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Knowledge and risk factors of sexual and reproductive health among adolescents
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Received: ,
Accepted: ,
How to cite this article: Emenike KK, Sanni OF, Musibau TA. Knowledge and risk factors of sexual and reproductive health among adolescents. J Reprod Healthc Med. 2026;7:5. doi: 10.25259/JRHM_41_2025
Abstract
Objectives:
Adolescents in rural communities of Nigeria often face significant challenges regarding sexual and reproductive health (SRH), including limited access to accurate information, services, and support systems. This study explored the knowledge and risk factors associated with SRH among adolescents in the rural area of Oyo State, Nigeria.
Materials and Methods:
A mixed-method cross-sectional study design was adopted. Quantitative data were collected from 240 adolescents aged 10–19 years, using interviewer-administered questionnaires through an open data kit, while qualitative data were obtained through 12 Focus Group Discussions. Quantitative data were analyzed using the Statistical Package for the Social Sciences (Version 28) with descriptive and inferential statistics, while thematic analysis was used for qualitative data through qualitative data analysis (QDA) Miner.
Results:
A total of 54.2% of adolescents had poor SRH knowledge, while 48.8% reported engaging in risky SRH behaviors. Although 89.2% had heard of condoms, only 14.0% reported using them. Older adolescents (15–19 years) were significantly more likely to have good SRH knowledge (adjusted odds ratio [AOR] = 4.96; p = 0.046), as were those with tertiary education (AOR = 17.44; p = 0.012) and those with sexual partners (AOR = 3.64; p < 0.001). Female adolescents had significantly higher odds of engaging in risky behaviors compared to males.
Conclusion:
Adolescents in this surveyed setting face substantial SRH challenges due to inadequate knowledge, low service utilization, and socio-cultural constraints. There is a critical need for comprehensive sexual education, expansion of youth-friendly SRH services, and community-based interventions that address gender norms and cultural barriers to support safe and informed adolescent decision-making in rural settings.
Keywords
Adolescent sexual and reproductive health
Rural Nigeria
Sexual risk behavior
Sexual and reproductive health knowledge
INTRODUCTION
Adolescents aged 10–19 represent a rapidly growing segment of the global population, accounting for approximately 16% worldwide and nearly 23% in Sub-Saharan Africa.[1] This demographic faces considerable sexual and reproductive health (SRH) challenges that remain inadequately addressed, particularly in low- and middle-income countries (LMICs). The World Health Organization (WHO) underscores the importance of adolescent SRH, citing a high prevalence of early and unintended pregnancies, unsafe abortions, sexually transmitted infections (STIs), including HIV/acquired immunodeficiency syndrome (AIDS), and sexual violence and coercion as major concerns globally.[2,3] These outcomes are often exacerbated by inadequate access to SRH information, services, and comprehensive sexuality education (CSE), especially in rural areas.[4]
Globally, adolescents are engaging in sexual activity at earlier ages, often in the absence of adequate knowledge or protection, while marriage is increasingly delayed, leading to a longer period of vulnerability between sexual debut and union.[5] This trend is especially concerning in Sub-Saharan Africa, where weak social, economic, and political systems hinder young people’s transition to adulthood. Over 60% of unintended adolescent pregnancies in the region result from limited contraceptive access, poor knowledge, and sociocultural taboos.[6] Nigeria exemplifies this trend, with a median age at sexual debut of approximately 15 years, and rural areas consistently recording higher rates of early pregnancies and lower contraceptive use.[7]
Rural communities like those in Oyo State, Nigeria, are disproportionately affected by poor infrastructure, weak health services, and sociocultural barriers. Adolescents in these areas often have limited SRH knowledge and minimal access to youth-friendly services.[8] Nigeria’s rural areas are usually defined by poor transportation systems, the absence of health professionals, and prevailing traditional norms that discourage open discussions around sexuality. As a result, adolescents are left to rely on inaccurate sources such as peers or unregulated media for information on SRH.[9]
Studies from other Sub-Saharan African countries and LMICs support these findings. In Uganda, Kenya, and Ghana, adolescents often report low SRH literacy, poor contraceptive access, and service-related stigma, leading to high rates of teenage pregnancy and STIs.[10,11] Furthermore, gender inequality, poverty, and harmful cultural practices further reinforce poor outcomes for girls in these contexts.[6]In Nigeria, condom usage remains low among sexually active adolescents, and when used, it is often incorrectly or inconsistently applied, further increasing the risk of STIs and unintended pregnancies.[12] A recent study found that adolescents’ reluctance to access SRH services stems not only from misinformation but also from fear of stigmatization and lack of confidentiality at healthcare facilities.[13] These findings align with reports by the United Nations Population Fund (UNFPA) and WHO, both of which emphasize the need for youth-friendly, accessible, and confidential SRH services to improve outcomes among adolescents.[2,14,15]
Understanding the knowledge and risk factors affecting SRH among adolescents in rural areas of Nigeria is critical for developing localized and culturally sensitive interventions. Research has shown that interventions tailored to the specific needs of adolescent populations can significantly improve SRH outcomes.[14] However, a major gap in teenage health research is the scarcity of granular, community-level data, particularly in underserved areas like those in Nigeria. Without this data, programs and policies risk being misaligned with the lived realities of adolescents, reducing their effectiveness. This study aims to fill this critical gap by examining the level of knowledge and perceived risk factors related to SRH among adolescents in rural areas of Oyo State. By doing so, it contributes to the broader goal of improving adolescent SRH in Nigeria and comparable low-resource settings worldwide.
