Key Social Norms Take-aways Social norms shape adolescents’ access to sexual and reproductive health services through intersecting systems of gender, age, economic inequality, religion, and geography. Girls—particularly those who are older, poor, rural, or from conservative religious households—experience compounded stigma, moral policing, restricted agency, and barriers to care, while boys often receive greater social tolerance. Supportive families, schools, and communities can buffer these constraints. The authors argue that improving access therefore requires addressing restrictive norms alongside economic, geographic, and institutional barriers rather than focusing only on service availability. Objectives: The study examined how intersecting social positions and power relations—including gender, age, socioeconomic status, religion, and rural–urban location—shape adolescents’ access to sexual and reproductive health services in Nyasa District, Tanzania.

Methods This qualitative case study included 60 adolescents aged 14–19 years from three wards, with equal representation of girls and boys, and six healthcare providers. Data collected from March to June 2025 included 60 semi-structured adolescent interviews, three mixed-gender focus group discussions with the same adolescents, six key informant interviews with healthcare providers, and review of policy and service documents. Intersectionality Theory guided participant selection, data collection, and analysis. Social norms were explored qualitatively through questions about community norms, authority relations, gender expectations, age hierarchies, religious and cultural expectations, and their influence on decisions to seek services. Data were analyzed using reflexive thematic analysis combining deductive and inductive coding and constant comparison.

Results Four interconnected themes emerged: gendered norms and age hierarchies; socioeconomic and rural–urban disparities; religious and cultural influences; and layered advantage and disadvantage. Girls faced greater stigma for seeking sexual and reproductive health information or services, while boys were generally more socially tolerated. Younger adolescents were often viewed as too immature to seek information, whereas older adolescents—especially girls—were presumed sexually active and stigmatized. Poverty, transportation costs, distance, and limited privacy further constrained rural adolescents. Religious teachings and cultural taboos discouraged contraceptive use and communication about sexuality. Conversely, supportive parents, schools, and progressive communities facilitated access, while poor rural girls experienced particularly compounded disadvantages.

Conclusions Adolescent access to sexual and reproductive health services exists along a continuum shaped by interacting social and structural factors. The authors recommend adolescent-friendly service corners, family and community engagement to challenge restrictive norms, peer-led education, reduced geographic and financial barriers, and youth-friendly, gender-sensitive healthcare to improve equitable access.