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Objectives: This study examined the association between self-determination in reproductive health decision-making and contraceptive use and healthcare-seeking behaviors among married female adolescents in rural Bangladesh. Methods: This study utilized data from an independent samples baseline-endline survey conducted with 591 married female adolescents (291 at baseline in 2020 and 300 at endline in 2022) participating in a community-based reproductive health intervention program in Badarganj, Bangladesh. Self-determination was measured using a composite index of five core decision-making domains (marriage timing, contraceptive use, spouse selection, pregnancy timing, and pregnancy termination), after excluding two domains with high missing rates to minimize bias. Participants were classified into high and low autonomy groups based on the median of the summed autonomy scores. Multivariable logistic regression was conducted to examine associations between self-determination level and health behaviors, adjusting for age, survey round, education level, number of living children, and age at marriage. Results: The high autonomy group had significantly higher odds of visiting healthcare facilities in the past 3 months compared to the low autonomy group (aOR=1.73, 95% CI: 1.08–2.78, p=.023). However, no significant associations were found between self-determination level and current use of any contraceptive method (aOR=1.03, p=.890) or antenatal/postnatal care utilization among ever-pregnant adolescents (aOR=1.40, p=.434). Conclusion: Self-determination significantly increased healthcare facility visits but did not affect contraceptive use among married female adolescents. These findings suggest that while individual autonomy facilitates physical access to healthcare, it may be insufficient to overcome structural barriers regarding contraception. Therefore, a dual approach is required: empowering individual autonomy for healthcare access and implementing structural interventions targeting family and social norms to improve family planning practices.