MATERIALS AND METHODS
Study design
This study utilized a mixed-methods approach to explore knowledge levels and risk factors on SRH among adolescents in Irepo Local Government Area (LGA), Oyo State, Nigeria. The quantitative component employed a descriptive cross-sectional survey, while the qualitative arm involved focus group discussions (FGDs). The quantitative survey was conducted using a structured, interviewer-administered questionnaire programmed through Open Data Kit (ODK). At the same time, the FGDs explored in-depth perceptions on parental roles, SRH challenges, and adolescent perspectives.
Study area
The study was conducted in Irepo LGA, a rural, agrarian district located in the northern part of Oyo State, Nigeria, with Kisi as its administrative headquarters. Irepo spans 1,010 km2 and is estimated to have a population of 173,300 as of 2022. The LGA comprises 10 wards: Agoro, Atipo, Iba I–V, Ikolaba, and Laha/Ajana. It borders Olorunsogo and Oorelope LGAs to the east and west and Baruten and Kaiama LGAs in Kwara State to the north. Agriculture is the primary occupation of over 88% of its residents, earning it the moniker “Food Basket of Oyo State.”
Study population
The target population consisted of adolescents aged 10– 19 years residing in selected communities within Irepo LGA. The age range is consistent with the WHO definition of adolescence. Both in-school and out-of-school adolescents were included to ensure a diverse, representative sample.
Sample size determination
The sample size was determined using Fisher’s formula for sample size estimation in population-based surveys:
Where n = the desired sample size
z = the standard normal deviate set at 1.96 (95% confidence interval)
p = the proportion of the target population estimated to be 28.0% of the total population (173,300) (NPC, 2022)
q = 1-p (1 - 0.28 = 0.72) d = desired level of accuracy, set at 0.05
n = 310
The non-response rate (NRR) will be calculated at 10%
NRR = 10/100 × 310 = 31
Therefore, the estimated sample size was 310, but the number increased to 341 after adding a 10.0% NRR. Thus, a total of 341 adolescents were targeted for the quantitative survey.
Sampling technique
A four-stage multistage sampling technique was used. Six wards (Agoro, Atipa, Iba I, Iba II, Ikolaba, and Laha/Ajana) were randomly selected by balloting. From each ward, three communities and five settlements per community were randomly chosen. In each settlement, households with eligible adolescents were identified through systematic sampling, and one adolescent per household was interviewed.
Eligibility criteria
Inclusion criteria
Adolescents aged 10–19 years residing in Irepo LGA who provided consent or assent (with parental consent for those under 18).
Exclusion criteria
Adolescents who were ill during data collection or whose parents/guardians declined consent.
Data collection procedure
Quantitative data collection
Data were collected using an interviewer-administered, semi-structured questionnaire through the ODK platform. The questionnaire consisted of five sections; Section A collected sociodemographic data, while Section B examined sexual and non-sexual risk behaviors. Section C assessed knowledge of SRH, including fertility, contraception, and STIs/HIV/AIDS. Section D explored sources of SRH information, and section E focused on challenges encountered and the utilization of related health services. Data collection took place in March 2023 over 2 weeks, from 10 a.m. to 5 p.m., Monday to Saturday. Private interviews ensured confidentiality and were conducted by four trained research assistants (two males, two females) and the lead researcher, with each assistant completing up to 15 interviews daily.
Qualitative data collection
Twelve FGDs were conducted, six with female adolescents and six with males, across the six selected wards. Each FGD included eight participants and lasted approximately 45 min. FGDs explored: Parental roles in adolescent SRH, Communication content and modes, Cultural and gender influences. Sessions were audio-recorded (with consent), transcribed verbatim, and supplemented with field notes.
Validity and reliability
Instruments were developed based on extensive literature reviews and consultations with public health experts. The questionnaire and FGD guide were reviewed multiple times and validated.
Pilot testing was conducted with 31 adolescents (10% of the sample) in a neighboring LGA. A Cronbach’s alpha of 0.71 confirmed internal consistency of the quantitative instrument. Items were revised where necessary based on the pilot.
