Key Social Norms Take-aways Prevailing social norms in Zimbabwe dictate a moral and reproductive trajectory in which young women are expected to marry, prove fertility by having a child, and only then begin using hormonal contraception. These norms lead many young, nulliparous women to avoid long-acting reversible contraceptives (LARCs), despite their availability, due to fears of infertility and social disapproval. Understanding and addressing these deep-rooted norms is essential for designing effective family planning interventions.

Objectives To explore how social norms and contextual influences shape young women’s contraceptive decision-making in Zimbabwe, especially in relation to uptake of long-acting contraception offered through the CHIEDZA integrated HIV and SRH service.

Methods The study used qualitative methods as part of a nested process evaluation within the CHIEDZA trial. Researchers conducted 72 semi-structured interviews with young female clients and service providers between April 2020 and November 2021 across three provinces in Zimbabwe. Interviews were analyzed thematically using interpretive analysis to explore the influence of social and community norms on contraceptive choices.

Intervention Details The CHIEDZA project is a community-based, youth-friendly integrated HIV and SRH intervention offering short-, medium-, and long-acting contraceptive methods. Initially, LARCs were provided via referral, but were later made available onsite. Despite this, uptake of LARCs remained low. The intervention also included contraceptive counseling and education by trained providers.

Results Despite free and accessible contraceptive options, only 38.7% of young women accessing CHIEDZA used any family planning, and fewer than 4% opted for LARCs. The dominant rationale among young women was to avoid contraceptives, especially LARCs, before proving fertility. Fear of infertility, influenced by peers, community members, and even some health providers, drove preferences for condoms or short-acting methods. Hormonal methods became socially acceptable only after childbirth. A few women diverged from this norm, valuing discretion and long-term protection, but faced stigma and misinformation.

Conclusions Social norms around fertility and womanhood strongly influence contraceptive decisions, often outweighing clinical advice or availability. Effective public health strategies must engage with community influencers and address misinformation to realign services with the social realities and reproductive intentions of young women.