Adolescents’ agency in negotiating social norms governing sexual and reproductive health services among the Nyasa people of Rural Tanzania

This study examined how adolescents in Rural Tanzania navigate social norms governing their access to Sexual and Reproductive Health Services. Informed by Giddens' Structuration Theory, we adopted a qualitative case study approach. Data were collected between March and June 2025 through 60 in-depth interviews and six focus group discussions (two in each ward) with adolescents and young people aged 14-19, as well as with six healthcare workers in Nyasa District. Thematic analysis, guided by Braun and Clarke's six-step framework, revealed three interrelated patterns of agency: norm reproduction, norm resistance, and norm negotiation. Adolescents and young people reproduced dominant norms by prioritising social acceptance through social conformity and behavioural self-regulation in line with community expectations, resistance through discreet strategies such as covert clinic visits, and norm negotiation by balancing compliance with selective access to services. In a context marked by rural poverty, intergenerational authority, and stigmatising gender expectations, adolescents actively navigated constraints while seeking to maintain dignity and community belonging. This study contributes to scholarship on social norms and adolescent health by advancing a nuanced understanding of how young people exercise agency within a restrictive cultural context. It also offers practical insights into culturally responsive interventions that move beyond policy rhetoric to address lived realities.