Background <p>Modern contraceptive use prevents unintended pregnancies and unsafe abortions. In Ghana, contraceptive prevalence is low, and determinants of use among women accessing private-sector sexual and reproductive health (SRH) services are understudied. This study examined these determinants among women attending private SRH clinics in Greater Accra.</p> Methods <p>A facility-based, cross-sectional survey was conducted (July–September 2024) at three randomly selected Marie Stopes International clinics. We enrolled 200 women aged 15–49 years via systematic random sampling (92.6% response rate). Data were collected electronically. Descriptive statistics and a multivariable modified Poisson regression with robust variance were used to identify factors associated with current modern contraceptive use, reported as Adjusted Prevalence Rate Ratios (aPRR). An a priori interaction between employment and residence was assessed.</p> Results <p>Modern contraceptive prevalence was 39.0% (95% CI: 32.4–45.9%). Implants (20.5%) were most used. Use was higher among women with an abortion history (aPRR = 1.44, 95% CI: 1.32–1.57), those believing abortion should be legal (aPRR = 1.22, 95% CI: 1.09–1.36), and those with tertiary education (aPRR = 1.15, 95% CI: 1.01–1.31). Urban residence was associated with lower use (aPRR = 0.85, 95% CI: 0.74–0.99). Exploratory analysis of a marginally significant interaction (<i>p</i> = 0.085) suggested this urban disadvantage was specific to employed women.</p> Conclusions <p>Among women at private clinics in Greater Accra, contraceptive use is modest and linked to abortion history, supportive legal attitudes, and education. The urban disadvantage among employed women suggests context-specific barriers. Programmes should integrate family planning into post-abortion care, enhance health literacy, and address urban access barriers. Strengthening private sector delivery is key for national strategy.</p>