Objective: To assess the level of husband’s involvement in and the key factors associated with birth preparedness and complication readiness (BPCR) in urban slums of Mangaluru, Karnataka, India Design: Cross-sectional community-based study Setting: 21 urban slums in Mangaluru, India Population: Resident men in 21 urban slums (whose wife had childbirth/s within one year) selected by multi-stage random sampling. Methods: We interviewed eligible husbands using a semi-structured questionnaire to collect data on socio-demography, wife’s obstetric and antenatal care (ANC) details, and husband’s involvement in six key BPCR practices. Main Outcome Measure: Husband’s optimal BPCR involvement (i.e. followed minimum four of six practices). Results: Of the 214 eligible husbands, 207 participated (96.7%-response rate) and 50.2% (95%CI:43.3-57.2) displayed optimal BPCR involvement. 98.6% of wives had ≥4 ANC visits, and 91.8% of husbands escorted wives for ANC at least once. Literate wife (AdjOR:6.5; 95%CI:1.4-28.9), ANC in first trimester (AdjOR:7.8; 95%CI:1.01-61.1), and receiving adequate advice on BPCR (AdjOR:47.8; 95%CI:10.4-219.8) were associated with husband’s optimal BPCR involvement. Conclusions: Only half of the husbands showed optimal BPCR involvement, and it was associated with wife’s literacy, ANC in first trimester, and receiving adequate BPCR information. Although nine of 10 husbands escorted their wives for ANC at least once, only about one-fourth of them received adequate information on BPCR, emphasising missed opportunities for health education during ANC. Grassroots health workers should engage husbands during ANC and explain various BPCR practices. Further qualitative research may help develop socio-culturally contextualised strategies to enhance the husband’s role in BPCR.