<![CDATA[Background: Maternal Mortality Rate (MMR) in Indonesia remains relatively high, and one strategy to reduce it is monitoring at least six antenatal care (ANC) visits (K6) during pregnancy. A preliminary survey at Hilimegai Health Center showed that K6 coverage declined from 45.4% (2019) to 19.7% (2021), indicating suboptimal utilization of complete ANC services among third-trimester pregnant women. Objective: this study aimed to determine internal factors (education, age, parity) and external factors (socio-culture, distance, transportation access, road infrastructure, facilities) associated with K6 visits among third-trimester pregnant women at Hilimegai Health Center, South Nias Regency. Methods: this study used a mixed methods design with a sequential explanatory strategy, a cross-sectional quantitative approach involving 41 third-trimester pregnant women (total population sampling), followed by in-depth interviews with 5 informants (head of the health center, MCH officer, and midwives). Data were analyzed using univariate and bivariate chi-square tests (α=0.05). Results: all eight variables examined were significantly associated with K6 visits: education (p=0.000), age (p=0.022), parity (p=0.013), socio-culture (p=0.000), distance (p=0.003), transportation access (p=0.005), road infrastructure (p=0.005), and facilities (p=0.004). Qualitative findings confirmed that long distances, limited transportation and road infrastructure, socio-cultural beliefs (including reliance on traditional healers), and low awareness of the importance of ANC were the main barriers to K6 visits. Conclusion: internal and external factors were consistently associated with K6 achievement among third-trimester pregnant women; strengthened health education, improved access, and community-based interventions (posyandu and health cadres) are needed to increase K6 coverage.]]>
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