Key Social Norms Take-aways Social norms surrounding pregnancy, marriage, motherhood, and abortion substantially constrained young women’s reproductive decision-making. Fear of parental rejection, community gossip, stigma, and reputational damage made pregnancy outside marriage—particularly while attending school—socially unacceptable and sometimes made abortion appear to be the only viable option. The discussion emphasizes that these pressures interact with restrictive abortion laws, economic dependence, gendered relationship dynamics, and limited reproductive health access, suggesting a need for community-level efforts to reduce stigma and strengthen social support alongside broader policy and service reforms.

Objectives The study explored factors shaping abortion decision-making among young women admitted with abortion-related complications at a referral hospital in Namibia, examining individual, interpersonal, community, and structural influences within a restrictive legal context.

Methods Researchers used a qualitative exploratory descriptive design and conducted 15 in-depth, semi-structured interviews with women aged 16–24 who were admitted with abortion-related complications. Participants were purposively sampled for variation in age, education, pregnancy history, and type of abortion complication. Interviews explored pregnancy experiences, decision-making, influencing factors, information and support, and perceptions of abortion legislation. Data were analyzed thematically using a socio-ecological framework and a combined deductive-inductive coding approach. Social norms were examined qualitatively through participants’ accounts of parental and community expectations, stigma and gossip, expectations that childbearing occur within marriage, religious beliefs about abortion, and partner and family influences.

Results Fear of social consequences was the strongest influence on decision-making: nine of ten participants attending school cited fear of parental reactions, while eight of 15 described fear of gossip or community judgment. All ten participants attending school identified educational concerns as important. Partner abandonment, pressure to terminate pregnancies, misinformation, and limited knowledge of legal abortion options further constrained decision-making. Cultural expectations that childbearing should occur within marriage stigmatized pregnancy and single motherhood outside marriage, while religious teachings contributed to guilt and moral conflict around abortion.

Conclusions Young women’s abortion decisions were shaped by interconnected social, economic, interpersonal, and structural pressures. Restrictive abortion laws combined with stigma, limited contraceptive access, and economic vulnerability to constrain reproductive autonomy and contribute to unsafe abortion-seeking. The authors call for abortion law reform, improved youth-friendly reproductive health services and contraceptive access, and interventions addressing stigma, social support, gender inequalities, and the economic conditions limiting young women’s choices.