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Gendered norms, sexual exploitation and adolescent pregnancy in rural Tanzania
Open accessAbstract
Adolescent pregnancy places girls at increased risk for poor health and educational outcomes that limit livelihood options, economic independence, and empowerment in adulthood. In Tanzania, adolescent pregnancy remains a significant concern, with over half of all first births occurring before women reach the age of 20. A participatory research and action project (Vitu Newala) conducted formative research in a rural district on the dynamics of sexual risk and agency among 82 girls aged 12–17. Four major risk factors undermined girls' ability to protect their own health and well-being: poverty that pushed them into having sex to meet basic needs, sexual expectations on the part of older men and boys their age, rape and coercive sex (including sexual abuse from an early age), and unintended pregnancy. Transactional sex with older men was one of the few available sources of income that allowed adolescent girls to meet their basic needs, making this a common choice for many girls, even though it increased the risk of unintended (early) pregnancy. Yet parents and adult community members blamed the girls alone for putting themselves at risk. These findings were used to inform a pilot project aimed to engage and empower adolescent girls and boys as agents of change to influence powerful gender norms that perpetuate girls' risk.RésuméLa grossesse accroît le risque de mauvais état de santé et de résultats scolaires médiocres chez les adolescentes, ce qui limite leurs moyens de subsistance, leur indépendance économique et leur autonomisation à l'âge adulte. En République-Unie de Tanzanie, la grossesse des adolescentes demeure une grave préoccupation, plus de la moitié des premières naissances se produisant avant que la femme ait 20 ans. Une recherche participative et un projet de mobilisation (Vitu Newala) a mené une analyse formative dans un district rural sur la dynamique de l'activité et des risques sexuels parmi 82 adolescentes âgées de 12 à 17 ans. Quatre principaux facteurs de risque compromettaient la capacité des jeunes filles à protéger leur santé et leur bien-être : la pauvreté, qui les incitait à avoir des relations sexuelles pour satisfaire leurs besoins essentiels, les attentes sexuelles de la part d'hommes plus âgés et d'adolescents, le viol et les rapports sexuels forcés (y compris les abus sexuels à un jeune âge), et les grossesses non désirées. Les rapports sexuels monnayés avec des hommes plus âgés, l'une des rares sources de revenu qui permettent aux adolescentes de satisfaire leurs besoins essentiels, étaient un choix fréquent de nombreuses filles, même s'ils augmentaient le risque de grossesse (précoce) non désirée. Pourtant, les parents et les membres adultes de la communauté tenaient les filles pour uniques responsables des risques encourus. Ces conclusions ont guidé un projet pilote visant à engager et autonomiser des filles et des garçons comme agents du changement pour influencer de puissantes normes sexuelles qui perpétuent les risques pris par les filles.ResumenEl embarazo en la adolescencia coloca a las niñas en mayor riesgo de tener mala salud y consecuencias educativas que limitan sus opciones de sustento, independencia económica y empoderamiento en la adultez. En Tanzania, el embarazo en la adolescencia continúa siendo una gran preocupación, ya que más de la mitad de todos los primeros nacimientos ocurren antes que las mujeres cumplen 20 años de edad. En un proyecto de investigación-acción participativa (Vitu Newala), se realizó un investigación formativa en un distrito rural sobre la dinámica del riesgo y actividad sexuales entre 82 niñas de 12 a 17 años de edad. Cuatro factores principales de riesgo debilitaron la capacidad de las niñas para proteger su propia salud y bienestar: la pobreza, por la cual se vieron obligadas a tener sexo para cubrir sus necesidades básicas; las expectativas sexuales tanto de niños de su edad como de hombres de edad más avanzada; violación y sexo forzado (incluido el abuso sexual a temprana edad); y el embarazo no intencional. El sexo transaccional con hombres de edad más avanzada era una de las pocas fuentes de ingreso que les permitía a las adolescentes satisfacer sus necesidades básicas, por lo cual era una opción común para muchas niñas a pesar de que aumenta el riesgo de tener embarazos no intencionales (a temprana edad). Sin embargo, los padres e integrantes de la comunidad adulta culpaban solo a las niñas por ponerse en riesgo. Estos hallazgos se utilizaron para informar a un proyecto piloto cuyo objetivo era empoderar a las y los adolescentes como agentes de cambio para influir en importantes normas de género que perpetúan el riesgo de las niñas.
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“low self-esteem and inability to resist sexual temptation [23, 28, 30, 31, 35, 38, 39]”
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“poverty [19, 23, 26, 28, 31–34, 36, 38, 41, 45]”
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“Unwanted sexual advances from adult males which often led to coercive sexual relations [19, 28, 31, 35].”
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“Also, unequal gender power relations [19, 27, 28, 30, 31, 35, 38, 39]”
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BackgroundInfluentialVivência de mulheres sobre contracepção na perspectiva de gênero
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“…factors i.e., coercive sexual relations, poverty, religion, early marriage, absence of affordable education, and non-use of contraceptives [7–9]; individual factors, i.e., excessive use of alcohol, substance abuse, educational status, low self-esteem, and inability to resist sexual…”
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“These include poverty that pushed them into having sex to meet basic needs, sexual expectations of older men and boys, age, rape, and coercive sex (including sexual abuse from an early age), and unintended pregnancy [11].”
