This study examines women's use of pregnancy-related medical care in Brazil and South Africa, two multiracial societies with very different histories of race-related legislation that could affect medical care utilization. The analysis uses nationally representative household-level data to show that inequality in the distribution of socioeconomic resources across racial groups and differences in the sociodemographic conditions surrounding individual pregnancies explain much of the racial difference in women's use of prenatal and delivery care in both countries. Even if these characteristics and resources were equalized across women however, the results suggest that non-White South African women would still be less likely than Whites to initiate prenatal care in the first trimester or to have a doctor present at the time of delivery. The mechanisms through which race works to influence the use of care are examined, and the Brazilian and South African contexts are discussed. These findings suggest that although state-sanctioned racism may help to explain the greater racial inequality in stunting in South Africa than in Brazil, reducing the disadvantage for non-Whites in South Africa and Brazil will depend on reducing fundamental inequalities in the distribution of socioeconomic resources and medical services that characterize many nations.