An intersectional analysis of social norms affecting adolescent access to sexual and reproductive health services in rural Tanzania

Abstract

This article examines how intersecting and mutually reinforcing social positions and power relations, including gender, age, socioeconomic status, religion, and rural–urban location, shape adolescents’ access to sexual and reproductive health services (SRHS) in Nyasa District, Tanzania. The study employed a qualitative case study design, collecting data through 60 semi-structured interviews and six focus group discussions with adolescents aged 14–19, six key informant interviews with healthcare providers, and a review of relevant policy and service documents. Data were analyzed thematically to identify patterns in adolescents’ engagement with social norms and the intersecting barriers to SRHS access. Findings revealed four main patterns affecting SRHS access: gendered norms and age hierarchies; socioeconomic and rural–urban disparities; religious and cultural intersections; and layered advantages and disadvantages reflecting power and structural inequality. Girls, particularly those who are rural, older, poorer, or from conservative religious backgrounds, faced compounded stigma and restricted mobility, whereas boys often experienced conditional privilege. Barriers to accessing sexual and reproductive health services included poverty, long distances to health facilities, and restrictive cultural norms. At the same time, supportive families, schools, and progressive communities facilitated resilience and better access to services. Access to SRHS among adolescents exists along a continuum rather than uniformly. The study highlights the importance of establishing adolescent-friendly service corners, strengthening family and community involvement, implementing peer-led education, and addressing geographic and financial barriers to promote equitable SRHS access in rural Tanzania.