Autonomy in decision-making during pregnancy is a key component of person-centered care, yet little is known about autonomy experiences of perinatal service users in Canada. We conducted multivariable regression analyses, using the validated My Autonomy in Decision-Making scale (see Table 1) as the outcome variable, and maternal characteristics as the independent variables. We controlled for pregnancy year, repeat observations, and gravidity and stratified by the healthcare provider type whom people rated (midwives or physicians). 5389 participants reported on 7049 interactions with healthcare providers between 2009 and 2022 as part of a national participatory action study. Midwifery clients reported very high autonomy scores, on average, while those who rated physicians were less likely to experience autonomy, although physician scores increased over time (See Figure 1). For women who rated physicians, the adjusted odds of high autonomy were significantly lower among young mothers (AOR=0.58, 95 % CI: 0.43-0.78); people with less education (AOR=0.67, 95 % CI: 0.49-0.91); respondents with insufficient income to meet financial obligations (AOR=0.49, 95 % CI: 0.36-0.68) and those with a very weak sense of belonging to their communities AOR=0.19, 95 % CI: 0.12-0.30). For people who rated midwives, the adjusted odds of experiencing autonomy were significantly lower among newcomers to Canada (AOR=0.34, 95 % CI: 0.15-0.77), respondents who needed social services during pregnancy (AOR=0.35, 95 % CI: 0.16-0.79), people with  high risk pregnancies (AOR=0.59, 95 % CI: 0.41-0.86), and those with a very weak sense of belonging (AOR=0.57, 95 % CI: 0.34-0.94) (see Table 2). Several factors were linked to higher odds of autonomy, including early entry into prenatal care, and sufficient time during prenatal appointments. The ability to lead decisions during pregnancy, birth and the postpartum period, is a reproductive right, yet minoritized communities reported significant loss of autonomy. Differences persisted across models of care, pointing to structural inequities in patient-led decision-making during pregnancy.