Dissertation (MSc Midwifery)Background: Unacceptable high maternal mortality rates remain a major challenge in many low income countries. Early detection and management of antenatal risk factors are critical for improved maternal and infant outcomes. The aim of this study was to test the effectiveness of the interactive messaging alert system in improving knowledge of obstetric danger signs, Antenatal care service utilization, individual birth preparedness and complication readiness (IBPACR) among pregnant women in Dodoma Municipal Methods: A quantitative quasi-experimental study with control was carried. Random selection of participants was employed to achieve a sample size of 450 pregnant women (Intervention=150 and Control=300). Interventions were matched to controls by gravidity and gestational age at a ratio of 1:2.The intervention group was enrolled in an interactive messaging alert system and received health education messages. The control group continued with the standard ANC services being offered in local clinics. A standard semi-structure questionnaire was used to collect baseline and post intervention data and analyzed by using SPSS software for both descriptive and inferential statistics. Results: The mean age of participants was 25.6 years with a range of 16 to 48 years. The mean scores in the post intervention between groups for knowledge on danger signs were (M=9.531,SD=2.666) in the intervention and (M=6.518,SD=4.304) for control and p<0.001 with the effect size of 85%. For IBPACR (M=4.165,SD=1.365) for intervention and (M=2.631,SD=1.775) control and p<0.001 with the effect size of 90% . For ANC utilization (M=2.77, SD=0.420) for intervention and (M=2.58,SD=0.495) for control and p<0.001 the effect size of 41.4% .Participants with college/university level of education, showed a significant improvement in knowledge, IBPACR and ANC utilization with p<0 .001 compared to lower levels. Conclusion: Interactive message alert system demonstrated to be effective in improving knowledge on obstetric and newborn danger signs, IBPACR and ANC service utilization in low resource settings