Family planning plays a crucial role in maternal and child health, population control, and women's empowerment. However, despite efforts to promote family planning services, the uptake of modern contraceptive methods in Taraba State remains low. This study examined the various health system factors that influence women's family planning decisions in Taraba State. To achieve these objectives, the study employed a multi-stage and random sampling technique to gather information from 889 respondents within the childbearing age (15–49 years). The data were analyzed using descriptive statistics like percentages, graphs, and charts while Pearson Correlation was used to ascertain the strength of the relationship between the variables of the study. The findings reveal robust positive correlations between healthcare provider advice, quality of care, accessibility, and information/education received with women's family planning decisions. Conversely, a moderate positive correlation was observed between government policies/regulations and these decisions. Notably, healthcare provider advice and quality of care emerged as significant influencers, stressing the crucial role of healthcare professionals and the importance of maintaining high-quality care standards. Moreover, the study highlights the imperative of accessible and well-equipped family planning facilities, health education, and accurate information dissemination for informed decision-making. The study recommended that addressing the availability, quality of care, accessibility, information, and policies is essential to empower women and improve their reproductive health outcomes.