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In Pakistan, reproductive behavior is shaped not only by individual characteristics but also by household hierarchies in joint family systems. This study examines how co-residence with a mother-in-law affects daughters-in-law’s fertility preferences and contraceptive use, and whether these patterns vary by urban–rural context and couple concordance on fertility intentions. Using the 2017–2018 Pakistan Demographic and Health Survey (N = 12,362) and a subsample of matched couples (N = 2,514), situating reproductive outcomes within joint-family system power dynamics, drawing on theories of gender as a status system and the interactional production of gender. Contrary to expectations, co-residence with a mother-in-law was associated with higher contraceptive use, indicating that mothers-in-law do not uniformly constrain reproductive autonomy. Parity, education, household wealth, and employment were stronger predictors of contraceptive behavior than household composition or couple concordance. These findings highlight the role of household hierarchies: daughters-in-law’s autonomy depends on both intergenerational dynamics and socioeconomic resources. Enhancing reproductive autonomy requires attention to household power structures as well as education and economic empowerment.