Parent-adolescent communication on sexual and reproductive health issues and associated factors among high school students in Awi Zone, Northwest Ethiopia: a mixed-methods study

Parent-adolescent communication on sexual and reproductive health (SRH) is critical for reducing risky sexual behaviors and preventing teenage pregnancy. However, cultural taboos and limited knowledge hinder open dialogue in Ethiopian communities. This study assessed the prevalence and factors associated with parent-adolescent SRH communication among high school students in Awi Zone, Northwest Ethiopia. A school-based mixed-methods study was conducted from January 1–30, 2026, among 422 randomly selected high school students (grades 9–12). A pretested, self-administered questionnaire was used. Parent-adolescent communication was defined as discussing at least two SRH topics with either parent. Data were analyzed using SPSS; multivariable logistic regression identified associated factors ( p < 0.05). Four focus group discussions with parents explored barriers. Of 412 respondents (97.6% response rate), only 101 (24.5%, 95% CI: 20.5–29.9) discussed at least two SRH topics with their parents. The most discussed topics were STI/HIV/AIDS (78.6%), puberty (75.0%), and menstrual period (60.7%); the least discussed were contraceptive methods (41.3%) and sexual intercourse (42.2%). Factors significantly associated with communication were grade 11 (AOR = 4.3, 95% CI: 1.7–10.7), grade 12 (AOR = 4.2, 95% CI: 1.6–11.2), students aged 20–24 (AOR = 0.2, 95% CI: 0.1–0.6), living with single parents (AOR = 2.4 (95% CI: 1.7–4.8) and maternal literacy (AOR = 2.3, 95% CI: 1.3–4.1). Qualitative findings identified shame, cultural unacceptability, and lack of parental knowledge as major barriers. Parent-adolescent SRH communication in Awi Zone is low, with less than one in four students discussing SRH with parents. Higher grade level and maternal literacy facilitate communication. Culturally sensitive interventions addressing shame and improving parental knowledge are urgently needed.