Dissertation (MSc Midwifery)Antenatal care services are amongst of determinants of maternal anemia during pregnancy. Maternal anemia is rated as a first indirect cause of maternal and neonatal death. This accounts for 50% of all pregnant women with inadequate ANC services utilization due to the lack of getting iron supplements during pregnancy. This study intended to assess the influence of ANC services utilization on prevention of anemia and its associated obstetric immediate outcomes among pregnant women at term in Magu District, Mwanza Region. The study was a hospital based analytical cross-sectional that involved 342 pregnant women who were selected using systematic sampling and it was conducted in Magu District. Structured questionnaires were used to collect data, and SPSS version 20 was used for data analysis. Descriptive statistics and inferential statistics were used for analysis. Results were presented in forms of tables and figures. Of all 342 participants, 214(63%) had low hemoglobin. 304(88.9%) pregnant women had late ANC. ANC services were found to be inadequate utilized for instance, hemoglobin screening was 36.3%, malaria screening was 17.8%and stool analysis for worm infestation were 14.3%. After adjusting for confounders, the study found that those who were not using anti-worms during pregnancy (AOR 2.257; 95% CI: 1.151-4.423, p value = 0.018) yet this was the sole predictor for anemia in pregnancy at term. Moreover, multiparity (AOR 0.405; 95%CI: 0.219-4.115; P= 0.004), grand-multiparity (AOR 0.382, CI 95%: 0.154 -0.946; P=0.038) and self-employment (AOR 4.505, CI: 95% 1.476 -13.750; P= 0.008) were the predictors for ANC services utilization. The prevalence of anemia in pregnancy at term was found to be significantly high. ANC booking was also inadequate though ANC visits coverage was adequate. The study further found that, ANC service provision was underutilized. Therefore, efforts should be done to ensure that anemia in pregnancy eliminated.