Understanding the Role of Stigma and Discrimination in Restricting Adolescents’ Access to Sexual and Reproductive Health Services in Tanzania

Agency for International Development, conducted an exploratory study to understand the role of stigma and discrimination in restricting adolescents' access to sexual and reproductive health services in Tanzania. The study aimed to explore the drivers of stigma and its impact on adolescents' access to services and information. Data were collected in two communities in Mwanza region, Tanzania, through participatory focus group discussions and semi-structured in-depth interviews with 191 participants, including young people, parents, healthcare providers, teachers, and a local NGO coordinator. A policy scan was also conducted to provide insight into the policy environment. The study found that stigma and discrimination surrounding adolescent and young people's premarital sexual activity and family planning were strongly evident in both study communities. Social norms, including expectations of appropriate behavior, pressure to maintain social standing, and the importance of fertility and childbearing, emerged as key drivers of stigma. Stigma and discrimination manifested in the family and community through shaming, name calling, isolation, physical punishment, and withdrawal of emotional and economic support. In health facilities, stigma and discrimination manifested through shaming, scolding, and excessive questioning from healthcare providers, and sometimes refusal of service. Secondary stigma felt by family members was also evident, reflecting the central importance of upholding social standing and how violations of social norms governing 'proper' or 'socially acceptable' behavior can undermine the social standing of not only the individual adolescent, but his or her family. The study highlights the prevalence of two key misconceptions related to stigma and SRH behavioral outcomes: the belief that knowing about contraception and access to SRH services would encourage promiscuity, and the misconception that use of hormonal contraception during one's adolescent years will lead to sterility later in life. Fear of disclosure and severely limited communication between adolescents and adults on SRH topics also emerged as factors affecting stigma and discrimination.