Introduction <p>The use of contraception has been effective in reducing unwanted pregnancy and sexually transmitted infections. However, it is not widely embraced by sexually active young people. The study aimed to investigate sexual autonomy and contraceptive use among married or cohabiting young women.</p> Methods <p>This study analysed the 2022 Demographic and Health Survey data. A total sample of 1003 (weighted) women aged 15–24 years were included. Frequency and percentages were computed at the univariate level and chi-square test at the bivariate level. At the multivariable level, binary logistic regression was conducted to determine the influence of sexual autonomy on contraceptive use.</p> Results <p>Majority of the participants had secondary or higher education, 85.1% were aged 20–24 years and 53.6% resided in rural areas. The results showed that 91% of the participants had sexual autonomy and 44.5% were using contraceptives. Exactly 94% of the participants with sexual autonomy were using contraceptives. At the bivariate level, women with sexual autonomy were two times more likely to use contraceptives (COR = 2.06; 95% CI: 1.12–3.77) compared to their counterparts. The relationship between sexual autonomy and contraceptive use was not statistically significant at the multivariable level.</p> Conclusion <p>These findings suggest that the apparent influence of sexual autonomy on contraceptive use is largely shaped by broader socioeconomic and relational determinants, underscoring the need for multifaceted interventions that address regional and partner dynamics, alongside individual empowerment. This study has demonstrated that cohabiting and married young women in Ghana reported high sexual autonomy and relatively low contraceptive use. This implies that married and cohabiting young women might be overlooked by youth-friendly services that often target the unmarried.</p>