This study explores into realized access to antenatal care utilisation in Uganda. This emanates from the fact that access to antenatal care is still a national nemesis, (National Service Delivery Survey Report, 2005). In Uganda, the Ministry of Health (MoH) recommends that a pregnant woman should attend antenatal care at least four times during pregnancy. Also she should attend antenatal care monthly during the first seven months, every two weeks in the eighth month, then weekly until birth. On the whole however, 42 percent of expecting women sought for antenatal care at least four times during pregnancy, 52 percent of them one to three visits which of course is below the MoH recommendation while six percent did not seek care at all, (Uganda Demographic Household Survey, 2000/2001). This clearly indicates the under utilization of antenatal care; with such a state of affairs, no wonder Uganda’s maternal mortality rate of 505 per 100,000 live births is high given the Millennium Development Goals maternal mortality rate target of 131 per 100,000 live births by 2015 (UNDP, 2007). Against that background, this study sought to establish the factors which determine realized access to antenatal care. More importantly the paper unearths the interaction between realised access to antenatal care, governance and household welfare. The study unearthed that both governance and household welfare to a great extent explain antenatal care utilisation.