Objective: This study investigated the use of a Maternal and Child Health (MCH) handbook, and related factors, in Mongolia. Design: Population-based cross-sectional study. Setting: Bulgan Province, Mongolia. Method: MCH handbook use was determined by examining whether participants had read it or recorded their health-related information into it. Multiple logistic regression analysis was performed to reveal factors related to MCH handbook utilisation. Results: Of the 716 participants, 631 (88.1%) read the MCH handbook and 428 (59.8%) recorded their health-related information in it. Mothers with middle or high educational attainment were more likely to have read it than were those with low educational attainment (adjusted odds ratio [AOR] = 2.52, 95% confidence interval [CI] = 1.41–4.50; AOR = 3.19, 95% CI = 1.29–7.93, respectively). Literate women and those who had been taught to use the handbook were more likely to read it (AOR = 3.19, 95% CI = 1.68–6.05; AOR = 2.42, 95% CI = 1.31–4.46, respectively). Mothers with a middle or very high wealth index were more likely to have read it than were those with a very low index. Mothers with middle or high educational attainment were more likely to make records in it than were those with low attainment. Mothers who were taught to use the handbook were more likely to make records in it, while those who had children with chronic diseases were less likely to do so. Conclusion: Women’s literacy levels, educational attainment, economic status and effective explanation of its usage must be considered in order to enhance the handbook’s effectiveness.