'She needs permission': A qualitative study to examine barriers and enablers to accessing maternal and reproductive health services among women and their communities in rural Tanzania

The objective of this study was to examine the factors which serve as barriers and enablers to accessing maternal and reproductive health services among women in rural Tanzania. A qualitative study, utilizing focus group discussions (FGDs), was conducted in three districts. An interview guide was developed that focused on individual or community-based factors affecting women's access to reproductive and maternal health services. Data was collected during December 2017 and May 2018, and analyzed using a thematic approach. The barriers included a lack of autonomy, lack of knowledge and education, travel and transportation barriers, lack of financial resources, lack of infrastructure, lack of confidentiality, lack of male involvement, cultural beliefs, and the use of traditional birth attendants. In contrast, the increased autonomy for women and the implementation of government policies were identified as enablers. Innovations need to be identified that address these barriers in order to increase access to maternal and reproductive health services in these districts.