Data analysis
Quantitative data
Data collected through ODK was exported to IBM Statistical Package for the Social Sciences version 26 for cleaning and analysis. Descriptive statistics (frequencies, percentages, and means) summarize sociodemographic and knowledge variables. Inferential statistics, including Chi-square tests, were used to examine associations. A P ≤ 0.05 was considered statistically significant.
Composite scores were calculated:
SRH risk behavior: Based on 11 items (≥2 rated as risky), SRH knowledge: 24 items, scored out of 28 (1–12 = poor knowledge; ≥13 = good knowledge), SRH challenges: 9-item scale (1–2 = low; 3–9 = high).
Qualitative data
Thematic content analysis was conducted using QDA Miner. Audio recordings were transcribed and coded. Themes were developed inductively by identifying patterns across participants’ narratives. Key themes were refined and supported by illustrative quotes.
Ethical considerations
Ethical clearance was obtained from the Oyo State Research Ethical Review Committee. Participants (and guardians, where applicable) were informed of the study purpose, voluntary participation, anonymity, and confidentiality. Each questionnaire was coded (without using names), and the data were securely stored using encrypted files and password protection.
Informed consent and confidentiality
Informed consent and assent were obtained. Participants were informed about the voluntary nature of the study and assured of their privacy. All data remained confidential and accessible only to the research team.
Risks and benefits
There was minimal risk to participants, both physical and psychological. Respondents could withdraw at any time. Although there was no monetary compensation, participants contributed to knowledge that may improve SRH services and education in their communities.
RESULTS
Quantitative results
Socio-demographic characteristics of the quantitative respondents
Table 1 shows that age of respondents range from 10-19 tears with a mean of 16.9 ± 2.2 years. The majority (84.6%) lies between 15 and 19-year age group. More than half of the respondents (65.4%) are females. All the respondents (100%) were single. The majority of the respondents were Yoruba (87.5%), Igbo (8.8%), and Hausa (3.8%). Most adolescents had secondary education (71.3%), 9.6% had tertiary education, 7.9% had primary education, 6.2% had no formal education, and 5.0% had vocational education. The majority of the respondents, 167 (69.6%), were Muslims, 27.5% were Christians, while 2.9% practices traditional religion.
| Variables | Frequency (n=240) | Percentage |
|---|---|---|
| Age (mean=16.9±2.2) | ||
| 10–14 years | 37 | 15.4 |
| 15–19 years | 203 | 84.6 |
| Sex | ||
| Male | 83 | 34.6 |
| Female | 157 | 65.4 |
| Marital status | ||
| Single | 240 | 100.0 |
| Ethnicity | ||
| Yoruba | 210 | 87.5 |
| Igbo | 21 | 8.8 |
| Hausa | 9 | 3.7 |
| Educational level | ||
| No formal education | 15 | 6.2 |
| Primary | 19 | 7.9 |
| Secondary | 171 | 71.3 |
| Vocational | 12 | 5.0 |
| Tertiary | 23 | 9.6 |
| Religion | ||
| Islam | 167 | 69.6 |
| Christianity | 66 | 27.5 |
| Traditional | 7 | 2.9 |
Knowledge of SRH among adolescents
Table 2 shows that 77 (32.1%) adolescents were aware of contraceptive pills, with only 2 (2.6%) reporting use. Awareness of condoms was high at 214 (89.2%), and 30 (14.0%) had used them. Awareness of injectable contraceptives stood at 103 (42.9%), but none reported usage. Calendar method awareness was 65 (27.1%), with 4 (6.2%) using it. Awareness of IUDs was 44 (18.3%), with no usage reported. Only 5 (2.1%) reported using other contraceptive methods. A total of 228 (95.0%) adolescents were aware of AIDS. 219 (91.3%) believed it can be transmitted through sexual intercourse and can be prevented, while 208 (86.7%) thought it can be passed from mother to child. 150 (62.5%) felt a healthy-looking person could have AIDS, and 118 (49.2%) perceived themselves at risk. 50 (20.8%) believed that AIDS is curable, and 53 (22.1%) thought that it could be transmitted through casual contact. Awareness of other STIs besides HIV/AIDS was reported by 173 (72.1%), while 37 (15.4%) knew the symptoms. In the past 12 months, 9 (3.8%) experienced unusual genital discharge, 8 (3.3%) had genital ulcers or sores, and 9 (3.6%) sought treatment.
