Purpose - The paper seeks to identify key features of prenatal care utilization and quality in western regions of China and to determine the factors affecting the quality of prenatal care. Design/methodology/approach - A descriptive, cross-sectional study was conducted. The instrument for the study was a 10-stem respondent-administered, structured questionnaire, designed in Chinese, composed of two segments: general information on infants who were under two years old; and their mothers. The authors determined the quality (both amount and content) of prenatal care using recommendations made by UNICEF and the Chinese Ministry of Health (MOH) jointly for rural areas of China. Findings - The median number of prenatal visits was three and rate of first trimester visits was 53.6 per cent (n=1,474). Over three quarters (75.3 per cent) of respondents had fewer than five prenatal visits, with this proportion highest in Gansu (95.8 per cent) and lowest in Shanxi (55.4 per cent) provinces. The percentage of women who received qualitatively adequate prenatal care services was only 1.8 per cent. No respondents in Gansu received a completely correct prenatal test, while this rate was 4.0 per cent in Shanxi and 0.2 per cent in Sichuan. Mothers' age (p=0.05), level of educational attainment (p=0.07) and place of prenatal care (p=0.01) were related to the quality of care. Originality/value - The prenatal care utilization among women in western regions of China is not adequate. Those women who have received prenatal care seldom receive qualitatively adequate prenatal care services, according to national standards. This situation clearly requires urgent attention and improvement.