Pregnancy is a period at which a woman's health is placed at risk. However, health care professionals providing antenatal care (ANC) can reduce that risk by monitoring women' health regularly arid offering both preventive and curative services. Worldwide, an estimated 515,000 women die of pregnancy-related causes, a rate of over 1,400 maternal deaths each year. The overwhelming majority of these deaths and complications occur in developing countries. Effective ANC, appropriate emergency treatment of complications and competent referral level encompass the most effective answers to reduction of maternal deaths. Data related to rural/urban difference concerning knowledge, attitudes and practices of women towards ANC in Alexandria are lacking. The present study is aimed at comparing knowledge, attitudes and practices towards ANC between rural and urban women in Alexandria and also, to identify certain related factors. A cross-sectional, community- based house-to-house survey was conducted in Alexandria using cluster-sampling technique (30 clusters from urban areas and30 clusters from rural areas). Each cluster consisted of 5 women who had given birth within the last 2 years preceding the survey. Urban women had a higher mean total score for their knowledge on ANC than their counterparts of rural women, with a statistical significant difference (11.23 +/- 2.91 and 6.59 +/- 4.14, respectively and Z = 9.73, P < 0.001). Also, Urban women had a significantly higher mean total score for their attitudes towards ANC compared to the rural women (10.66 +/- 2.33 versus 8.55 +/- 2.39, P < 0.001). Concerning maternal practices, the current study revealed rural/urban disparities as significantly higher proportions of urban women had proper practices during antenatal period in their last pregnancy as regards utilization, earlier initiation and frequent visits of antenatal care. On the other hand, nearly half of urban women (45.3%) had not been vaccinated during their last pregnancy compared to only 24.7% of rural ones, (P < 0.001).