No significant differences in sexual and reproductive health knowledge and attitudes were found between male and female adolescents in rural Thatta, Pakistan, though marital status, parental occupation, household income, and mother's education were significantly associated with KAP scores.
Key Findings
Results
No significant differences in mean scores of knowledge and attitudes were found between male and female adolescents in rural Thatta, Pakistan.
Among 632 adolescents surveyed, 82.7% were females and 17.3% were males, aged 14-19 years.
Study was conducted across 62 villages in Thatta, Gharo, and Jungshahi registered under the Global Network Maternal and Newborn Health Registry.
The modified 'Asking Young People about Sexual and Reproductive Behaviors' tool was used to assess KAP related to HIV, STI, family planning, and pregnancy.
Despite no knowledge or attitude differences by sex, a statistically significant difference of 0.13 (95% CI 0.005, 0.24) in practice scores was observed between males and females.
Results
Marital status and father's occupation were significantly associated with sexual and reproductive health knowledge scores among adolescents.
Marital status was associated with knowledge scores (β 5.13; 95% CI 1.34, 8.91) in design-based multivariable analysis.
Father's occupation was also significantly associated with knowledge scores (β 3.41; 95% CI 0.90, 5.93).
Analysis was performed using multiple linear regression on Stata V.15.0.
These associations suggest that married adolescents and those whose fathers are employed had higher knowledge scores.
Results
Marital status, household income, father's occupation, and mother's education were each significantly associated with adolescent attitudes toward sexual and reproductive health.
Marital status was positively associated with attitude scores (β 1.34; 95% CI 0.82, 1.86).
Household income was negatively associated with attitude scores (β -2.36; 95% CI -4.64, -0.07).
Father's occupation was negatively associated with attitude scores (β -1.42; 95% CI -2.52, -0.33).
Mother's education was negatively associated with attitude scores (β -1.41; 95% CI -2.71, -0.11).
All associations were identified through design-based multivariable linear regression analysis.
Results
Marital status and mother's occupation were significantly associated with sexual and reproductive health practices among adolescents.
Marital status was positively associated with practice scores (β 0.24; 95% CI 0.06, 0.41).
Mother's occupation was positively associated with practice scores (β 0.64; 95% CI 0.38, 0.90).
These were the only two sociodemographic variables significantly associated with practices in the multivariable model.
Practices assessed included behaviors related to HIV, STIs, family planning, and pregnancy.
Methods
The study population consisted predominantly of female adolescents from rural villages in Thatta, Pakistan, with sexual and reproductive health risks including unwanted pregnancies, unsafe abortions, STIs, and sexual violence.
632 adolescents aged 14-19 years were included in the cross-sectional study.
82.7% of participants were female.
Participants were drawn from 62 villages in Thatta, Gharo, and Jungshahi.
The study used a modified version of the 'Asking Young People about Sexual and Reproductive Behaviors' tool to assess KAP.
Conclusions
The authors recommend community awareness programmes to improve sexual and reproductive health KAP for both male and female adolescents in Thatta.
The recommendation stems from findings of no gender-based differences in knowledge and attitudes, suggesting both sexes have similar gaps.
Findings highlight the role of sociodemographic factors such as parental occupation, marital status, and household income in shaping KAP.
The study was set in a rural context in Pakistan, where access to sexual and reproductive health information may be limited.
Authors emphasize that improved knowledge, positive attitudes, and better practices can mitigate risks associated with adolescent sexual and reproductive health.
What This Means
This research suggests that among teenagers aged 14-19 living in rural villages in Thatta, Pakistan, boys and girls have similarly limited knowledge and attitudes about sexual and reproductive health topics such as HIV, sexually transmitted infections, family planning, and pregnancy. While there was a small but statistically significant difference in actual health-related practices between males and females, no such differences were found for knowledge or attitudes. The study surveyed 632 adolescents, the majority of whom (82.7%) were female, across 62 villages.
This research suggests that certain family and social factors play an important role in shaping what teenagers know and how they think and behave around sexual and reproductive health. Specifically, whether a teenager was married, what their father did for work, how much income the household earned, and whether their mother was educated or employed were all linked to differences in knowledge, attitudes, or practices. For example, married adolescents tended to score higher on knowledge and certain attitude measures, possibly because marriage exposes them to more direct health-related experiences or information.
This research suggests that because both boys and girls in this rural Pakistani setting have similarly limited sexual and reproductive health knowledge, community-level education and awareness programs should be designed to reach all adolescents regardless of gender. The findings also point to the importance of addressing broader socioeconomic factors — such as parental employment and household income — when designing interventions aimed at improving adolescent health outcomes in low-resource rural settings.
Inayat Ali A, Azam I, Tikmani S, Saleem S. (2025). Sexual and reproductive health knowledge, attitudes and practices among adolescents in rural Thatta, Pakistan: a cross-sectional study.. BMJ open. https://doi.org/10.1136/bmjopen-2024-096404