Despite antenatal care presenting opportunities to identify and monitor women at risk, use of recommended antenatal care services remains. Barriers preventing use of antenatal services vary between countries, and limited knowledge exists about the link between geographical settings and antenatal service use. The objective of this cross-sectional quantitative study was to explore geographical variations and investigate how social demographic characteristics affect use of antenatal care for women in Sierra Leone using the Andersen behavioral model. The data used were from the 2016 maternal death surveillance report of the whole counrty (N =706). Logistic regression analysis was used to determine the individual predictor effects on antenatal care, including geographical location, the age of women, marital status, parity, and institution of birth impact. Southern, Northern, and Eastern women had significantly lower odds of attending the recommended antenatal services compared to women in the Western region (OR = .517, p = .019; OR = .497, p = .021; OR = 0.014, p = .041, respectively). The odds of married women attending the recommended antenatal services was 7.3 times more than that of the single women (OR = 7.397). Also, significantly associated with less uptake of recommended antenatal visits was lower education level among women (OR = .517). This study will contribute to positive social change by highlighting inequities in antenatal care use among women, thus allowing for accurate targeting of health promotion programs and ultimately saving lives of mothers and children of Sierra Leone through more inclusive policies.