| Variables | Frequency (n=240) | Percentage |
|---|---|---|
| Knowledge and practice of family planning | ||
| Awareness of contraceptive pills | 77 | 32.1 |
| Use of contraceptive pills (if aware) | 2 | 2.6 |
| Awareness of condoms | 214 | 89.2 |
| Use of condoms (if aware) | 30 | 14.0 |
| Awareness of injectable contraceptives | 103 | 42.9 |
| Use of injectable contraceptives (if aware) | 0 | 0 |
| Awareness of the calendar (menstrual cycle) method | 65 | 27.1 |
| Use of the calendar method (if aware) | 4 | 6.2 |
| Awareness of intrauterine devices (IUD) | 44 | 18.3 |
| Use of IUD (if aware) | 0 | 0 |
| Use of other contraceptive methods | 5 | 2.1 |
| Knowledge of HIV/AIDS | ||
| Awareness of AIDS | 228 | 95.0 |
| Belief that AIDS is curable | 50 | 20.8 |
| Belief that AIDS can be transmitted through sexual intercourse | 219 | 91.3 |
| Belief that AIDS can be transmitted through casual workplace contact | 53 | 22.1 |
| Belief that a pregnant woman with AIDS can transmit it to her baby | 208 | 86.7 |
| Belief that a healthy-looking person can have AIDS | 150 | 62.5 |
| Perceived personal risk of getting AIDS | 118 | 49.2 |
| Belief that AIDS can be prevented | 219 | 91.3 |
| Knowledge of STI (signs and symptoms of STI) | ||
| Awareness of other sexually transmitted infections (besides HIV/AIDS) | 173 | 72.1 |
| Knowledge of STI symptoms | 37 | 15.4 |
| Knowledge of STI (access to treatment) | ||
| History of unusual genital discharge in the past 12 months | 9 | 3.8 |
| History of genital ulcers or sores in the past 12 months | 8 | 3.3 |
| Sought treatment for genital symptoms (most recent episode) | 9 | 3.6 |
SRH: Sexual and reproductive health, HIV: Human immunodeficiency virus, AIDS: Acquired immunodeficiency syndrome, STI: Sexually transmitted infection
SRH risk behavior among adolescents
Figure 1 illustrates the distribution of SRH risk behaviors among adolescents. A slightly higher proportion, 123 (51.2%), reported not engaging in risky SRH behaviors, while 117 (48.8%) reported engaging in risky behaviors.
Knowledge of SRH among adolescents
Figure 2 illustrates the level of knowledge of SRH among adolescents. A total of 130 (54.2%) adolescents were found to have poor knowledge of SRH, while 110 (45.8%) demonstrated good knowledge.
Incidents: Sexual risk behavior among adolescents
Figure 3 shows that most adolescents reported having a boyfriend/girlfriend (47.9%), while fewer had ever had sexual intercourse (18.8%), mainly between ages 15–19 (17.9%). Recent sexual activity was low (8.3%), with similar reports for the number of partners. Condom use was reported by 14.2%. Risky behaviors such as transactional sex (0.4%), alcohol use, smoking, and sex after night parties were minimal or absent.
Demographic factors associated with knowledge of SRH among adolescents
Table 3 illustrates the demographic factors significantly associated with adolescents’ knowledge of SRH. Adolescents aged 15–19 years were significantly more likely to have good SRH knowledge compared to those aged 10–14 years (adjusted odds ratio [AOR] = 4.955, p = 0.046). Christians also had higher odds of good knowledge compared to those of other religions (AOR = 6.052, p = 0.050). Adolescents with tertiary education were significantly more knowledgeable than those with no formal education (AOR = 17.440, p = 0.012). In addition, those with a boyfriend, girlfriend, or sexual partner had significantly higher odds of good SRH knowledge (AOR = 3.635, p < 0.001).
| Variables | Poor knowledge (%) | Good knowledge (%) | COR (95% CI) | p-value | AOR (95% CI) | p-value |
|---|---|---|---|---|---|---|
| Adolescents’ knowledge of SRH | 130 (54.2) | 110 (45.8) | - | - | - | - |
| Gender | ||||||
| Male | 54 (41.5) | 29 (26.4) | References | - | - | - |
| Female | 76 (58.5) | 81 (73.6) | 1.985 (1.146–3.437) | 0.014* | 1.537 (0.785–3.012) | 0.210 |
| Age category | ||||||
| 10–14 years | 35 (26.9) | 2 (1.8) | References | - | - | - |
| 15–19 years | 95 (73.1) | 108 (98.2) | 19.895 (4.660–84.930) | <0.001* | 4.955 (1.030–23.851) | 0.046* |
| Religion | ||||||
| Islam | 98 (75.4) | 69 (62.7) | 0.939 (0.204–4.328) | 0.935 | 1.921 (0.359–10.262) | 0.445 |
