The prevalence and risk factors associated with peripartum psychological distress-a unifying factor among common mental disorders (CMDs)-are not widely understood in underresourced settings. Cross-sectional data were collected from 664 pregnant women who reported for antenatal care at any of one of the 11 midwife and obstetrics units in Cape Town, South Africa. The prevalence of prepartum psychological distress was 38.6%. Associated factors included low socioeconomic status as measured by asset ownership (odds ratio [OR], 1.45; 95% CI, 1.24-1.68), recent physical abuse and/or rape (OR, 1.94; 95% CI, 1.57-2.40), complications during a previous birth (OR, 1.18; 95% CI, 1.01-1.38), and having given birth before (OR, 1.61; 95% CI, 1.21-2.14). The high prevalence of psychological distress is consistent with those found in other South African studies of peripartum CMDs. If effective context-specific interventions are to be appropriately designed, closer investigation of a broader symptomology associated with peripartum CMDs in these settings is warranted.