Developing Country Studies 2017, Vol.7(5)Generally, adolescents/teenagers sexual and reproductive health (SRH) needs are largely unmet in developing countries despite this group’s size. This paper examines teenage girls’ accessibility to reproductive health services and factors contributing to teenage pregnancy. The study on which the paper is based adopted a crosssectional explanatory design and was conducted in Mtwara Region, Tanzania covering four secondary schools. Teenage girls in the four secondary schools were randomly selected to participate in the study. Data was collected using questionnaires, focus groups discussions and key informant interviews. A total of 156 people participated in the study. Quantitative data was analyzed using SPPS while qualitative data was analyzed using content analysis. Generally, results show that teenage pregnancy is a major problem in Mtwara and the attributing factors include poverty, culture, desire for money, peer pressure, lack of education on reproductive health issues and poor parental support. Results also show that teenagers in Mtwara lack access to youth friendly reproductive health services. Additionally, the findings show a disparity in terms of access to reproductive health services (RHS) between rural and urban teenage girls: those in the urban area had relatively more access compared with their rural counterparts. It is therefore concluded that access to reproductive health services for teenage girls is a serious challenge in Mtwara region. It is hereby recommended it is recommended that households be empowered to earn sufficient income to provide for their families, particular emphasis should be put on non-farm income generating activities. It is also recommended that youth friendly SRH services be established in the study areas; doing so will improve youth’s access to the same.