Knowledge and Attitudes Toward Sexual and Reproductive Health Among Adolescents Studying in Government Schools in...

Adolescents' sexual and reproductive health (SRH) knowledge and attitudes are critical determinants of future health behaviors and service utilization. In Nepal, despite the inclusion of comprehensive sexuality education (CSE) within the national curriculum, evidence suggests persistent gaps in SRH knowledge and unfavorable attitudes among school-going adolescents, particularly in public school settings. This study aimed to assess the level of SRH knowledge and attitudes and factors associated with favorable SRH attitudes among adolescents.

A school-based cross-sectional study was conducted among adolescents aged 10-19 years enrolled in Grades 8-10 in three purposively selected government schools in Tansen Municipality, Palpa District. Data were collected using a structured, self-administered questionnaire covering SRH knowledge domains (puberty, abortion, sexually transmitted infections, and family planning) and SRH attitudes. SRH knowledge was categorized as poor, moderate, and good for respective domains. Likewise, attitude was measured using 10 Likert-scale statements and categorized as favorable or unfavorable. Descriptive statistics summarized knowledge and attitudes, whereas binary and multivariable logistic regression analyses were used to identify factors associated with favorable SRH attitudes. Results are presented in adjusted odds ratios (AOR) and 95% confidence intervals (CI).

Among the 228 participants, moderate knowledge was most common across SRH domains, whereas good knowledge remained limited. Nearly two-thirds (62.3%) of adolescents demonstrated unfavorable SRH attitudes. Adolescents with moderate (AOR = 4.41, 95% CI: 1.09-17.83) and good knowledge of abortion (AOR: 4.93; 95% CI: 1.35-17.95; p = 0.016) were significantly more likely to have favorable SRH attitudes compared with those with poor knowledge.

Lower percentage of adolescents with good SRH knowledge and higher percentage with unfavorable attitudes highlight gaps in SRH education in government schools. CSE, including abortion-related education, could be prioritized in government schools to uplift the SRH knowledge and attitudes.