Maternal Knowledge and Utilization of the Maternal and Child Health Handbook in Rural and Urban Areas

The relationship between maternal knowledge and Maternal and Child Health (MCH) Handbook utilization may vary across care settings. This secondary analysis examined recorded scores among 120 third-trimester pregnant women recruited consecutively at Samata (urban, n = 63) and Bajeng (rural, n = 57) Primary Health Centres in Gowa, Indonesia, during May–July 2025. Participants attended antenatal care and brought their handbook. Pooled and within-facility correlations and adjusted linear regression assessed the knowledge–utilization association. Mean knowledge scores were 82.14 and 45.70, and utilization scores were 71.13 and 53.40, in Samata and Bajeng, respectively. Knowledge correlated positively with utilization in both facilities (r = 0.640 and 0.506). After adjustment for setting, age, education, employment, and gravidity, each 10-point difference in knowledge corresponded to a 4.24-point difference in utilization (95% confidence interval 3.24–5.24). Exploratory analyses indicated curvature, and differences between setting-specific slopes were sensitive to model specification. Higher knowledge was associated with higher reported utilization among handbook-bringing antenatal attendees. The cross-sectional design and one facility per setting preclude causal conclusions and separation of facility characteristics from rural–urban context.