tests for syphilis, 10.5% were anemic and 10.3% were hypertensive. The perinatal mortality rate in the group that did not have antenatal care was found to be 4.8 times greater than that in the group that received antenatal care. 1 way of facilitating detection of risk factors is by designing an appropriate record card. An example of such a card has been successfully tested in rural areas of Kenya. The quality of antenatal care can be assessed by maternal height, blood pressure, blood group, hemoglobin, serological test for syphilis and urine examination for protein and sugar. Private doctor antenatal care tended to be inferior to hospital care. Just under 20% of the women were under 20 years old while 44% were 35 and over. A comparatively larger proportion of adolescents did not receive antenatal care. Primigravida and highly parous mothers are also classified as high risk cases. Nearly 15% of the mothers were single and showed a marked tendency for lack of antenatal care and health care center utilization. Anemia existed in 10.5% of a sample of 789 women. ...