| Christianity | 28 (21.5) | 38 (34.5) | 1.810 (0.375–8.737) | 0.460 | 6.052 (1.002–36.541) | 0.050* |
| Others | 4 (3.1) | 3 (2.7) | References | - | - | - |
| Ethnicity | ||||||
| Yoruba | 111 (85.4) | 99 (90.0) | 3.122 (0.634–15.379) | 0.162 | 1.370 (0.175–10.722) | 0.764 |
| Igbo | 12 (9.2) | 9 (8.2) | 2.625 (0.437–15.777) | 0.292 | 0.635 (0.058–6.922) | 0.709 |
| Hausa | 7 (5.4) | 2 (1.8) | References | - | - | - |
| Educational Level | ||||||
| No formal education | 13 (10.0) | 2 (1.8) | References | - | - | - |
| Primary/secondary | 111 (85.4 | 79 (71.8) | 4.626 (1.015–21.076) | 0.048* | 3.924 (0.628–24.537) | 0.144 |
| Vocational | 3 (2.3) | 9 (8.2) | 19.500 (2.690–141.346) | 0.003* | 9.249 (0.967–88.452) | 0.053 |
| Tertiary | 3 (2.3) | 20 (18.2) | 43.333 (6.349–295.759) | <0.001* | 17.440 (1.894–160.595) | 0.012* |
| Having a boyfriend, girlfriend, or sexual partner | ||||||
| No | 94 (72.3) | 31 (28.2) | References | - | - | - |
| Yes | 36 (27.7) | 79 (71.8) | 6.654 (3.779–11.717) | <0.001* | 3.635 (1.873–7.058) | <0.001* |
Source: Field survey *significant at p < 0.05. SRH: Sexual and reproductive health, COR: Certificate of registration, CI: Confidence interval, AOR: Adjusted odds ratio
Demographic profiles associated with risk factors of SRH among adolescents
Table 4 illustrates the demographic factors significantly associated with sexual SRH risk behaviors among adolescents. Female adolescents had significantly higher odds of engaging in risky SRH behaviors compared to males at both univariate (COR = 1.882, p = 0.022) and multivariate levels (AOR = 1.980, p = 0.022). Adolescents with vocational education were more likely to engage in risky behaviors than those with no formal education (COR = 32.500, p < 0.001; AOR = 30.321, p = 0.0002). Similarly, those with tertiary education also had significantly increased odds (COR = 43.333, p < 0.001; AOR = 39.183, P < 0.001). Primary/secondary education was also associated with increased risk at the univariate level (COR = 5.262, p = 0.032), although this was not statistically significant at the multivariate level (AOR = 4.638, p = 0.069).
| Variables | Not risky (%) | Risky (%) | COR (95% CI) | p-value | AOR (95% CI) | p-value |
|---|---|---|---|---|---|---|
| Adolescents’ risk behaviors of SRH | 130 (54.2) | 110 (45.8) | - | - | - | - |
| Gender | ||||||
| Male | 51 (41.5) | 32 (27.4) | References | - | - | - |
| Female | 72 (58.5) | 85 (72.6) | 1.882 (1.094–3.236) | 0.022* | 1.980 (1.103–3.552) | 0.022* |
| Religion | ||||||
| Islam | 85 (69.1) | 82 (70.1) | 0.386 (0.073–2.045) | 0.263 | 0.475 (0.084–2.676) | 0.399 |
| Christianity | 36 (29.3) | 30 (25.6) | 0.333 (0.060–1.843) | 0.208 | 0.348 (0.057–2.114) | 0.252 |
| Others | 2 (1.6) | 5 (4.3) | References | - | - | - |
| Ethnicity | ||||||
| Yoruba | 104 (84.6) | 106 (90.6) | 3.567 (0.724–17.573) | 0.118 | 1.874 (0.242–14.496) | 0.547 |
| Igbo | 12 (9.8) | 9 (7.7) | 2.625 (0.437–15.777) | 0.292 | 1.660 (0.165–16.738) | 0.667 |
| Hausa | 7 (5.7) | 2 (1.7) | References | - | - | - |
| Educational level | ||||||
| No formal education | 13 (10.6) | 2 (1.7) | References | - | - | - |
| Primary/secondary | 105 (85.4) | 85 (72.6) | 5.262 (1.156–23.961) | 0.032* | 4.638 (0.887–24.252) | 0.069 |
| Vocational | 2 (1.6) | 10 (8.5) | 32.500 (3.877–272.470) | 0.001* | 30.321 (3.353–274.204) | 0.0002* |
| Tertiary | 3 (2.4) | 20 (17.1) | 43.333 (6.349–295.759) | <0.001* | 39.183 (5.066–303.077) | <0.001* |
Source: Field survey *significant at p < 0.05. SRH: Sexual and reproductive health, COR: Certificate of registration, CI: Confidence interval, AOR: Adjusted odds ratio
Qualitative results
Theme 1: Knowledge of SRH
Adolescents had a basic understanding of SRH, often linking it to sexual activity, pregnancy, and disease prevention.
Basic understanding of SRH
Most adolescents demonstrated a basic understanding of SRH, linking it to sexual activity, pregnancy, and bodily changes.
A participant observed: “It is a reproductive system and is about sexual intercourse between two partners, either male and male, female and female, or male and female.”
Awareness of risks and benefits
Many participants recognized the importance of SRH in preventing unwanted pregnancies, STIs, and ensuring emotional well-being.
