In Tanzania, the problem of early sexual initiation among adolescent girls and adolescent girls and young women has remained a persistent public health and human rights challenge that continues to draw the attention of policymakers. Evidence suggests that in some parts of the country, as much as 70% of women had their sexual debut as minors, underscoring the urgency to understand all drivers of early sexual debut among this population. While scholars have pointed to addressing a range of factors that work to expose adolescent girls and young women to early sexual initiation, the role of coercion at first sex has been less explored.

We used cross-sectional data from the 2022 Tanzania Demographic and Health Survey.

A total sample of 1242 sexually active unmarried adolescent girls and young women aged 15–24.

Our study relied on logistic regression models to examine the role of coerced sex on early sexual initiation among sexually active unmarried adolescent girls and young women aged 15–24 years in Tanzania.

We found that 31% and 14% of sexually active unmarried adolescent girls and young women experienced early sexual initiation and coerced first sex, respectively. At the bivariate level, we discovered that those who indicated that they willingly wanted to have their first sex were less likely to initiate sex early (OR=0.44, 95% CI 0.27 to 0.72). At the multivariate level, the significance of these relationships largely holds, even after sequentially accounting for sociodemographic (OR=0.50, 95% CI 0.30 to 0.82) and HIV-related characteristics (OR=0.50, 95% CI to 0.30 to 0.83).

We recommend re-examination of policy addressing early sexual initiation in Tanzania by incorporating coerced sex as one of the major determinants needing urgent attention. Intensifying awareness creation on the risk of early sexual initiation through coerced sex, especially among adolescent girls and boys, will go a long way to help reduce the incidence of early sexual initiation.

Achieving universal health coverage requires the use of health research evidence in decision-making; however, this remains understudied in lower and middle-income countries (LMICs) such as Tanzania. Despite several health sector reforms and the availability of locally generated research, evidence indicates that the use of such research in health planning and decision-making remains limited in Tanzania, creating a gap between research production and its practical application. This study examined the extent of research evidence used in health planning and the factors influencing its use among health planning teams.

A sequential exploratory mixed-methods design was employed, starting with qualitative data from focus group discussions (N=6) and KIIs (N=34) with health planners from selected regions in Tanzania, recruited based on their direct involvement in health planning, using semistructured guides informed by the Capability, Opportunity, Motivation-Behaviour (COM-B) model. This was followed by a quantitative survey of 422 participants meeting the same inclusion criteria, administered with a structured questionnaire derived from the model. The COM-B framework guided both tool development and analysis. Qualitative data were thematically analysed using a framework approach, yielding three themes, while quantitative data were analysed using descriptive statistics and binary logistic regression.

Qualitative findings revealed barriers such as limited knowledge and skills, inadequate access to knowledge translation tools, poor dissemination processes, financial and technical constraints, and lack of training. Opportunities included supportive guidelines, research coordinators, collaborations, dedicated budgets and improved internet access. Motivators such as job promotions, professional development, allowances and targeted training were also identified. Quantitative results showed moderate evidence use (66.2%), slightly higher than in other LMICs. Barriers included suboptimal dissemination (74.5%; OR=2.035, p=0.0008), inadequate resources (70.0%; OR=0.965, p=0.8759) and lack of training (63.7%; OR=1.361, p=0.1806). Integrated findings highlighted convergence on dissemination, resource and training challenges, with divergence in statistical significance between methods.

Barriers related to dissemination, resources and training hinder evidence use. Interventions such as digital repositories, guideline development and capacity building, alongside institutionalised frameworks, resource allocation and accountability mechanisms, are essential to strengthen evidence-based health planning in Tanzania.