Knowledge of fertile windows and associated factors among female high school students in Warra Jarso district, Ethiopia using a mixed-methods approach

Understanding the fertility period is crucial for delaying pregnancy. Many female students lack accurate knowledge, leading to unintended pregnancies and unsafe abortions, contributing to maternal death and school dropout. Most research focuses on adult women, overlooking the unique challenges faced by adolescents. This highlights the need for targeted studies on younger females. Therefore, this study aimed to assess knowledge of fertile windows and associated factors among female students of high schools in Warra Jarso District, North Shewa Zone, and Oromia, Ethiopia. An institution-based cross-sectional study with a convergent mixed-methods approach was conducted among high school students in Warra Jarso from March 01 to April 01, 2024. A simple random sampling technique was used to select 417 study participants. The quantitative data were collected using self-administered questionnaires, and focus group discussions were used for the qualitative part. Epi Data version 4.6 was used for data entry, and SPSS version 26.0 software was used for data analysis. The multivariable logistic regression model included variables with a P value < 0.2 in the bivariate analysis. The degree of association was expressed using adjusted odds ratios (AORs) with a 95% confidence interval (CI) at a P value < 0.05. The magnitude of fertile window knowledge was 24.9% (95% Cl: 20.9, 29.0). Age group (17-19 years) (AOR = 2.1, 95% CI = 1.9, 8.8), having sex (AOR = 3.0, 95% CI = 1.4, 4.7), history of pregnancy (AOR = 3.2, 95% CI = 1.2, 8.8), contraceptive use (AOR = 9.0, 95% CI = 4.1, 19.3) and a positive attitude towards fertility knowledge (AOR = 5.0, 95% CI = 2.6, 9.4) were significantly associated with knowledge of the fertility window. Three main themes emerged from the qualitative analysis: Personal experiences and attitudes towards fertility as enablers while misconceptions about ovulation and fertility as barriers. The level of knowledge about the fertile window among participants was relatively low. Factors such as being in the 17-19 age group, having had sexual experience, a history of pregnancy, contraceptive use, and a positive attitude toward fertility knowledge were significantly associated with higher levels of knowledge about the fertile window. Additionally, the qualitative study identified the enablers and barriers to knowledge of fertile windows. The implementation of comprehensive sexual and reproductive health programs with a focus on fertility awareness is recommended for female high school students.