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Background: Knowledge and acceptance of contraceptives are widely assumed to lead to use, but evidence from sub-Saharan Africa suggests that a gap often remains. Community-based data on this gap, and on rural–urban differences, are scarce for Anambra State, south-east Nigeria. Objectives: To (1) assess and compare the level of knowledge of contraceptives among rural and urban women of reproductive age, (2) assess and compare the level of acceptability of contraceptives among rural and urban women of reproductive age, and (3) determine the prevalence and pattern of contraceptive utilization, side effects, discontinuation and perceived accessibility among women of reproductive age in Anambra State. Methods: A community-based comparative cross-sectional study was conducted among 427 women aged 15–49 years (205 rural, 222 urban) selected through multistage sampling from 12 Local Government Areas across the three senatorial zones. A self-structured questionnaire (Cronbach’s alpha 0.82) measured knowledge (13 true/false items), acceptability (11 five-point Likert items) and utilization. Data were analysed with SPSS version 27 using descriptive statistics, chi-square tests and, for rural–urban comparisons, Welch t-tests with effect sizes and 95% confidence intervals (CIs) recomputed from the reported group summaries.