Antenatal care (ANC) is considered a success story in low- and middle-income countries (LMIC), as its uptake is very high. This paper aims to assess its effectiveness to reduce maternal mortality and promote maternal health in LMIC. Facility-based deliveries attended by skilled personnel are required. Focused on counseling, ANC could lead to facility-based delivery, but socioeconomic and cultural factors, and the quality and accessibility of services determine its uptake. A package of evidence-based interventions during ANC reduces maternal mortality and morbidity. ANC provides a platform to address social problems such as gender violence as well. Despite the opportunities ANC represents, challenges are found at client, workforce and health system levels.