OBJECTIVE To assess utilization of antenatal care (ANC) and its determinants in a conflict-affected area in Northern Sri Lanka. METHODS A cross-sectional study was conducted among pregnant mothers who had completed 36 weeks of gestation, and were admitted or referred to 2 leading hospitals in Vavuniya district. METHODS Data were collected from 392 mothers using an interviewer-administered questionnaire. RESULTS 55% of the respondents reported that their families were affected directly by conflict. Approximately 68% of mothers were registered by public health midwife (PHM) for ANC; 31.4% were registered before 12 weeks of gestation; 38.5% were visited at home by PHM; 37.8% had the first clinic visit before 12 weeks; and 90.1% made at least 4 clinic visits. The average number of antenatal visits to specialist clinics (5.34, 95%CI: 5.03-5.65) was significantly higher than field clinics (2.97, 95%CI: 2.69-3.25). On average, a pregnant woman was seen by PHM at home 1.47 times. ANC utilization was significantly poor in women whose families were affected by conflict, living in active conflict areas and urban regions, had a lower education level, and were not involved in decision making on ANC. CONCLUSIONS Provision of field antenatal clinics, early entry to ANC, and domiciliary care by PHM need improvement.