Key Social Norms Take-aways Social norms around gender roles, fertility expectations, and male dominance in reproductive decision-making both constrain and shape women’s contraceptive use; however, women actively navigate and resist these norms through strategies such as asserting bodily autonomy, relying on pragmatic and economic reasoning, and using contraception covertly. Compassionate counselling can help shift perceived norms by legitimizing women’s autonomy and countering misinformation.

Objectives The study aimed to explore how women in central Uganda who used post-abortion intrauterine devices (IUDs) navigated socio-cultural norms, gendered power relations, and barriers to contraceptive use, and how they overcame challenges that typically discourage uptake.

Methods This qualitative study used in-depth interviews with 24 women aged 19–42 who had initiated IUD use following treatment for incomplete abortion across four health facilities in central Uganda (January–August 2023). Data were analyzed using reflexive thematic analysis. Social norms were explored indirectly through women’s narratives about gender roles, fertility expectations, partner influence, stigma, and community perceptions, rather than through standardized quantitative norms measures.

Results Women’s decisions to use IUDs were shaped by a combination of personal autonomy, pragmatic considerations, and economic realities, often in tension with prevailing norms favoring large families and male authority. Many women asserted their right to make reproductive decisions based on the physical burden of pregnancy and financial responsibility for children, even when this conflicted with partner or societal expectations. However, gender norms and power imbalances still influenced decision-making, with some women needing partner approval or anticipating opposition. Compassionate post-abortion contraceptive counselling played a critical role in increasing confidence, dispelling myths, and enabling women to negotiate or justify their choices. A key strategy identified was covert IUD use, which allowed women to circumvent partner opposition, social judgment, and community pressure while still achieving their reproductive goals.

Conclusions The study concludes that women’s contraceptive behaviors are deeply embedded in social norms and power dynamics, but women exercise agency by navigating and, at times, subverting these constraints. High-quality, empathetic post-abortion counselling and support for both overt and covert contraceptive use are critical for enabling women’s reproductive autonomy. Efforts to improve sexual and reproductive health should integrate gender-transformative approaches that address harmful norms and power imbalances while strengthening women’s decision-making capacity.