Objective To identify factors predicting uptake of voluntary HIV counselling and testing in pregnant women. Methods All pregnant women receiving ante‐natal group health education at St Camille Medical Center, Ouagadougou, Burkina Faso from 1 May 2002 to 30 April 2004 were offered voluntary HIV counselling and testing. If they consented, the women were pre‐test counselled, tested by two rapid tests giving immediate results and post‐test counselled. Results Less than one‐fifth of pregnant women [1216/6639 (18.3%, CI 17.4–19.3%)] accepted voluntary HIV counselling and testing, mainly at the first ante‐natal visit (83.4%) and at early gestational age (73.4% before week 24). The HIV seroprevalence rate was 10.6%(8.8–12.5%). The uptake rate was independently associated with age, the number of previous pregnancies and the number of previous miscarriages. Conclusions …