Key Social Norms Take-aways Social and cultural expectations around adolescent sexuality substantially shape adolescent girls’ access to contraception in Mahama refugee camp. Community expectations favor abstinence before marriage and often frame contraception as appropriate only for married women. Girls therefore anticipate shame, gossip, stigma, and being labeled as sexually immoral if seen seeking contraception, discouraging use even when services are available. The authors emphasize that improving access requires addressing these community norms and expected social consequences alongside individual beliefs and structural barriers; private, youth-friendly services and supportive peer educators can reduce anticipated stigma and help normalize contraceptive access.

Objectives To identify factors influencing access to contraceptive services among adolescent refugee girls aged 10–19 in Mahama refugee camp, Rwanda, and generate evidence to inform interventions using Social Cognitive Theory.

Methods This qualitative descriptive study conducted 19 in-depth, semi-structured interviews with adolescent girls aged 10–19 between May and August 2022. Participants were purposively selected to represent differences in schooling, marital status, and pregnancy experience. The interview guide used Social Cognitive Theory to examine individual, social, and environmental influences, including knowledge and beliefs, self-efficacy, family and peer influences, religious leaders, community norms, peer educators, stigma, and service accessibility. Interviews were transcribed, translated, and analyzed thematically using deductive Social Cognitive Theory-based coding followed by inductive coding for emerging themes.

Results Contraceptive access was facilitated by free services, supportive healthcare workers and peer educators, community awareness activities, knowledge of contraception, and private, conveniently located youth-friendly centers. Conversely, cultural and religious expectations, stigma, shame, and misconceptions restricted access. Girls described contraception as being viewed as appropriate for married women and feared being labeled “loose” or immoral if they sought services. Religious and cultural beliefs discouraging premarital sex and contraception further reinforced these barriers. Misconceptions about infertility and serious health effects also generated fear. Structural barriers included contraceptive stockouts and shortages of healthcare providers.

Conclusions Contraceptive accessibility among adolescent refugee girls reflects the interaction of personal beliefs, social norms, and structural conditions. The authors recommend multilevel action that ensures reliable contraceptive supplies and sufficient staffing while strengthening youth-friendly services and community awareness efforts to challenge stigma, shame, misconceptions, and restrictive expectations surrounding adolescent contraceptive use.