Antenatal care (ANC) remains one of the most critical pillars of maternal and child health, serving as a primary preventive and promotive intervention to reduce adverse birth outcomes and maternal mortality. Despite global progress in improving maternal health indicators, delayed initiation, irregular attendance, and suboptimal quality of antenatal care persist across low- and middle-income countries, particularly in Sub-Saharan Africa and parts of South and Southeast Asia. This research article provides a comprehensive, theory-driven synthesis and original analytical interpretation of existing empirical evidence on antenatal care utilization, maternal knowledge of pregnancy danger signs, socio-demographic determinants, and their relationship with adverse birth outcomes. Drawing strictly on the provided references, this study integrates findings from cross-sectional studies, systematic reviews, meta-analyses, demographic health surveys, and institutional health profiles to construct a multilayered explanatory framework. The article explores how structural factors such as food security, health system accessibility, urban–rural disparities, and policy environments interact with individual-level determinants including maternal education, pregnancy intention, spousal support, and exposure to mass media. Furthermore, it examines the mediating role of maternal knowledge, early risk detection, and continuity of care in shaping maternal and neonatal outcomes. By moving beyond descriptive summaries, this paper elaborates on causal pathways, theoretical implications, contextual variations, and countervailing explanations. The findings underscore that antenatal care utilization is not merely a behavioral choice but a socially embedded practice shaped by intersecting economic, cultural, informational, and institutional forces. The article concludes with a critical discussion of methodological limitations in existing studies and proposes future research and policy directions aimed at strengthening equitable, timely, and effective antenatal care systems.

Antenatal care utilization, maternal health, adverse birth outcomes

Abame, D. E., Abera, M., Tesfay, A., Yohannes, Y., Ermias, D., Markos, T., & Goba, G. (2019). Relationship between unintended pregnancy and antenatal care use during pregnancy in Hadiya Zone, Southern Ethiopia. Journal of Reproduction & Infertility, 20(1), 42–50.

Abimbola, J. M., Makanjuola, A. T., Ganiyu, S. A., Babatunde, U. M. M., Adekunle, D. K., & Olatayo, A. A. (2016). Pattern of utilization of ante-natal and delivery services in a semi-urban community of North-Central Nigeria. African Health Sciences, 16(4), 962–971.

Alvionita, V., Erviany, N., Farahdiba, I., Elba, F., Asih, F. R., Restanty, D. A., et al. (2023). Deteksi Dini Risiko Tinggi Kehamilan. Get Press Indonesia.

Anisa, A., Munir, R., & Lestari, F. (2022). Hubungan pengetahuan ibu hamil tentang tanda-tanda bahaya kehamilan dengan pemanfaatan buku kesehatan ibu dan anak (KIA). Journal of Midwifery Care, 2(02), 95–105.

Chirwa, E., Kapito, E., Jere, D. L., Kafulafula, U., Chodzaza, E., Chorwe-Sungani, G., et al. (2020). An effectiveness-implementation hybrid type 1 trial assessing the impact of group versus individual antenatal care on maternal and infant outcomes in Malawi. BMC Public Health, 20(1), 1–13.

Dibaba, Y., Fantahun, M., & Hindin, M. J. (2013). The effects of pregnancy intention on the use of antenatal care services: Systematic review and meta-analysis. Reproductive Health, 10(1), 50.

Dinkes Aceh. (2021). Profil Kesehatan Aceh. Dinas Kesehatan Aceh.

Dinkes Aceh Besar. (2020). Profil Kesehatan Aceh Besar. Dinas Kesehatan Aceh Besar.

Fatema, K., & Lariscy, J. T. (2020). Mass media exposure and maternal healthcare utilization in South Asia. SSM – Population Health, 11, 100614.

Hailemichael, H. T., Debelew, G. T., Alema, H. B., Weldu, M. G., & Misgina, K. H. (2020). Determinants of adverse birth outcome in Tigrai region, North Ethiopia: Hospital-based case-control study. BMC Pediatrics, 20(1), 1–10.

Hondro, S. M. K., Pasaribu, V. S. O., Purba, E. M., Manurung, H. R., Dewi, E. R., & Marliani, M. (2022). Factors associated with the irregularity of antenatal care visits at the Amandraya Health Center in South Nias Regency. Jurnal Eduhealth, 13(02), 904–911.

Kemenkes RI. (2022). Profil Kesehatan Kementerian Kesehatan Republik Indonesia. Jakarta.

Kolahi, A. A., Abbasi-Kangevari, M., Abdollahi, M., Ehdaeivand, F., & Arshi, S. (2018). Pattern of prenatal care utilization in Tehran: A population-based longitudinal study. Women and Birth, 31(3), e147–e151.

Kolola, T., Morka, W., & Abdissa, B. (2020). Antenatal care booking within the first trimester of pregnancy and its associated factors among pregnant women residing in an urban area: A cross-sectional study in Debre Berhan town, Ethiopia. BMJ Open, 10(6), e032960.

Morhason-Bello, I. O., Fagbamigbe, A. F., Mumuni, T. O., Adesina, O. A., Abdus-Salam, A. R., Ifemeje, A., & Ojengbede, O. A. (2016). Evaluation of correct knowledge of key danger signs in pregnancy among antenatal clinic attendees at a tertiary health facility in Nigeria. Nigerian Journal of Clinical Practice, 19(2), 227–232.

Mwilike, B., Nalwadda, G., Kagawa, M., Malima, K., Mselle, L., & Horiuchi, S. (2018). Knowledge of danger signs during pregnancy and subsequent healthcare seeking actions among women in Urban Tanzania: A cross-sectional study. BMC Pregnancy and Childbirth, 18(1), 4.

Puskesmas Krueng Barona. (2021). Profil Kesehatan. Krueng Barona.

Saragih, E., Masruroh, M., Mukhoirotin, M., Herawati, T., Hutagaol, A., Cathryne, J., et al. (2022). Kesehatan Ibu dan Anak. Yayasan Kita Menulis.

Siahaan, M. (2018). Hubungan riwayat kunjungan ANC ibu hamil dengan proses persalinan di RSUD Dr. Tengku Mansyur Kota Tanjung Balai Tahun 2018. Institut Kesehatan Helvetia.

Tamirat, K. S., Sisay, M. M., Tesema, G. A., & Tessema, Z. T. (2021). Determinants of adverse birth outcome in Sub-Saharan Africa: Analysis of recent demographic and health surveys. BMC Public Health, 21(1), 1–10.

Tesfaye, G., Loxton, D., Chojenta, C., Semahegn, A., & Smith, R. (2017). Delayed initiation of antenatal care and associated factors in Ethiopia: A systematic review and meta-analysis. Reproductive Health, 14, 1–17.

UNICEF. (2019). More women and children survive today than ever before – UN report.

World Health Organization. (2019). The State of Food Security and Nutrition in the World 2019: Safeguarding Against Economic Slowdowns and Downturns. Food and Agriculture Organization.

Yanti, Y. E. (2018). Hubungan pengetahuan ibu dan dukungan suami pada ibu hamil terhadap keteraturan kunjungan antenatal care di Puskesmas Wates Lampung Tengah Tahun 2014. Jurnal Kebidanan Malahayati, 1(2).

Zile, I., & Villerusa, A. (2019). Comparison of antenatal care factors and neonatal outcomes in rural and urban contexts. European Journal of Public Health, 24(Suppl_2).