The objective of the study is to identify racial disparities in prenatal care (PNC) utilization and to examine the relationship between PNC and preterm birth (PTB), low birth weight (LBW) and infant mortality in Mississippi. Retrospective cohort from 1996 to 2003 linked Mississippi birth and infant death files was used. Analysis was limited to live-born singleton infants born to non-Hispanic white and black women (n = 292,776). PNC was classified by Kotelchuck's Adequacy of Prenatal Care Utilization Index. Factors associated with PTB, LBW and infant death were identified using multiple logistic regression after controlling for maternal age, education, marital status, place of residence, tobacco use and medical risk. About one in five Mississippi women had less than adequate PNC, and racial disparities in PNC utilization were observed. Black women delayed PNC, received too few visits, and were more likely to have either "inadequate PNC" (P < 0.0001) or "no care" (P < 0.0001) compared to white women. Furthermore, among women with medical conditions, black women were twice as likely to receive inadequate PNC compared to white women. Regardless of race, "no care" and "inadequate PNC" were strong risk factors for PTB, LBW and infant death. We provide empirical evidence to support the existence of racial disparities in PNC utilization and infant birth outcomes in Mississippi. Further study is needed to explain racial differences in PNC utilization. However, this study suggests that public health interventions designed to improve PNC utilization among women might reduce unfavorable birth outcomes especially infant mortality.