| Sumario: | Background: Modern contraceptive use is vital for women's reproductive autonomy and maternal-child health, yet recent nationally representative studies on its determinants among married women in Lesotho are limited. Objective: This study addresses these gaps using the latest Lesotho Demographic and Health Survey to provide updated evidence on prevalence and determinants. Design: A cross-sectional study using nationally representative survey data. Methods: The 2023–2024 Lesotho Demographic and Health Survey data were used for analysis. A weighted sample of 3102 married women of reproductive age from 400 enumeration areas across 10 districts was included in the analysis. A multilevel mixed-effects binary logistic regression model was employed to identify individual- and community-level factors associated with modern contraceptive use. Significant factors were determined using odds ratios with 95% confidence intervals and a p value of <0.05. Results: Modern contraceptive use was reported by 65.6% of married women. Women aged 35–49 were less likely to use modern contraceptives than younger women (adjusted odds ratio (AOR) = 0.65, 95% CI: 0.43–0.98). Women with primary (AOR = 4.5, 95% CI: 1.9–10.4), secondary (AOR = 5.6, 95% CI: 2.4–13.1), or higher education (AOR = 6.1, 95% CI: 2.3–16.5), as well as those whose husbands had higher education (AOR = 1.8, 95% CI: 1.02–3.2), were more likely to use modern contraceptives. Employed women (AOR = 1.4, 95% CI: 1.07–1.5), joint decision-making with husbands (AOR = 1.45, 95% CI: 1.13–1.7), and knowledge of modern contraceptives (AOR = 1.8, 95% CI: 1.09–3.7) were also associated with higher use. Women with one to two living children (AOR = 9.7, 95% CI: 6.3–14.9) and those with three or more children (AOR = 16.4, 95% CI: 9.0–29.9) were more likely to use modern contraceptives. At the community level, women in all other districts had lower odds of use than those in Butha-Buthe. Conclusion: Current modern contraceptive use among married women was moderately high. Key predictors included women's and husbands' education, employment, parity, joint decision-making, and contraceptive knowledge, while older women and certain districts had lower odds. These findings highlight the need for targeted interventions to enhance education, economic empowerment, spousal communication, and equitable access.
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