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Background: Institutional delivery is an important factor in reducing maternal and neonatal mortality in developing countries. Antenatal care is an opportunity to promote the benefits of skilled birth attendance. However, there was no systematically reviewed evidence about the effect of antenatal care utilisation on institutional delivery in developing countries so far.Aim: The aim of this review was to systematically search, appraise, and synthesise the available evidence on the effect of antenatal care utilisation on institutional delivery in developing countries.Inclusion criteria: Types of Participants; Women in developing countries between 15-49 years of age, who have had at least one birth in a health care institution. Types of intervention; Antenatal care visits according to World Health Organisation recommendations. Types of outcomes; Maternal outcomes such as proportion of women who gave birth in a health care institution and Proportion of women who develop any complications associated with pregnancy. Types of studies; Quantitative studies conducted in developing countries with cross sectional, case -control or cohort, experimental or quasi experimental study designs. Search strategy; A search for published and unpublished studies in English language was undertaken restricted by from a publication date of January 1990 to December 2010.Methodological quality: all papers selected for potential inclusion in the review were subjected to a rigorous, independent appraisal by two critical reviewers using the standard Joanna Briggs Institute tools.Data collection and analysis: Information was extracted and analysed using Revman software.Results: This review revealed that those women who had antenatal care visits were almost eight times more likely to deliver in health institutions than those women who had no antenatal care visits (Odds Ratio=7.70, 95% Confidence Interval=7.02-8.43). It also revealed that antenatal care visits reduces the risk of developing pregnancy complications by 25% (Odds Ratio=0.75, 95% Confidence Interval=0.61-0.91).Conclusions and Recommendations: There was a clear and firm consensus in the identified articles regarding the effect of antenatal care for promoting institutional delivery and reducing pregnancy complications. Further studies to determine causal relationship between institutional delivery and other socioeconomic factors, in line with antenatal careutilisation, are warranted.