Key Social Norms Take-aways This study underscores how entrenched gender norms in the Simiyu region of Tanzania severely restrict women’s and girls’ access to reproductive health services. Norms that prioritize male authority, devalue women’s autonomy, and equate female worth with childbirth reinforce systemic barriers to healthcare. Women face stigma and even violence for using family planning without spousal consent, while responsibilities like household labor and lack of control over resources further limit their time and mobility. Despite these constraints, the study also identifies emerging shifts through community sensitization and increased women’s participation in decision-making, offering a pathway for transforming harmful norms.
Objectives The study aimed to identify gender-based enablers and barriers that influence women’s and girls’ access to and utilization of reproductive, maternal, newborn, child, and adolescent health (RMNCAH) services in Simiyu Region, Tanzania, with a particular focus on how gender norms, roles, decision-making, and access to resources shape health outcomes.
Methods A cross-sectional qualitative study was conducted using 16 focus group discussions (FGDs) and 30 in-depth interviews (IDIs) across three districts (Bariadi, Busega, and Meatu) in the Simiyu Region. Participants included married and unmarried women and men, adolescents, community leaders, health workers, and local officials. Data were collected through semi-structured guides and analyzed thematically using NVivo software, based on a conceptual framework adapted from ecological systems theory.
Results Four major thematic areas were identified: (1) Gender social norms dictate that men are household decision-makers and restrict women’s use of family planning and maternal health services. Women often seek care in secret due to fear of reprisal. (2) Decision-making power is concentrated with men, and women’s health decisions require male consent—even in emergencies—leading to delayed care and adverse outcomes. (3) Gendered roles burden women with domestic and economic tasks, limiting time for health care. (4) Access to resources is highly unequal; women lack control over finances, land, and assets, impeding their ability to seek timely care. Boys are prioritized over girls for resources and education, further entrenching inequality.
Conclusions Social norms that reinforce male dominance, female subordination, and unequal resource distribution are major barriers to RMNCAH service utilization. Addressing these inequities requires community-wide interventions that promote gender-equitable decision-making, empower women economically, and challenge harmful beliefs. The study highlights promising shifts through community awareness and increased women’s roles in decision-making, signaling opportunities for sustainable norm transformation to support women’s reproductive health rights.