Background: Maternal healthcare utilization is influenced by an intricate network of forces, including social, economic, cultural, and religious factors. As a result, theoretical support is required for a thorough understanding of early ANC and its determinants, which are crucial to this work, as well as conceptual clarity. The goal of this study is to identify the aspects that influence rural women's use of antenatal care services in Metoubas district. Design: A descriptive research design was followed in this study. Settings: The study was conducted at 13 family medicine centers in Metoubas district. Subjects: A convenient sample of 300 pregnant women attending the previously mentioned settings was proportionally allocated. Tools: The data was gathered utilizing an organized interview schedule and pregnant women's knowledge regarding antenatal care services utilization structured interview schedule and characteristic ANC services. Results: More than one-tenth of the pregnant women (14.7%) had a poor knowledge score regarding their antenatal care services, whereas 85.3% had a fair knowledge score. Also, nearly three-fourths of the pregnant women (75.7%) had a low utilization of ANC score services, whereas 12.0% and 12.3% had moderate and high utilization of ANC services, respectively. In addition, most of the studied women (90.0 and 90.3%, respectively) do not agree about the acceptability of waiting for a doctor's long time and that MCH provides health education. Conclusion: The factors associated with ANCU utilization include geographic accessibility, availability, affordability, and acceptability. Also, most of the studied women reported the acceptability of waiting for a doctor's long time and that MCH provides health education, the availability of health workers' regular and adequate medication equipment supplies, the affordability of coastal transportation suitability and coast medication investigation examination and that MCH is easily accessible and that MCH is near their house as factors associated with ANCU utilization. Recommendations: Enhance pregnant women's knowledge of antenatal care and the appropriate time to begin by informing pregnant women about the necessity of receiving prompt ANC, hazards of pregnancy, and warning signs. Reinforce studies documenting the need to promote the utilization of ANC among pregnant women at the health facility.