Contraceptive Decision-Making Autonomy Among Married Women in Nigeria: Regional Disparities and Determinants Using the 2024 NDHS

Background Women’s autonomy in contraceptive decision-making is a key component of reproductive rights and gender equality, yet remains low in many low- and middle-income countries, including Nigeria. Understanding the current patterns and determinants of contraceptive autonomy is essential for accelerating progress toward Sustainable Development Goal (SDG) 5. This study examined the prevalence, regional disparities, and sociodemographic predictors of contraceptive decision-making autonomy among married women in Nigeria using the 2024 Nigeria Demographic and Health Survey (NDHS). Methods This cross-sectional study analyzed data from 24,819 married women aged 15–49 years from the 2024 NDHS. Contraceptive autonomy was defined as women independently making decisions regarding contraceptive use. Descriptive statistics summarized respondents’ characteristics, and logistic regression models assessed crude and adjusted associations between predictors and autonomy. All analyses applied sampling weights to account for the NDHS complex survey design. Statistical significance was set at p < 0.05. Results Overall, 37% of married women reported autonomy in contraceptive decision-making. Autonomy was highest in the South West (51%) and lowest in the North West (31%). In the adjusted model, older age increased autonomy, including women aged 35–39 years (AOR = 1.25; 95% CI: 1.03–1.52; p = 0.025) and 40–44 years (AOR = 1.31; 95% CI: 1.07–1.60; p = 0.009). Higher household wealth was associated with autonomy—poorer (AOR = 1.26; p < 0.001) and richer households (AOR = 1.26; p < 0.001) compared with the poorest. Employed women had higher odds of autonomy (AOR = 1.49; 95% CI: 1.38–1.60; p < 0.001). Regional disparities persisted: autonomy was higher among women in the North East (AOR = 1.25; p < 0.001), South East (AOR = 1.41; p < 0.001), and South West (AOR = 1.70; p < 0.001), but lower in the North West (AOR = 0.88; p = 0.015) relative to North Central. Conclusion Contraceptive decision-making autonomy among married women in Nigeria remains low and varies substantially across demographic, socioeconomic, and regional contexts. Interventions aimed at enhancing women’s reproductive agency should prioritize education, economic empowerment, and culturally responsive strategies tailored to regions with persistent gender inequalities, particularly in the northern zones. Strengthening women’s autonomy is essential for improving reproductive health outcomes and advancing SDG 5 targets.