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“Girls may face difficulties obtaining and paying for contraceptives [23] or for an abortion after an unplanned pregnancy.”
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“Adolescent girls in Tanzania are often coerced into early sexual activity with the prospect of being paid or given small necessities or gifts (Hagues, 2019; McCleary-Sills et al., 2013).”
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“Thus, gender is crucial in understanding the sexual behaviours of adolescents regarding their condom use and sexual experiences [12, 26, 27].”
Teenage mothers report poor health and economic functioning in Western Kenya: A call to action
Jakubowski, A., Nakiyingi, E. K., Wamae, J., Oyugi, S. O., Starnes, J. R., Mudhune, S. A., Nyawade, B., Ochieng, W., Kelvin, E., Odhong, T., et al. (2025) · PLOS Global Public Health · doi:10.1371/journal.pgph.0004732 · Cited by 6
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BackgroundGebeyehu, A. A., Teshome, A. A., Teshager, W., Dagnaw, F. T., Tiruneh, M., Dessie, A. M., Anely, D. T., Tesfaw, A., Damtie, D. G., & Yenew, C. (2023) · PLoS ONE · doi:10.1371/journal.pone.0287460 · Cited by 3
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BackgroundAdverse Childhood Experiences and Child Sexual Exploitation in Ghana
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Multilevel Analysis of Childbearing in Childhood in Tanzania’s Rufiji District
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“An occurrence of sexual intercourse before age 15 is more likely to be unplanned than after that age [20], and consequently heightens chances of both unplanned pregnancy and sexually transmitted infections (STIs), including HIV/ AIDS [21].”
BackgroundResultInfluentialNkata, H., Marques, S. C. S., Nyamhanga, T. M., & Barros, H. (2021) · Porto Biomedical Journal · doi:10.1097/j.pbj.0000000000000141 · Cited by 3
“expulsion due to pregnancy also made some parents to tolerate or even actively support the early use of contraception by their daughters.(26)”
BackgroundPERAN KOMUNITAS DALAM PENCEGAHAN KEHAMILAN TIDAK DIINGINKAN PADA REMAJA
Pertiwi, N. F. A. (2020) · Midwifery Journal Jurnal Kebidanan UM Mataram · doi:10.31764/mj.v5i2.1855 · Cited by 3
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“According to research conducted by McCleary-Sills et al. (2013),”
Petlele, R., Mkwananzi, S., & Odimegwu, C. O. (2024) · Journal of Public Health · doi:10.1007/s10389-024-02361-5 · Cited by 2
“Poverty makes girls susceptible to exploitation as they engage in sex in exchange for money to meet their basic needs such as ‘school fees, food, clothing, health care and transporta-tion’ (McCleary-Sills et al. 2013).”
Caregiver attitudes towards HIV testing and contraceptive services for adolescents in Tanzania
Alexander, K., Gitagno, D., Mtei, R. J., Minja, A., Lema, I., Egger, J. R., van Praag, E., Kaaya, S., & Baumgartner, J. N. (2025) · AIDS Care · doi:10.1080/09540121.2025.2569975 · Cited by 2
“…can have a wide array of consequences for girls, including health complications during pregnancy or labor for both mother and baby, challenges associated with miscarriages and abortion, and educational disruption (McCleary-Sills et al., 2013; Mombo-Ngoma et al., 2016; Triantafyllidi et al., 2024).”
Kakuru, D. M. (2023) · Women · doi:10.3390/women3020024 · Cited by 2
Which rights matters: Girls’ education at the expense of their sexual and reproductive rights?
Lövgren, L. (2024) · World Development Perspectives · doi:10.1016/j.wdp.2024.100571 · Cited by 3
Philibert, L., & Lapierre, J. (2022) · Sexologies · doi:10.1016/j.sexol.2022.01.001 · Cited by 2
(2021) · International Journal of Research in Sociology and Anthropology · doi:10.20431/2454-8677.0603003 · Cited by 1
“…2016; Wood & Hendricks, 2017), peer influence (Salami, Ayegboyin & Adedeji, 2014; Mushwana et al., 2015), sexual violence based on a power imbalance between the two sexes (McCleary-Sills et al., 2013; Atuyambe et al., 2015), and the poverty of adolescent girls’ families (Gyan, 2013; Lambani, 2015).”
BackgroundPertiwi, N. F. A., Triratnawati, A., Sulistyaningsih, S., & Handayani, S. W. (2022) · Jurnal Kesehatan Reproduksi · doi:10.22146/jkr.69824 · Cited by 2
Mohammed, A., Musah, B. I., Mahmoud, B., Issah, A. D., & Doke, E. (2025) · Journal of Sexual Aggression · doi:10.1080/13552600.2025.2490094 · Cited by 1
“This finding speaks to what has been found in several studies (McCleary-Sills et al., 2013) where there is a social expectation that young adults financially support themselves and their families.”
