Key Social Norms Take-aways This study reveals that entrenched socio-cultural and religious norms in Northwest Ethiopia strongly disapprove of premarital sex, discourage adolescent sexual and reproductive health (SRH) service use, and inhibit open communication about sexuality between adolescents and adults. While the study does not use formal social norms theory or measurements (e.g., injunctive or descriptive norms), it provides rich qualitative evidence of prevailing expectations and sanctions that function as injunctive norms. These include expectations of virginity until marriage, shame associated with contraceptive use, and cultural taboos around discussing SRH topics. Critically, the study finds that these norms persist equally in areas with and without the Youth Friendly Services (YFS) program—suggesting that the YFS intervention has not effectively shifted community-level norms. To improve adolescent SRH outcomes, YFS interventions must more directly address and engage with local norms.

Objectives To explore whether socio-cultural norms influencing adolescent SRH behavior differ between areas with and without Youth Friendly Services (YFS) programming.

Methods A qualitative case study design was used. Data were collected in 2019 from 112 participants across YFS program and non-program areas using semi-structured interviews, 12 focus group discussions, 18 key informant interviews, and 4 in-depth interviews. Participants included unmarried adolescents, parents, community elders, religious leaders, teachers, and health professionals. Data were thematically analyzed using prior codes developed from the interview guide.

Results The study found no major difference in socio-cultural norms related to adolescent sexuality between YFS program and non-program areas. In both contexts, premarital sex was strongly stigmatized, especially for girls. Communication between parents and adolescents about SRH was minimal due to embarrassment, fear of encouraging sexual activity, and taboos about discussing reproductive anatomy. SRH service utilization by unmarried adolescents was perceived as inappropriate and immoral. Religious leaders and community members rejected contraceptive use for unmarried youth and associated it with sin. As a result, adolescents—particularly girls—often concealed pregnancies or sexually transmitted infections, avoiding available health services out of fear of judgment.

Conclusions Cultural and religious norms continue to govern adolescent sexuality, creating significant barriers to SRH communication and service use. The YFS program, as implemented, has not shifted these norms. Future efforts must explicitly engage with social norms and address community-level beliefs and taboos to effectively support adolescent SRH.