Determinants of antenatal care utilization among Saudi females: application of Andersen’s behavioral model: a cross-sectional study

Antenatal care (ANC) is pivotal for maternal and child health outcomes. In Saudi Arabia, while there has been significant progress in healthcare access and quality, disparities in ANC utilization persist. This study applies Andersen’s expanded behavioral model to identify determinants of ANC utilization among Saudi women in Jazan. A cross-sectional study was conducted at urban and rural PHC centers (January–June 2023). Of 385 eligible women, 370 participated (96.1%). Variables mapped to predisposing, enabling, and need domains were analyzed using multivariable logistic regression; significance was set at p < 0.05. Adequate ANC utilization (≥ 8 contacts, in line with WHO recommendations) was significantly more likely among employed women (AOR 1.94, 95% CI 1.22–3.10, p = 0.005), older women, (per year AOR 1.06, 1.01–1.11, p = 0.020), and those whose husbands had primary education (vs. none: AOR 11.96, 1.89–75.79, p = 0.008). Surprisingly, higher maternal education was associated with lower odds of adequate utilization (university vs. none: AOR 0.12, 0.03–0.56, p = 0.007). This study identified a combination of socio-demographic, economic, and health-related factors that significantly influence both awareness of and engagement with ANC services among Saudi women. It highlights how maternal employment status, age, and husband’s education affect ANC awareness and utilization in the Jazan region. Customized interventions targeting these determinants can enhance ANC uptake and improve maternal and neonatal health outcomes.