Key Social Norms Take-aways Social norms are central to low adolescent contraceptive uptake in Neno district. Despite widespread recognition of the harms of early pregnancy, cultural and religious norms discouraging premarital sex and adolescent contraception often outweigh health concerns. Stigma associates contraceptive use, particularly among girls, with promiscuity, while masculine expectations linking fertility with virility can discourage pregnancy prevention among boys. Community stigma also reinforces parental and partner opposition, adolescents’ fear and shame, and judgmental provider behavior. The authors argue that information and service-delivery interventions alone are insufficient; programs must directly address these interconnected normative expectations through sustained dialogue.

Objectives To explore barriers, facilitators, and preferences related to contraceptive uptake among adolescents aged 15–19 in rural Neno district, Malawi, using a rights-based socio-ecological perspective.

Methods This phenomenological qualitative study conducted 18 in-depth interviews with adolescents, religious and traditional leaders, healthcare workers, and youth community-based distribution agents, and four focus group discussions with 38 parents/guardians. Data were analyzed using a hybrid deductive-inductive thematic approach guided by a rights-based socio-ecological model. Social norms were examined through accounts of stigma, community judgment, gendered power relations, parental and partner opposition, cultural and religious expectations, masculinity and fertility expectations, and sanctions surrounding adolescent sexuality and contraception.

Results Three themes emerged: stigma, misinformation, and systemic barriers; agency and support facilitating uptake; and a paradox between acknowledged pregnancy risks and sustained resistance to contraception. Barriers included stigma, misinformation, parental and partner opposition, gendered power imbalances, judgmental providers, inadequate privacy, and stock-outs. Facilitators included accurate information, supportive peers and partners, youth-friendly providers, and adolescents’ desire to avoid pregnancy and protect educational goals. Despite recognizing the consequences of early pregnancy, cultural and religious expectations continued to discourage contraception, while some boys described pressure to demonstrate masculinity through fertility.

Conclusions Improving uptake requires confidential, nonjudgmental adolescent-responsive services alongside sustained normative dialogue with adolescents, parents, partners, providers, and religious and community leaders.