Key Social Norms Take-aways This study reveals that anticipated stigma—particularly among young women—linked to emergency contraceptive pill (ECP) use in Accra, Ghana and Lusaka, Zambia is rooted in social norms that conflate ECP use with promiscuity, irresponsibility, or even abortion. While most users did not actually experience stigma when accessing ECPs, fears of judgment from providers, peers, and community members remain high, especially in clinical settings. These fears deter open discussion and routine use. Repositioning ECPs as a normal, on-demand method—rather than solely for emergencies—can help shift social norms and reduce stigma, improving reproductive autonomy and expanding contraceptive choices for vulnerable populations.
Objectives The study aimed to explore beliefs, attitudes, and experiences related to emergency contraceptive pills (ECPs), including their use as a regular on-demand contraceptive method, and to assess stigma and barriers to use among women and men in Ghana and Zambia.
Methods A qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in urban Accra and Lusaka. Participants included women aged 18–35 and men aged 18–30, stratified by ECP user status, marital status, and procurement experience. FGDs were analyzed inductively to explore societal and community norms, while IDIs followed a deductive thematic approach based on a user journey framework.
Results Three major themes emerged: (1) ECPs are widely trusted and often preferred due to their effectiveness, simplicity, and ability to prevent pregnancy after unprotected sex; (2) ECPs are valued as an on-demand method, particularly for those with infrequent sexual activity, but myths about hormonal damage and health risks deter repeated use; (3) anticipated stigma—especially among young women—was much higher than actual experienced stigma, with fears largely centered around provider judgment, community labeling, and social rejection. Pharmacy settings were generally less stigmatizing than clinics. Participants appreciated the privacy and discretion of pharmacies but warned that young or unmarried individuals could still face provider bias or refusal of service.
Conclusions ECPs are a promising option for self-managed contraception, especially in urban African contexts where discretion and control are important. However, their full potential is hindered by persistent myths and strong social norms that stigmatize use, particularly for unmarried or young women. Expanding access to accurate information, supporting pharmacy-based provision, and framing ECPs as safe and responsible for on-demand use could reduce stigma and meet the contraceptive needs of diverse users. Interventions must challenge the norms that pathologize frequent ECP use and promote reproductive autonomy as a legitimate and respected choice.