Cuthbert, G., Likindikoki, S. L., Kakoko, D., & Abeid, M. S. (2025) · PLOS mental health. · doi:10.1371/journal.pmen.0000315 · Cited by 1
“More-over, cultural and societal norms prevalent in Tanzania settings may also play a role, as younger single pregnant women may face stigma and rejection [29], which can add to their existing stressors and contribute to their experience of psychological distress.”
Antabe, R., Sano, Y., Anfaara, F. W., Kyeremeh, E., & Kalolo, A. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-094780 · Cited by 1
“Contextualising the role of poverty in the risk of teenage pregnancy in Tanzania, McCleary-Sills et al 17 opined that it may push adolescents into sexual activities as a means to meet their basic needs.”
Philibert, L., Ngangue, P., Lapierre, J., Mulatris, P., Prophète, A., Kiki, G. M., & Ntanda, G. M. (2023) · Journal of Public Health in Africa · doi:10.4081/jphia.2023.2436 · Cited by 1
“Based on their experience and observation of teenage fertility in Haiti, the participants in this study perceived the following: teenage pregnancy as a problem with multiple determinants, teenage pregnancy as a social problem in Haiti, and the various negative consequences of teenage pregnancy.”
BackgroundUnravelling the gender bind, uncovering the heterogeneity of domination
Murphy, S. P., Shilla, D. J., Chua, C. L., Raphael, C., O’Rourke, N., & Middlehurst-Schwartz, M. (2018) · Comparative Education · doi:10.1080/03050068.2018.1543378 · Cited by 4
“Though literature on gender norms and narratives in the Tanzanian context exists (McCleary-Sills et al. 2013, Posti-Ahokas and Lehtomaki 2014), little has been written at the higher education level.”
BackgroundTeenage Pregnancy: Causes and Counseling Approaches
Kimaiyo, L. C. (2021) · The International Journal of Humanities & Social Studies · doi:10.24940/theijhss/2021/v9/i1/hs2101-015 · Cited by 1
Access to reproductive health and HIV services among young mothers in Tanzania
Obare, F., Almeida, A., Odwe, G., Mwanga, J., Undie, C., Hiza, M., & Mwanga, F. (2017) · doi:10.31899/rh7.1001 · Cited by 1
“Adolescent girls are particularly vulnerable to the risk of unplanned pregnancy and STI/HIV infection because of gender norms that perpetuate poor sexual negotiations (McCleary-Sills et al. 2013; Varga 2003).”
BackgroundMofokeng, P. P. (2021) · ResearchSpace (University of KwaZulu-Natal) · Cited by 2
Mbarushimana, V., Conco, D. N., & Goldstein, S. (2021) · Research Square · doi:10.21203/rs.3.rs-1043620/v1 · Cited by 1
Klugman, J., Hanmer, L. C., Twigg, S., Hasan, T., McCleary‐Sills, J., & Santamaría, J. (2014) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-0359-8_ch3
Self-citationAzende, P. M. (2018) · University of Huddersfield Repository (University of Huddersfield)
Mboneko, N. E., & Iramba, I. F. W. (2022) · Research Square · doi:10.21203/rs.3.rs-2256004/v1
Metadata
- Authors
- McCleary-Sills, J., Douglas, Z., Rwehumbiza, A., Hamisi, A., & Mabala, R.
- Affiliations
- International Center for Research on Women (US)
- Venue
- Reproductive Health Matters
- Publisher
- Informa UK Limited
- Published
- 2013-01
- Volume
- 21
- Issue
- 41
- Pages
- 97-105
- ISSN
- 0968-8080 (ISSN-L)
- 1460-9576
- OpenAlex
- W2039161495
- Cited by
- 76
- References
- 22
- Citations by year
- 2025: 6 · 2024: 9 · 2023: 9 · 2022: 9 · 2021: 12 · 2020: 8 · 2019: 7 · 2018: 5 · 2017: 3 · 2016: 3 · 2015: 3 · 2014: 2
- FWCI
- 4.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Reproductive Health Matters (publishedVersion)
- PubMed (publishedVersion)
- SSRN Electronic Journal (submittedVersion)
- Funders
- ViiV Healthcare
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Adolescent Sexual and Reproductive Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Social Sciences › Sociology and Political Science › Sex work and related issues
- Keywords
- adolescent pregnancy, gender norms, sexual exploitation, transactional sex, unintended pregnancy, sexual risk, rape, sexual abuse, poverty, gender-based violence, rural Tanzania, youth empowerment, unintended pregnancy prevention, adolescent sexual and reproductive health
- MeSH terms
- Adolescent, Age Factors, Child, Female, Gender Identity, Humans, Health Knowledge, Attitudes, Practice, Pilot Projects, Pregnancy, Pregnancy in Adolescence, Sex Work, Risk Factors, Rural Population, Sex Offenses, Socioeconomic Factors, Tanzania, Pregnancy, Unplanned
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