A discussant said: “It refers to the physical and emotional well-being, which includes the adolescents to remain free from unwanted pregnancy and from any transmitted infection.”
Gaps in comprehensive knowledge
Despite basic awareness, many adolescents expressed confusion or a lack of in-depth understanding of SRH concepts.
A discussant admitted: “Have no idea.”
Another participant confessed: “I have no knowledge about it.”
Gender differences in perception
Gender played a role in how SRH was understood. Girls often focused on menstrual health and hygiene, while boys emphasized STIs and abstinence. A girl explained: “We discussed about my menstrual cycle period.”
A boy shared: “We discussed how to protect oneself against sexually transmitted infections, which might occur as a result of unprotected sexual intercourse.”
Theme 2: Risk factors of SRH
Major risk factors identified include the following:
Early sexual activity and peer pressure
Adolescents acknowledged that peer pressure and curiosity often lead to early sexual activity, increasing vulnerability to health risks.
A discussant mentioned: “Some adolescents engage in illegal sex due to peer pressure or curiosity.”
Another participant noted: “They may start because of friends.”
Unwanted pregnancy and unsafe abortion
Many participants recognized the dangers of early pregnancy and unsafe abortion, especially for adolescents who lack access to proper healthcare.
A discussant reported: “If you get pregnant at this age, you may resort to unsafe abortion which can lead to death.”
Another participant added: “Unsafe abortion can cause untimely death.”
STIs
Awareness of STIs such as HIV/AIDS and syphilis was present, with some participants linking unprotected sex to these infections.
A discussant observed: “You can contract diseases like HIV/AIDS if you engage in unprotected sex.”
Another participant warned: “There are many diseases you can have during unprotected sexual acts like STI (HIV/AIDS, Gonorrhea, etc.).”
Lack of access to healthcare services
Adolescents reported limited access to SRH services, often due to stigma, lack of trust, or poor availability of youth-friendly services.
A discussant shared: “Lack of access to health services and parents’ discussion.”
Another participant noted: “No access to SRH issues from my parents and health workers.”
Cultural and religious barriers
Cultural and religious norms were frequently cited as obstacles to open SRH discussions and access to accurate information.
A discussant expressed: “Religiously, I am not permitted to ask such questions on SRH.”
Another participant said: “By cultural and by religious, I am not permitted to discuss sexual and reproductive health at this age.”
DISCUSSION
This study investigated the knowledge and risk factors associated with SRH among adolescents in a rural Nigerian community. The findings reveal complex interactions between education, age, gender, cultural norms, and access to health services, factors echoed in wider Sub-Saharan African literature.
Adolescent knowledge of SRH
Over half (54.2%) of adolescents demonstrated poor knowledge of SRH, consistent with regional patterns. Similar knowledge gaps have been widely documented in Sub-Saharan Africa, especially in rural and underserved settings, where educational attainment and socio-economic opportunities are limited.[16] In this study, the low uptake of condoms (14.0%) despite high awareness (89.2%) may be due to factors such as cost, non-availability, or personal preference. Knowledge alone is insufficient, as barriers such as accessibility, affordability, and sociocultural preferences influence adolescents’ actual use of SRH methods. Limited awareness of contraceptive options, low use of condoms, and misunderstanding of HIV/AIDS transmission routes further emphasize the need for comprehensive SRH education. Similar studies in Uganda and Kenya found substantial gaps in STI knowledge and contraceptive literacy despite exposure to SRH campaigns.[17,18]
Educational attainment emerged as a critical determinant, as adolescents with tertiary education were 17 times more likely to have good SRH knowledge. Despite some awareness of basic SRH concepts, the study indicates that formal school-level sexual education is limited and inconsistently delivered, leaving many adolescents reliant on informal sources for guidance. This aligns with findings from Zambia and Malawi, where improved SRH outcomes correlate with higher levels of education and targeted school-based interventions.[19] Moreover, this finding is consistent with regional findings in Sub-Saharan Africa that education is one of the most powerful enablers of SRH literacy and safer behaviors.[16] This finding indicates that awareness campaigns may have reached these adolescents but failed to convey scientifically accurate, actionable information. Without deep understanding, adolescents are less equipped to make informed choices, leaving them vulnerable to STIs, early pregnancies, and unsafe abortions.[6]
Sexual and reproductive risk behaviors
Almost half (48.8%) of adolescents engaged in risky SRH behaviors. While sexual debut remained relatively low at 18.8%, the presence of multiple sexual partners and low condom usage among those sexually active raises concern. This mirrors broader research indicating that peer pressure, lack of SRH knowledge, and socio-cultural taboos drive unsafe sexual practices in adolescents.[20] It is also consistent with broader regional evidence indicating that adolescents in Sub-Saharan Africa engage in early and often unprotected sex due to misinformation, peer pressure, and limited agency.[21,22] Interestingly, adolescents with romantic or sexual partners had better SRH knowledge. This may reflect increased curiosity, peer learning, or exposure to SRH discussions through informal means. However, this “experiential knowledge” often lacks scientific accuracy and can reinforce misinformation.[23]
