The present study describes the use of a home-based antenatal card in a sample of 120 consecutive women who were giving birth at a large teaching hospital in the city of León, Nicaragua. Information was obtained by interviews with the women before leaving hospital and all data on their antenatal cards and regarding delivery outcome were analysed. Antenatal care attendance by the 120 women was 93 per cent, and 86 per cent had received an antenatal card. However, only in 33 per cent of the cases had the card been adequately used: inappropriate handling in hospital was the commonest cause of non-use. Suggestions for a revision of the card are presented in the companion article, in which we also stress the importance of continuous training of the health personnel.