Information on women's use of antenatal clinic (ANC) service, including malaria prevention and treatment during pregnancy, was collected during a national malaria knowledge, attitudes, and practices survey in Malawi. Among 1531 households, 809 (53%) included a woman who had carried a pregnancy past the second trimester within the past 5 years. Of these, 756 (93%) women reported at least one ANC visit during pregnancy (median= 4); 336 (42%) attended 5 or more times. Approximately half (51%) reported delivering in a hospital; 5% delivered in a clinic; 13% delivered at home with a trained birth attendant; and 28% delivered at home with only family attending. Women at increased risk for delivery complications (eg primigravidas and grand multigravidas) were no more likely to attend ANC or deliver in hospital than women without increased risk. The woman's level of education was the only significant predictor of initiating ANC care, continued ANC attendance, and delivery in hospital. In a setting where 43% of women pregnant within the past 5 years had received no formal education and 70% had completed less than 5 years, this survey identified a critical need for targeting health messages towards poorly educated women to ensure proper utilization of antenatal care services, including coverage with malaria prevention throughout pregnancy.