Gender differences were prominent. Female adolescents were significantly more likely to engage in risky behaviors, possibly due to power imbalances and economic dependence, as previously reported in rural Uganda and Malawi.[24] This finding might also reflect societal gender norms that disempower girls in negotiating safe sex, a phenomenon extensively documented in Sub-Saharan Africa.[25] Moreover, adolescents with vocational and tertiary education also had higher odds of risky behaviors, suggesting that educational exposure without targeted SRH curricula may not mitigate risk but could reflect increased freedom or social mobility without corresponding support. Qualitative data showed that peer influence and poor parental communication drive sexual risk behaviors. Adolescents cited peer pressure and cultural or religious norms that discourage open discussions about sexuality. Similar findings in Tanzania and Malawi reveal that social silence around sexuality leads to uninformed or risky decisions among youth.[26]
Barriers to accessing SRH services
Despite high awareness of condoms and HIV/AIDS, the uptake of services was remarkably low. For instance, no adolescents used injectables or IUDs, and less than 4% sought treatment for STI symptoms. These findings point to barriers such as stigma, provider attitudes, and lack of adolescent-friendly services, as found in similar rural settings in Sub-Saharan Africa.[27]Qualitative insights from this study reinforce these findings, with participants citing parental disapproval, religious taboos, and lack of privacy as obstacles to accessing care.
The role of structural interventions was evident in successful models from Zambia, where economic support combined with community dialogue and sexuality education reduced sexual activity and improved contraceptive use.[28] In contrast, the absence of such programs leaves adolescents to rely on informal sources, such as peers, for SRH information, often resulting in misconceptions and risk-taking behaviors.
Moreover, the lack of youth-friendly health services limits access to accurate SRH information and care. Community-driven interventions, such as peer-led hubs, mobile applications, or loyalty-based SRH access schemes, have shown promise in Zambia and Kenya in improving HIV testing, contraceptive uptake, and risk perception.[29,30]
Implications for policy and practices
The study highlights substantial gaps in adolescents’ SRH knowledge and practices in rural Oyo State, emphasizing the need for targeted interventions. Strengthening CSE in schools and communities is essential, with content that is age-appropriate, culturally relevant, and skills-based to improve understanding and informed decision-making. Expanding adolescent-friendly health services in rural areas is also crucial to ensure confidential, non-judgmental, and youth-centered care, including better access to modern contraceptives and STI prevention. Collaboration with parents, religious leaders, and traditional institutions can help address cultural barriers and promote open discussions on SRH. Gender-sensitive and peer-led programs are needed to empower adolescents, especially girls, while mitigating peer and social pressures. Finally, using local data to guide resource allocation and tailor interventions to the specific needs of underserved adolescents will foster safer SRH practices and improve adolescent well-being in rural communities.
Limitations and mitigations
The study relied on self-reported data, which may be subject to social desirability bias. However, privacy was ensured during interviews to encourage honest responses. In addition, while the findings are context-specific, they offer insights relevant to similar rural and underserved settings globally.
CONCLUSION
This study revealed substantial gaps in SRH knowledge and a high prevalence of risky behaviors among adolescents in Nigeria, driven by limited access to services, cultural taboos, and inadequate education. Strengthening CSE, improving adolescent-friendly services, and engaging community stakeholders are essential for promoting healthier outcomes among rural adolescents.
Ethics approval:
The research/study was approved by the Institutional Review Board at Oyo State Ministry of Health, number NHREC/OYOSHRIEC/10/11/22, dated 18th January 2023.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
References
- Data Monitoring the situation of children and women: Investing in a safe, healthy, and productive transition from childhood to adulthood is critical. 2024. Available from: https://data.unicef.org/topic/adolescents/overview [Last accessed on 2025 Jul 10]
- [Google Scholar]
- Sexual and reproductive health and research: Postpartum haemorrhage. 2024. Geneva. Switzerland: World Health Organization; Available from: https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexual-health [Last accessed on 2025 Jul 10]
- [Google Scholar]
- WHO releases new guideline to prevent adolescent pregnancies and improve girls’ health. 2025. World Health Organization. Available from: https://www.who.int/news/item/23-04-2025-who-releases-new-guideline-to-prevent-adolescent-pregnancies-and-improve-girls--health [Last accessed on 2025 Jul 10]
- [Google Scholar]
- Promoting and safeguarding the sexual and reproductive health of adolescents. 2022. Geneva: World Health Organization; Available from: https://www.who.int/publications/i/item/RHR-policybrief4 [Last accessed on 2025 Jul 10]
- [Google Scholar]
- Adolescent sexual and reproductive health: The global challenges. Int J Gynaecol Obstet. 2015;131(Suppl):S40-2.
