Background: Pregnancy complications are preventable with appropriate antenatal care (ANC). However, ANC attendance recommendations vary. Objective: This study investigated ANC practices and predictors of ANC visits among pregnant women in western Jamaica during 2010. Methods: A cross-sectional study was conducted among 356 pregnant women. ANC visits were categorized as not meeting recommendations (<4 ANC visits), meeting WHO and the Jamaican Ministry of Health recommendations of a minimum of 4 ANC visits (4-6 ANC visits) or meeting previously standard recommendation of ≥7 visits. Differences in demographic factors, health status, ANC services received and ANC knowledge by ANC attendance were assessed and a multinomial forward-selection stepwise logistic regression model was used to identify predictors of ANC attendance. Results: Most women had an adequate number of ANC visits with 53.4% attending ≥ 7 ANC visits and 27.2% attending 4-6 visits. Despite this, 19.4% of the women had inadequate ANC care and a large portion did not receive key ANC services such as folic acid supplementation (48%), information on breastfeeding (32%) and nutrition (13%). Employment status, number of live births, distance from clinic, history of diabetes or hypertension, possession of ANC card at delivery, receiving iron supplementation and HIV counseling and testing and antenatal care knowledge were predictors of ANC visits. Conclusion: Although most women met the WHO or Jamaican ANC recommendations, many women still did not receive key ANC services. Further investigation of ANC practices and a standardized ANC curriculum may improve provision of adequate ANC services.