Introduction: user’s perception of quality of ANC services crucially impacts continuity of use of these services and hence pregnancy outcome. However in our community, ANC user’s perceptions of quality are not known.

Methods: an observational analytic cross-sectional study was carried out amongst pregnant women attending selected government health centres in the Buea Health District. We recruited 385 consenting pregnant women for the study. Demographic and clinical data were collected using structured questionnaires. The data was entered into Microsoft Excel and exported toEpi-Info (Version 3.5.1) for analysis.

Results: geographical accessibility and perceived quality of care were the predominant reasons for choosing or changing a site for ANC. One third of respondents (30.1%) attended a health centre out of their catchment health area with Buea Town health centre receiving the highest proportion of women out of the health area (56.8% of attendees). Knowledge about antenatal care varied and majority of respondents (96.4%) were satisfied with the antenatal services received. However, there were elements of dissatisfaction with health centre services, poor sitting facilities, amenities, few health education talks and poor nursing skills. High educational level (high school and university) (X² = 8.714; p = 0.01) and first time pregnancy(X²= 4.217; p= 0.04) were significantly associated with poor satisfaction.

Conclusion: policy makers should implement changes in the health care delivery system taking into account the users’ preferences, more so in the light of increasing female education in Cameroon.