<![CDATA[Background: The global maternal mortality ratio (MMR) was estimated at 197 per 100,000 live births in 2023. High-quality antenatal care (ANC) is essential for reducing maternal morbidity and mortality. In North Sumatra, only 80.32% of pregnant women completed six ANC visits (K6). Satisfaction with ANC services may influence adherence to recommended ANC visits. A preliminary survey at Tutun Sehati Primary Clinic indicated the need for further investigation of this relationship. Purpose: To assess the quality of ANC services and the level of satisfaction among pregnant women and to determine the associations between ANC service quality, maternal satisfaction, and adherence to ANC visits at Tutun Sehati Primary Clinic in 2026. Method: This quantitative study employed a cross-sectional design. The sample comprised 53 pregnant women from a population of 113. The sample size was determined using the Slovin formula with a 10% margin of error, and participants were recruited using accidental sampling. Data were collected using the SERVQUAL questionnaire, which was adopted in full from Sianipar et al. (2025). Data were analyzed using univariate analysis with frequency distributions and bivariate analysis using the Chi-square test. Results: Of the 53 respondents, 35 (66.0%) rated the quality of ANC services as good, while 36 (67.9%) reported a high level of satisfaction. The Chi-square test demonstrated a statistically significant association between ANC service quality and adherence to ANC visits (p < 0.001), as well as between pregnant women's satisfaction and adherence to ANC visits (p = 0.003). Conclusion: ANC service quality and pregnant women's satisfaction were significantly associated with adherence to ANC visits. These findings highlight the importance of maintaining and improving the quality of ANC services and patient satisfaction to support adherence to the recommended K6 ANC schedule.]]>
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