This study analysed the factors influencing the utilisation of maternal healthcare services among women of reproductive age in Tanzania, using data from the 2022 Tanzania Demographic and Health Survey (TDHS). A Fairlie decomposition technique was employed to decompose differences in maternal healthcare service utilisation between rural and urban areas in Tanzania. The findings revealed that rural women, on average, have a lower probability of utilising maternal healthcare services compared to urban women. The decomposition analysis showed that the rural-urban gap in maternal healthcare utilisation is primarily explained by differences in household wealth index (37.2%), women’s education level (18.1%), distance to health facilities (12.6%), exposure to media (8.7%), insurance coverage (3.9%), and occupational status (4.1%). The study recommends targeted interventions to improve maternal healthcare utilisation, including empowering women through enhanced access to resources and opportunities. Key strategies include promoting girls’ education beyond primary school through scholarships or vocational training to improve socio-economic outcomes. Moreover, leveraging mass media to raise awareness, streamlining insurance enrolment, and reducing out-of-pocket maternity care expenses are emphasized. The study suggests reliable transportation, expanded telehealth services, and the establishment of satellite clinics in underserved areas to enhance access.