Background Maternal and neonatal mortality rates continue to be high in sub-Saharan African countries, including Ghana. Timely and regular antenatal care (ANC) during pregnancy are essential for early identification and management of potential risk factors associated with poor pregnancy outcomes. The purpose of this study was to investigate the uptake of ANC services in the East Akim Municipality of Ghana and identify factors influencing ANC utilization. Methods A cross-sectional study which employed stratified sampling methodology to select 310 women in their reproductive ages (15–49 years) in East Akim Municipality was conducted. A structured questionnaire was used to examine the determinants of ANC utilization among respondents. Data was managed using Microsoft Excel 2016 and analysed using Stata version 14. Descriptive, bivariate and multivariable logistic regression analyses were performed. Results ANC attendance, at least once during pregnancy, was almost universal (98.4%) with 83.5% making 4 + visits. However, only 58% of respondents made early ANC visits in the first trimester and 61% attended all regularly scheduled visits. Employment status, distance to health facility and pregnancy intention were significantly associated with regular ANC attendance. Self-employed women were 2.4 times more likely to attend ANC regularly (AOR: 2.42, 95%CI :1.20–4.88) than the unemployed; those who lived < 5 km to a health facility were 3.2 times more likely to attend ANC regularly than those who lived > 10 km (AOR: 3.24, 95%CI: 1.20, 8.72); and women with intended pregnancies were 2.5 times more likely to attend all ANC scheduled visits than those with unintended pregnancies (AOR: 2.46, 95%CI: 1.32, 4.57). Conclusion Although ANC utilization in East Akim Municipality is high, socioeconomically disadvantaged women who were unemployed; lived more than 10 km from a health facility; and those with unintended pregnancies did not attend ANC early and regularly. Interventions to ensure equitable access to quality reproductive health services at the community level for all women, irrespective of their socioeconomic background, is needed to improve timely and regular ANC utilization. These include strengthening of community-based health centers, provision of ANC through outreach services to poor women in remote, hard-to-reach locations and improvements in the socioeconomic conditions in which people live.