BACKGROUND AND OBJECTIVE: Prenatal care is an important strategy for achieving reproductive health. Despite the importance of maternity care in maternal health, some mothers are not adequately cared for. The aim of this study was to determine the factors affecting the Adequacy of Prenatal Care Utilization (APNCU) Index in the first level of network system in Iran. METHODS: This cross-sectional study was conducted in six provinces of Iran in 2016. Mothers whose date of delivery was 2-6 months

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... ore the study were randomly selected. Data were collected using a researcher-made checklist and questionnaire containing 34 personal, family-related and environmental questions and 23 prenatal care-related questions based on health records and interviews with mothers and samples were divided into four groups according to the Adequacy of Prenatal Care Utilization index: 1: inadequate (less than 50% of expected care), 2: intermediate (50-79%), 3: adequate (80-109%), 4: adequate plus (110% and more), and the results were analyzed. FINDINGS: Among 2655 studied mothers, the mean of total care during pregnancy was 6.43±1.7 times and according to the Adequacy of Prenatal Care Utilization index, 121 (4.6%) mothers had inadequate care, 603 (22.7%) mothers had intermediate, 1648 (62.1%) mothers had adequate and 283 (10.7%) mothers had adequate plus care. There was a significant relationship between the risk of maternal mortality in each province, urban population, prenatal care, time of first pregnancy care, maternal age, spouse s participation and education level, and adequacy of prenatal care (p<0.05). CONCLUSION: This study showed that the adequacy of prenatal care, although influenced by social and personal factors, is at an appropriate level.