Barriers to uptake of reproductive information and contraceptives in rural Tanzania: An intersectionality informed qualitative enquiry

Objectives: Access to reproductive information and contraception continues to be a critical unmet need in Tanzania and impedes the realization of reproductive health rights. This study examined key sources of reproductive information and contraception (RIC) and the factors influencing their uptake by women in Mbeya region of Tanzania. Setting: This qualitative study was undertaken in a rural ward in a district in the south of the Mbeya Region Participants: In-depth interviews were undertaken with 48 women users and two nurses working in public health facility, and focus group discussions with 16 home-based care workers in the district. Participants were recruited through a local NGO in the region, and via snowball sampling. All interactions were recorded, translated and transcribed and sought to identify the available resources and barriers in utilising them. Results: Participants reported six main sources of reproductive information and contraceptives: public health facilities, non-governmental organization (NGO) mobile clinics, other women, Mganga wa Asili (witchdoctors/traditional doctors), and Duka la Dawa (Pharmacy). Women users and healthcare workers identified a range of individual (age, marital status, geography) and health system-wide factors shaping women’s reproductive choices and preventing uptake of contraceptives. The study also revealed structural factors such as gender, ethnicity, indigeneity as key determinants of access and health seeking, placing women from Sukuma and Maasai communities is most disadvantageous position. Historical social disadvantage, patriarchal social controls and the pressure to preserve socio-cultural traditions that women experience in the Maasai and Sukuma tribes underpin their disconnect from mainstream services. Conclusion: Women’s reproductive choices and their uptake of contraceptives are shaped by the interaction of a range of individual, household, institutional and structural factors. An intersectional lens enables examination of the ways in which these factors interact and mutually constitute disadvantage and privilege.