Antenatal care (ANC) plays a critical role in reducing maternal and neonatal mortality, yet coverage remains low in the rural areas of Padang Lawas, North Sumatra, Indonesia. This study aimed to examine the relationship between cultural beliefs and ANC visit frequency among pregnant women. A cross-sectional analytical observational design was employed, involving 362 participants selected through proportionate stratified random sampling across four sub-districts. Data were collected using a validated questionnaire, with internal reliability confirmed by Cronbach’s alpha. Multivariate logistic regression was conducted to identify key predictors of ANC attendance. The results revealed that cultural beliefs were the most influential factor affecting ANC visits (B = 1.493, Exp(B) = 4.466; 95% CI: 2.093–9.533; p = 0.001), alongside knowledge, education, income, access to health services, and family support. These findings underscore the need for culturally sensitive health education programs and the empowerment of community health workers to address local norms and barriers. Tailored interventions that integrate cultural understanding are essential to improving maternal health service utilization in rural Indonesian settings. © 2025, Green Publication. All rights reserved.