Key Social Norms Take-aways Social norms and stigma surrounding unintended pregnancy, abortion, contraceptive use, and young women’s sexuality strongly shape unsafe abortion practices in Bongo District. Fear of family shame, community judgment, school expulsion, partner disapproval, and breaches of confidentiality can make the social consequences of an unintended pregnancy feel more immediate than the health risks of unsafe abortion. The normalization of unsafe abortion may further reduce perceptions of its danger and reinforce informal providers as an accepted option.

Objectives The study examined determinants of unsafe abortion among young women aged 15–25 in Bongo District, Ghana, focusing on community perceptions of unsafe abortion, contraceptive knowledge and use, health-system access, and socio-cultural and economic influences.

Methods This exploratory qualitative study purposively recruited 34 young women from five communities. Individual semi-structured interviews explored experiences and attitudes related to unsafe abortion, contraceptive knowledge and barriers, health-system access, and socio-cultural and economic determinants. Data were analyzed thematically using Braun and Clarke’s six-phase framework. Social norms were explored qualitatively through participants’ accounts of community judgment, stigma, family honor and shame, partner disapproval, expectations around young women’s reproductive behavior, confidentiality concerns, and the perceived normalization of unsafe abortion.

Results Participants described unsafe abortion as common and increasingly normalized. Although many women knew of contraceptive methods, misinformation about infertility and side effects, partner opposition, shyness, and anticipated community judgment discouraged use. Unintended pregnancy was particularly consequential because disclosure could bring family shame, school expulsion, partner abandonment, and community stigma, encouraging secrecy and unsafe abortion. Formal services were also constrained by cost, distance, judgmental provider attitudes, and confidentiality concerns, making cheaper and more discreet informal providers attractive alternatives.

Conclusions Unsafe abortion among young women in Bongo District reflects the interaction of structural, financial, health-system, and socio-cultural barriers rather than simply inadequate knowledge. Reducing unsafe abortion therefore requires simultaneous attention to affordability and accessibility of formal services, confidential and non-judgmental care, contraceptive misconceptions, and the social environment that stigmatizes unintended pregnancy and constrains young women’s reproductive decision-making.