This study explores the complex dynamics of maternal healthcare utilization in Bihar, India, with a specific focus on antenatal care (ANC) services. The study identifies the influence of gendered decision-making on ANC utilization, synthesizing data from the National Family Health Survey (NFHS-5) conducted in 2019–21. Utilizing logistic regression models, the research dissects factors affecting ANC visits, considering variables such as decision-making authority, media exposure, caste, age, household size, religion, wealth index, education, and place of residence. Results reveal disparities in ANC utilization, with decision-making dynamics significantly impacting outcomes. Caste, age, wealth index, education, and media exposure emerge as critical determinants. For instance, Scheduled Caste/Scheduled Tribe mothers face higher vulnerability, while higher education and media exposure positively correlate with ANC utilization. Urban–rural differentials and religious influences also contribute to variations. The study employs a robust statistical approach, evidenced by a likelihood ratio test and goodness-of-fit indicators. The findings underscore the multifaceted nature of maternal healthcare utilization, emphasizing the need for targeted interventions considering gender, socio-economic, and cultural dimensions.