INTRODUCTION:
South Africa has a progressive legal framework permitting access to safe abortion. Despite this, unsafe abortion remains common, particularly among adolescent girls and young women. Abortion stigma has been identified as a key barrier to accessing safe services, yet limited research has examined how social norms and community attitudes shape this stigma. This study explores perceptions and understandings of abortion stigma among healthcare providers, educators, faith leaders, and community stakeholders in two urban townships in Cape Town, South Africa.

METHODS:
This study reports on a secondary analysis of qualitative data from an exploratory study conducted in Khayelitsha and Gugulethu. Ten in-depth interviews were undertaken with healthcare providers, teachers, faith leaders, and community organisation representatives. Interviews were analysed thematically using the Social Ecological Model to examine how abortion stigma operates across individual, interpersonal, institutional, community, and structural levels.

RESULTS:
Abortion stigma emerged as a multi-layered and deeply entrenched reality. At the individual level, adolescent girls and young women were perceived to internalise shame, guilt, secrecy, and fear related to abortion. Interpersonal dynamics, including parental silence, peer gossip, and moral judgement, reinforced isolation and fear of disclosure. At the institutional level, judgemental attitudes, knowledge gaps, and inconsistent practices among healthcare providers undermined trust in services. At the community and structural levels, prevailing socio-cultural norms, religious teachings, and dominant cultural narratives positioned abortion as morally unacceptable, perpetuating stigma despite legal protections.

CONCLUSIONS:
The persistence of abortion stigma reflects a paradox between progressive legislation and deeply rooted social, cultural, and institutional norms. Addressing stigma requires coordinated, multi-level interventions, including values clarification training for healthcare providers, strengthened Comprehensive Sexuality Education through schools, families, and digital platforms, and community engagement strategies. Reducing stigma is essential to ensuring equitable access to safe abortion services for adolescent girls and young women in South Africa.