Introduction Despite being recognized as a human right by the United Nations, contraception remains inaccessible for many newcomer youth in Canada. Through this national qualitative investigation, called ‘Ask Us’, we investigated the experiences, attitudes, and decision-making needs of newcomer youth in Canada.

Methods This study was co-designed with youth patient partners and settlement service providers (SSP) and guided by constructivist grounded theory. Youth peer researchers conducted national, community-based outreach to advertise the study with underserved youth. We conducted one-on-one videoconference interviews with newcomer youth of all genders, aged 15 to 25, living across Canada. After transcribing audio-recorded interviews, we completed an inductive analysis to identify youth’s decisional needs for contraception choices. We then conducted a deductive analysis using Levesque’s Patient-centred Access to Healthcare framework, identifying opportunities to implement shared decision-making interventions.

Results Analysis of 14 newcomer youth interviews resulted in three themes about youth’s contraception decisional needs: a) Sex is a shameful thing that we don’t talk about; b) Preferring discreet contraception options that allow youth to ‘Grab n Go’; and c) I think you learn from and trust your friends. We also identified that youths’ ‘Ability to Seek and Pay’, and ‘Ability to Perceive and Engage’ with contraception prescribers in the health system constrained their ability to make values-congruent choices.

Discussion Newcomer youth’s perspectives highlight that stigma, confidentiality, and social influences are key factors in their contraception choices. Our results indicate the need to provide newcomer youth with tailored information, and decision-making resources for contraception. Involving SSPs in interprofessional shared decision-making may further support newcomer youth in navigating the healthcare system.

Conclusion Shared decision-making interventions for newcomer youth may be tailored to address issues of stigma, confidentiality, and the social influence of peers on contraception choices.