Background: Antenatal Care is a critical intervention in maternal and neonatal health that has reduced mortality and improved outcome. In regions such as Western Uttar Pradesh, systemic inequities, socio-economic challenges, and infrastructural gaps undermine the effectiveness of ANC services. This review examines the current scenario of ANC in Western Uttar Pradesh, analysing its determinants, challenges, and strategies for improvement. Key Analysis: This review synthesized the evidence from articles in refereed journals, national health reports and regional studies in order to provide an all-inclusive understanding of the impact of ANC. The key areas of focus included service accessibility, quality of care, the effect of sanitation on maternal health, and the mixing of intellectual health aid in ANC. Discussion: Consistent ANC attendance also leads to the reduction of neonatal mortality, but there exist disparities in the access and quality of ANC services across different regional and urban/rural stratifications. Inadequate sanitation facilities mean lesser access to clean water and waste management, mainly to accelerated hazard of contamination and headaches which include preterm birth, anaemia, and maternal mortality. Deficiencies in health infrastructure and psychosocial support also pose a threat to maternal health. Despite the progress in reducing maternal mortality ratios at the national level, regional imbalances remain stark in Western Uttar Pradesh, highlighting the necessity of targeted interventions. Conclusion: Improving ANC in Western Uttar Pradesh requires multi-dimensional quality healthcare, community engagement, and attention to critical health determinants such as sanitation and mental health. Poor sanitation directly affects the health of mothers, exposes them to infections and complications during pregnancy, thus nullifying any effect the ANC service would have otherwise produced. Similarly, untreated mental fitness problems during pregnancy together with tension and strain can worsen complications. This makes comprehensive mental health support part of ANC an essential intervention to be implemented globally and tailored appropriately to the factors at play, especially in this regional context of Western Uttar Pradesh. Improved ANC outcomes would thereby translate into healthier maternal and neonatal outcomes for this underserved region.