Key Social Norms Take-aways Social norms around adolescent sexuality, fertility, and contraceptive use significantly shape contraceptive conversations and decision-making among adolescent girls and young women (AGYW) in Malawi. Unmarried and nulliparous AGYW face the greatest communication barriers due to stigma and cultural expectations that link contraceptive use to promiscuity and nonbarrier methods to infertility. These norms suppress conversations, restrict access to accurate information, and limit the use of effective contraceptive methods. Tailored interventions must dismantle these social norms and expand supportive communication channels, especially for the most vulnerable AGYW.

Objectives This study aimed to examine the content, context, and impact of contraceptive conversations between AGYW and their intimate partners, peers, and older female family members in Lilongwe, Malawi, and to explore how these interactions differ based on AGYW’s relationship status and parity.

Methods A qualitative study was embedded in the Girl Power-Malawi quasi-experimental project. Sixty AGYW aged 15–24 were purposively selected for in-depth interviews based on their service uptake and HIV status. Interviews explored contraceptive communication patterns, analyzed using thematic content analysis, with comparisons drawn by marital status and childbearing experience.

Intervention Details The study was part of Girl Power-Malawi, which tested different models of youth-friendly reproductive health service delivery at four health facilities. While this specific article reports qualitative findings, it drew participants from a broader intervention aimed at improving service uptake.

Results Contraceptive conversations were shaped by both the type of social tie and the AGYW’s relationship status and parity. Conversations with partners often served as gatekeepers to contraceptive use, while peers and older women offered method-specific advice. However, unmarried and nulliparous AGYW were less likely to initiate conversations due to fear of judgment or being perceived as sexually active. Myths about nonbarrier methods causing infertility and cultural expectations to demonstrate fertility further discouraged discussions. Participants trusted older women most for accurate information, but such conversations were rare. Fear of partner violence, social stigma, and misinformation undermined AGYW’s ability to advocate for their reproductive health needs.

Conclusions Contraceptive communication patterns reflect and reinforce social norms that hinder access to information and services, particularly for unmarried, nulliparous AGYW. Interventions should address these norms directly by involving partners, peers, and older women as trusted messengers while equipping AGYW with the skills to navigate stigma and misinformation. Communication-based strategies that target these dynamics can enhance contraceptive uptake and reproductive autonomy.