Maternal mortality remains a major public health and socioeconomic challenge, with Nigeria contributing disproportionately to the global maternal death index. Although largely preventable, many women, especially in rural areas, face barriers such as limited access to skilled care, cultural practices, poverty, and inadequate health infrastructure. This study examines the determinants of antenatal care (ANC) utilisation among pregnant women in the Makurdi area of Nigeria, focusing on awareness, socioeconomic and health system factors, and cultural influences. The researchers used a descriptive survey design guided by the Health Belief Model (HBM). The researchers selected a sample of 300 pregnant women aged 18–45 years from a study population of 1,327 women registered for ANC. Data were collected through systematic and simple random sampling from three major facilities — Benue State University Teaching Hospital, Federal Medical Centre Wadata, and Bishop Murray Medical Centre — using a validated, structured questionnaire. Results show high awareness of ANC services, but utilisation is limited by socioeconomic constraints (spousal support, transport, and work schedules), health system challenges (accessibility and quality of facilities), and cultural beliefs (patriarchal control and religious restrictions). The study concludes that while ANC is essential, socioeconomic and cultural barriers in Nigeria, particularly in Makurdi, hinder effective utilisation. It recommends community-based education, financial support for ANC, improved healthcare facilities and staffing, and culturally sensitive programs that engage community leaders to address these barriers