- [Google Scholar]
- Adolescent sexual and reproductive health for all in Sub-Saharan Africa: A spotlight on inequalities. Reprod Health. 2021;18(Suppl 1):118.
- [Google Scholar]
- Nigeria demographic and health survey 2013. National Population Commission. 2014:201-21. Available from: https://dhsprogram.com/pubs/pdf/FR293/FR293.pdf [Last accessed on 2025 Oct 10]
- [Google Scholar]
- Assessment of child poverty in rural border communities of South-Western and Central Nigeria. Econ Reg Stud. 2022;15:107-25.
- [Google Scholar]
- Variations in utilization of health facilities for information and services on sexual and reproductive health among adolescents in South-East, Nigeria. Niger J Clin Pract. 2021;24:1582-9.
- [Google Scholar]
- Adolescent sexual and reproductive health in Sub-Saharan Africa: Who is left behind? BMJ Glob Health. 2020;5:e002231.
- [Google Scholar]
- Examining the recent trends in adolescent sexual and reproductive health in five countries of Sub-Saharan Africa based on PMA and DHS household surveys. Reprod Health. 2021;18(Suppl 1):121.
- [Google Scholar]
- Beliefs and misconceptions about contraception and condom use among adolescents in south-east Nigeria. Reprod Health. 2021;18:7.
- [Google Scholar]
- Teenage pregnancy: Prevalence, pattern and predisposing factors in a tertiary hospital, Southern Nigeria. Asian J Med Health. 2020;17:1-5.
- [Google Scholar]
- Women and girls safe spaces: A guidance note based on lessons learned from the syrian crisis Vol 148. New York: United Nations Population Fund; 2015. p. :148-62.
- [Google Scholar]
- Youth friendly services for sexual and reproductive health: A handbook for service providers. 2021. Available from: https://india.unfpa.org/sites/default/files/resource-pdf/youth_friendly_services_guide_and_handbook_for_service_providers_0.pdf [Last accessed on 2025 Jul 10]
- [Google Scholar]
- Inequalities in early marriage, childbearing and sexual debut among adolescents in Sub-Saharan Africa. Reprod Health. 2021;18(Suppl 1):117.
- [Google Scholar]
- Risky sexual behaviours and knowledge of contraceptives among adolescent girls in Kirinyaga County, Kenya. East Afr J Health Sci. 2024;7:436-49.
- [Google Scholar]
- Sexual health of very young adolescents in South Western Uganda: A cross-sectional assessment of sexual knowledge and behavior. Reprod Health. 2018;15:148.
- [Google Scholar]
- Improving adolescent access to contraception in SubSaharan Africa: A review of the evidence. Afr J Reprod Health. 2020;24:152-64.
- [Google Scholar]
- Individual and relational dynamics perceived to influence the sexual behaviour of adolescents in Ethiopia: A qualitative study. Front Reprod Health. 2024;6:1348953.
- [Google Scholar]
- Boys are not exempt: Sexual exploitation of adolescents in Sub-Saharan Africa. Child Abuse Negl. 2017;65:14-23.
- [Google Scholar]
- A review of studies of sexual behavior of school students in Sub-Saharan Africa. Scand J Public Health. 2002;30:148-60.
- [Google Scholar]
- Barriers to effective parent-adolescent communication on sexuality in rural Southern Malawi. Afr J Reprod Health. 2025;29:120-30.
- [Google Scholar]
- Norms of masculinity: Community voices on sexual and reproductive health communication in rural southwestern Uganda. Cult Health Sex. 2025;27:1420-35.
- [Google Scholar]
- Safer sex negotiation and parity among women in Sub-Saharan Africa. J Biosoc Sci. 2023;55:74-86.
- [Google Scholar]
- Exploring adolescent engagement in sexual and reproductive health research in Kenya, Rwanda, Tanzania, and Uganda: A scoping review. PLOS Glob Public Health. 2022;2:e0000208.
- [Google Scholar]
- Factors influencing access to and utilisation of youth-friendly sexual and reproductive health services in Sub-Saharan Africa: A systematic review. Reprod Health. 2021;18:135.
- [Google Scholar]
- Effects of economic support, comprehensive sexuality education and community dialogue on sexual behaviour: Findings from a cluster-RCT among adolescent girls in rural Zambia. Soc Sci Med. 2022;306:115125.
- [Google Scholar]
- The impact of community-based, peer-led sexual and reproductive health services on knowledge of HIV status among adolescents and young people aged 15 to 24 in Lusaka, Zambia: The Yathu Yathu cluster-randomised trial. PLOS Med. 2023;20:e1004203.
- [Google Scholar]
- HIVFactSheet: A mobile application designed and implemented by youth peer mentors to facilitate HIV and reproductive health care among adolescents and young adults [Research Square] 2020.
- [Google Scholar]