Introduction Antenatal care services are vitally important in monitoring pregnancy and identifying the risk factors during pregnancy. However, many pregnant women under-use these services and factors associated with under-use are not well explained. Therefore, this study aimed to use the health belief model and self-determination theory to explore antenatal care services use among postnatal women in the Mara region. Methods A hospital-based cross-sectional study involving postnatal women from April to July 2020 was conducted using a structured questionnaire. A total of 384 postnatal women were recruited using systematic sampling. The associations between constructs of the health belief model and self-determination theories with antenatal care service variables were examined using the Chi-squared test, followed by logistic regression analysis. P<0.05 at 95% confidence interval was considered statically significant. Results Of 384 participants, 53.4% were self-determined on antenatal care services use, 46.9% had a high level of perception on antenatal care services use and 49.7% had adequate knowledge on antenatal care services use. Being from the Kurya tribe reduced the odds of being self-determined. Most (85.9%) postnatal women had attended fewer than eight recommended antenatal care visits. Multivariate analysis showed low autonomy (P=0.038), and low perceived barriers (P=0.007) were predictors for antenatal care visits. Conclusions Antenatal care services are still inadequately used in the Mara region. Low perceived autonomy and low perceived barriers are significantly associated with antenatal care services use. Health management teams and health stakeholders should collaborate to improve the situation.

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