Women’s decision-making power concerning modern contraceptive use plays a pivotal role in enhancing its adoption. Nonetheless, in Ethiopia, the available data on this subject remains sparse and inconsistent. This study aimed to determine the prevalence and identify the factors influencing women’s decision-making power on modern contraceptive use in Girawa district, Eastern Ethiopia, between January 1–30, 2024. A community-based cross-sectional survey was carried out among 510 married women using contraceptives, selected through a multistage sampling approach in Girawa district. Both descriptive statistics and logistic regression analyses were utilized. The data collection tool was developed based on a review of relevant literature and underwent pretesting. Trained data collectors administered the questionnaire via face-to-face interviews. Data were cleaned and entered using Epidata and analyzed using SPSS version 20. Descriptive statistics, including frequencies, tables, and percentages, were used to summarize the data. Binary logistic regression was first conducted to identify variables for multivariable analysis using a p-value threshold of <0.25. Variables meeting this criterion were then included in the multivariable model to adjust for confounding factors. Associations were reported using adjusted odds ratios (AORs) with 95% confidence intervals (CIs), and statistical significance was declared at p-values below 0.05. The prevalence of women’s decision-making power on modern contraceptive use was found to be 78% (95% CI: 74.4–81.6). Factors positively associated with greater decision-making power included: women’s educational status (primary: AOR = 10.51 [5.37, 20.56]; secondary or higher: AOR = 2.58 [1.35, 4.93]), husband’s education level (primary: AOR = 2.53 [1.33, 4.81]; secondary or above: AOR = 2.25 [1.08, 4.68]), being employed by the government (AOR = 5.29 [1.44, 19.57]), number of ANC visits (1–3: AOR = 2.16 [1.18, 3.95]; ≥4: AOR = 1.86 [1.85, 4.05]), having a positive attitude (AOR = 2.83 [1.28, 6.25]), and good knowledge about modern contraceptive methods (AOR = 3.67 [1.78, 7.56]). In Girawa district, about three out of four married women reported having decision-making power on modern contraceptive use. This empowerment was significantly linked to factors such as educational attainment, employment status, utilization of Antenatal Care (ANC) services, positive attitudes toward contraception, and adequate knowledge of modern contraceptive methods. Efforts focusing on these areas may further enhance women's autonomy in making informed contraceptive choices.
