The prevalence of human immunodeficiency virus (HIV) infection is lower in Madagascar than in continental African countries, but recently it has steadily risen. To identify factors that facilitate or deter condom use among married couples in Madagascar, a cross-sectional study was conducted by means of a questionnaire survey of 977 women attending 10 health facilities for antenatal care and child care. Information on reproductive and socioeconomic factors was obtained, and logistic regression analysis was used to identify factors contributing to condom use. Child death and women’s earnings were statistically significant factors for condom use, with an odds ratio of 2.0 (95% confidence interval (CI): 1.2-3.5) for the former and 1.6 (95% CI: 1.1-2.3) for the latter in the logistic regression analysis. The promotion of economic independence among women and the reduction of child mortality deserve greater attention in the planning of HIV prevention policy in Madagascar.