Key Social Norms Take-aways Social norms around adolescent sexuality, parental authority, and family communication strongly shape adolescents’ access to sexual and reproductive health (SRH) services. Caregivers widely endorsed norms that adolescents are “too young for sex” and should not seek SRH services without parental knowledge, which discourages independent access to contraception. In contrast, HIV testing was more socially accepted, suggesting that HIV testing has become normalized in some communities, though caregivers still prefer adolescents to test with adult support. These norms can limit adolescents’ ability to access services independently even when national policies permit it.

Objectives This study examined factors shaping caregivers’ attitudes toward adolescents independently accessing contraception and HIV testing and counseling (HTC) services in Tanzania, and explored differences in attitudes by service type and adolescent gender.

Methods The study used qualitative methods, conducting 42 semi-structured interviews with parents and guardians of adolescents participating in the VITAA study in Tanzania. Interviews were translated and analyzed using deductive thematic analysis informed by the extended Theory of Planned Behavior for parent-for-child health behaviors, focusing on caregiver attitudes, perceived community norms, and perceived behavioral control over adolescent behavior.

Intervention Details Not applicable. The interviews were conducted within the broader VITAA cluster randomized trial evaluating a school–clinic partnership for adolescent wellness visits, but this paper reports only qualitative findings from caregiver interviews.

Results Caregivers were more supportive of adolescents independently accessing HIV testing than contraception. About 57% supported independent HIV testing, compared with 26% supporting independent contraceptive access. Positive attitudes toward HIV testing were driven by the belief that adolescents should know their health status, though caregivers worried adolescents might struggle to cope with positive results or fail to share results without adult support. Attitudes toward contraception were more negative and shaped by norms that adolescents should not be sexually active, concerns that contraception would encourage sexual behavior, and misinformation about infertility risks. Gender norms also influenced attitudes, with caregivers of girls more likely to emphasize pregnancy prevention and infertility concerns due to the greater social consequences of adolescent pregnancy for girls.

Conclusions Caregiver attitudes toward adolescent SRH services reflect tensions between protecting adolescent health and enforcing social norms around sexuality and parental authority. While HIV testing is increasingly accepted, resistance to contraceptive access remains strong. Addressing caregiver concerns and social norms through targeted communication and education may help improve adolescent access to SRH services.