Adolescent sexual and reproductive health literacy in Saudi Arabia: The roles of school type and maternal education

BACKGROUND: Adolescent sexual and reproductive health (SRH) literacy remains uneven in conservative settings. We assessed SRH knowledge among female secondary-school students in Al-Madinah Al-Monawara and examined socio-demographic correlates and parent-daughter communication. METHODS: Cross-sectional survey of 389 students (grades 10-12) selected via stratified cluster sampling from government and private schools (20 June-20 July 2024). A validated Arabic questionnaire measured domain-specific SRH knowledge (menstruation, reproductive anatomy, contraception, sexual relationships), sexually transmitted disease (STD) awareness, and parent-daughter communication. Analyses included t-tests/ANOVA, Pearson correlations, and multivariable OLS with HC3-robust SEs. RESULTS: Knowledge gaps were concentrated in contraception and sexual relationships; 61 students incorrectly endorsed casual contact as a transmission route for STDs. Private-school students had higher composite SRH scores than government-school peers (t-test, p < 0.01). Maternal education correlated with SRH knowledge (r = 0.38, p < 0.001). Scores varied by age (ANOVA F = 4.67, p = 0.009), but age was not an independent predictor in regression. In multivariable models, private-school attendance (β = 0.212, p = 0.018) and higher maternal education (β = 0.043, p = 0.019) independently predicted higher SRH knowledge; paternal education, age, and family size were non-significant. Parent-daughter discussions were infrequent; 72% of students supported school-based SRH education. CONCLUSIONS: SRH literacy among Saudi adolescent girls is uneven, with prominent misconceptions in contraception and transmission. School type and maternal education are actionable levers. Culturally attuned, standardized curricula-especially in government schools-combined with parent-focused communication supports are warranted to close knowledge gaps and reduce stigma.