Key Social Norms Take-aways In Uganda, restrictive gender norms, social stigma, and patriarchal power dynamics profoundly shape how young women experience unintended pregnancy and unsafe abortion. While abortion is socially condemned and legally ambiguous, young women enact agency through clandestine abortions as a means of reclaiming control over their futures. The decision to abort is framed as both a moral failure and a moral responsibility, reflecting deep normative contradictions. Secrecy serves as a key strategy to navigate stigma, but it also delays care and increases health risks. These norms place the burden of reproductive responsibility on women while simultaneously limiting their choices, highlighting the urgent need for norm-shifting, gender-sensitive reproductive health services.
Objectives To explore how young women in Uganda negotiate reproductive agency in the context of unintended pregnancy and unsafe abortion, and how gender norms and power imbalances influence their decisions and experiences of post-abortion care.
Methods A qualitative study was conducted with 18 in-depth interviews among 17 young women aged 15–25 seeking post-abortion care at a national referral hospital in Kampala. Interviews explored the social, relational, and institutional factors surrounding their abortion decisions. Thematic analysis was used, applying Ortner’s theory of agency to interpret how women navigated constraints and asserted control within a power-laden social context.
Results Participants reported significant power imbalances in relationships, limited access to contraception, and coercion in sexual encounters. Abortions were often pursued in secrecy due to fear of social condemnation, family rejection, and reputational harm. Social norms associated abortion with immorality and “failed womanhood,” yet many women viewed it as the only viable path to preserve education, economic security, and future opportunities. Secrecy delayed care-seeking and contributed to health complications. Despite constrained circumstances, women demonstrated strategic agency—making calculated decisions to protect themselves, resist male control, and shape their reproductive trajectories. Post-abortion, many expressed strong intentions to use contraception, often asserting a newfound sense of autonomy.
Conclusions Young Ugandan women’s abortion decisions reflect both structural disempowerment and acts of resistance within rigid gender and social norms. Abortion can be an agentive act, even when undertaken in conditions of inequality and risk. Health systems must recognize this complexity by offering respectful, youth-friendly, and stigma-free reproductive health services. Expanding access to post-abortion contraception and promoting norm change around adolescent sexuality and reproductive rights are critical steps toward enabling reproductive agency.