Abstract: To explore the coordinated development path between urbanization and water resource utilization in Henan Province, this paper constructed a comprehensive evaluation index system for urbanization development and water resource utilization over the study period from 2008 to 2024. Employing the entropy weight method, grey relational degree iterative model, coupling coordination degree model, and obstacle degree model, the study systematically analyzed the development levels of the two systems, the temporal and spatial evolution characteristics of their coupling coordination relationship, and precisely identified the key factors constraining development. The results showed that the overall urbanization development level of Henan Province had exhibited a steady upward trend, while the water resource utilization showed characteristics of periodic fluctuation. The coupling coordination degree had evolved from imbalance to coordination, and further from barely coordinated to well-coordinated. Spatially, the overall coordination level had improved, ultimately forming a pattern of “local agglomeration of good coordination and full coverage of moderate coordination”. The constraint factors shifted continuously with development stages: in the early stage, extensive industrial water use served as the core constraint, while in the later stage, population concentration gave rise to domestic water pressure; the inherent deficiency in water resource endowment persists, and coupled with extreme hydrological fluctuations, the system exhibited relatively weak climate resilience. Based on these findings, optimization recommendations are proposed from four aspects: improvement of public services and spatial regulation, market-based allocation and intensive use of water resources, regionally differentiated synergistic governance, and climate-adaptive management, to facilitate the high-quality coordinated development of urbanization and water resource utilization in Henan Province.