Background <p>In Malawi, adolescents and young people face significant health system barriers when accessing sexual reproductive health services, including post-abortion care. Overall, 60% of all abortion cases result in complications requiring medical treatment, a burden that disproportionately affects young girls. This study aimed to explore the lived experiences of adolescent girls and young women receiving post-abortion care at Thyolo district hospital, a secondary hospital located in southern Malawi.</p> Methods <p>An interpretive phenomenological design was employed with 15 participants selected through purposive sampling. Data was collected through in-depth interviews and analysed using inductive thematic analysis. The social ecological model was adopted as a conceptual lens for discussing the results.</p> Results <p>Participants described intense emotional responses such as shame, fear, confusion, and relief upon recognising the need for post-abortion care. Family and social support, healthcare referral systems and guidance, transportation, and socioeconomic status significantly influenced the decision to seek care. In addition, community bylaws, perceived benefits, and prior experiences also shaped their decisions to utilise care.</p> Conclusion <p>Adolescent girls and young women’s interactions with their environment shape their experience of post-abortion care. Therefore, aside from strengthening referral and diagnostic systems, improving young women’s experiences of post-abortion care necessitates multilevel interventions that combine community and healthcare provider sensitisation.</p>