Background: Although antenatal care (ANC) services are offered free of charge at public healthcare facilities in India, Bihar state has a low ANC utilization rate due to service quality gaps. This study examines these gaps from the perspective of Left-Behind Wives (LBWs) residing in urban low socioeconomic environments in the absence of husbands. The research also aims to identify the predictors for efficient use of ANC services at government health centres and the effect of source of information on perception towards ANC services. Method: A cross-sectional survey was carried out to capture responses from 165 respondents residing in low socioeconomic regions of two administrative blocks of the Patna district of India. Effective utilization was measured as a binary variable, based on antenatal check-ups, iron-folic acid consumption, institutional delivery, and tetanus vaccination. Regression analysis was used to assess the predictors of utilization of ANC services. Analysis of Variance (ANOVA) was used to analyze the effect of source of information on perception towards ANC services. Results: The most significant aspect that predicts the efficient use of ANC services at government health centres was ‘human resource’ (AOR = 3.35, R2 = 0.80), followed by ‘counselling service’ (AOR = 2.41) and ‘infrastructure and equipment condition’ (AOR = 1.76). There was no significant effect of source of information on perception (p > 0.05). Conclusion: This study reveals reasons for underutilization, perception, and opportunities related to ANC services at government centres. It also provides vital insights for policymakers for the development of maternal healthcare in underperforming states of India, ultimately contributing to the health empowerment of LBWs.