Maternal health services are provided in Pakistan through primary, secondary and tertiary care facilities and utilization for at least one visit is up to 61% in some areas. In most rural areas, however, antenatal coverage is closer to 10% and most of Balochistan Province is rural. This study assesses the provision and utilization of antenatal care (ANC) services and identifies barriers that limit utilization of the Government’s routine ANC services in a tribal community in Jhal Magsi District of Balochistan Province, Pakistan. The study was conducted in the Pattri Union Council of Jhal Magsi District with both qualitative and quantitative methodologies. Eight focus groups were conducted among married women and men separately in the villages of Pattri Union Council and a cross-sectional quantitative survey was conducted among 513 pregnant women aged 18 to 40 years. Only 14.4% of the study respondents ever had received ANC services at a government health facility. Short distance from residence to health facility, high income, less number of parity, any education, any perceived pregnancy related problem and knowledge about ANC were positively associated with ANC (p<0.001) utilization. However attitude toward government health facility showed negative association with such ANC. A multivariable logistic model also showed significant positive association of family income, education, parity, and distance from residence to health facility with accessing ANC services. Attitude showed a negative association. (Knowledge could not be assessed with logistic regression.) Qualitative data also supported quantitative results as most of the male and female respondents revealed low knowledge and negative attitudes towards the ANC services provided at the government health facilities. Comprehensive health promotion and access to health services in the tribal community for routine ANC should be increased and implementation should be more targeted to increase the uptake of routine ANC services. This study suggests that, at the policy level, participation of women and their husbands in maternal health promotion programs that increase awareness will have long-term positive effects on ANC utilization in the Baloch community.