title: Barriers to access reproductive health care for pregnant adolescent girls: a qualitative study in Tanzania.
abstract: OBJECTIVE
  In Tanzania, approximately 25% of adolescents give birth and 50% more become sexually active during adolescence. We hypothesised that reproductive health education and services for adolescent girls are inaccessible and conducted this study to gain insights into their perceptions of sexually transmitted infections (STIs) and barriers to reproductive health service utilisation in rural Mwanza, Tanzania.
  
  
  METHODS
  We conducted nine focus groups among pregnant adolescents aged 15-20 years. Data were transcribed, translated and coded for relevant themes using NVivo10 software for qualitative data analysis.
  
  
  RESULTS
  Most participants were aware of the dangers of STIs to themselves and their unborn babies, but did not perceive themselves as at risk of acquiring STIs. They viewed condoms as ineffective for preventing STIs and pregnancies and unnecessary for those in committed relationships. Stigma, long waiting times, and lack of privacy in the clinics discouraged adolescent girls from seeking reproductive health care.
  
  
  CONCLUSIONS
  Reproductive health care for adolescent girls who are not pregnant is practically nonexistent in Tanzania. Healthcare access for pregnant young women is also limited. Targeted changes to increase clinic accessibility and to provide reproductive health education to all rather than only pregnant women have the potential to address these gaps.
authors.affiliation: Department of Pediatrics and Child Health, Bugando Medical Centre, Mwanza, Tanzania.
authors.forename: Adolfine
authors.initials: A
authors.lastname: Hokororo
authors.affiliation: Department of Obstetrics and Gynecology, Bugando Medical Centre, Mwanza, Tanzania.
authors.forename: Albert F
authors.initials: AF
authors.lastname: Kihunrwa
authors.affiliation: Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kalluvya
authors.affiliation: National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.affiliation: Center for Global Health, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Fitzgerald
authors.affiliation: Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania.|Center for Global Health, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Downs
mesh_terms: D000293:Adolescent; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D011247:Pregnancy; D011253:Pregnancy in Adolescence; D034121:Reproductive Health Services; D013636:Tanzania
keywords: Adolescent; Mwanza; Pregnancy; Reproductive health; Sexually transmitted disease