The study was carried out between January 1 and January 30, 2026, using a school-based design that randomly selected 422 students across grades 9 through 12 in the Awi Zone. Researchers used a pretested, self-administered questionnaire, a method chosen deliberately to reduce social desirability bias in a setting where sexual topics are rarely voiced openly. Students completed the questionnaires independently, without parents present, and no identifying information was collected. Of the 422 students approached, 412 responded, yielding an exceptionally high response rate of 97.6 percent and lending considerable statistical weight to the findings.

The operational definition at the heart of the study was straightforward but consequential: parent-adolescent communication was counted only when a student had discussed at least two distinct sexual and reproductive health topics with either parent. By that standard, just 101 of the 412 respondents qualified, producing a prevalence of 24.5 percent with a 95 percent confidence interval of 20.5 to 29.9 percent. In practical terms, fewer than one in four adolescents in the study population could rely on their parents as a source of structured information about their own bodies, reproduction, or sexual health. The remaining three-quarters were left to navigate puberty, menstruation, and emerging sexual questions through other, often less reliable channels.

The topic-level breakdown reveals a striking hierarchy of what families are willing to discuss. The most commonly addressed subjects were sexually transmitted infections including HIV and AIDS, raised by 78.6 percent of communicating students, followed by puberty at 75.0 percent and menstrual health at 60.7 percent. At the bottom of the list sat the very topics most directly tied to pregnancy prevention: contraceptive methods, discussed by only 41.3 percent, and sexual intercourse itself, discussed by 42.2 percent. This pattern suggests that even within families that do communicate, the conversation tends to stop short of the practical, decision-relevant information adolescents need most, skirting the mechanics of sex and contraception while dwelling on disease and biological development.

To identify which adolescents were most likely to communicate with their parents, the researchers employed multivariable logistic regression using SPSS, adjusting for potential confounders and checking for multicollinearity with variance inflation factors, with statistical significance set at a p-value below 0.05. The results pointed to a clear educational gradient. Students in grade 11 had more than four times the odds of discussing sexual and reproductive health with their parents compared with younger peers, with an adjusted odds ratio of 4.3 and a 95 percent confidence interval of 1.7 to 10.7. Grade 12 students showed a nearly identical association, with an adjusted odds ratio of 4.2 and a confidence interval of 1.6 to 11.2. The interpretation is intuitive: as adolescents approach the end of secondary school and adulthood looms closer, parents appear more willing to break the silence, perhaps recognizing that the window for protective guidance is closing.

Age and family structure also shaped the odds of communication, though in unexpected directions. Students aged 20 to 24 were substantially less likely to communicate with their parents than younger adolescents, with an adjusted odds ratio of 0.2 and a confidence interval of 0.1 to 0.6. The authors suggest this inverse relationship may reflect the growing autonomy of older students, who increasingly seek information from peers, partners, or media rather than from home. Meanwhile, adolescents living with single parents had roughly two and a half times the odds of communication, with an adjusted odds ratio of 2.4 and a confidence interval of 1.7 to 4.8, a finding that may reflect the intensified bonds and concentrated caregiving responsibilities that often characterize single-parent households. Maternal literacy emerged as another powerful facilitator: adolescents whose mothers could read and write had 2.3 times the odds of parent-adolescent communication, with a confidence interval of 1.3 to 4.1, underscoring the pivotal role of mothers as health educators and the cascading effect of female education across generations.

The quantitative survey was only half of the study. To understand why so many families remain silent, the researchers conducted four focus group discussions with parents, and the qualitative findings paint a vivid picture of the social architecture of taboo. Shame emerged as the dominant barrier, with parents describing deep embarrassment at the prospect of discussing sexual matters with their own children. Cultural unacceptability compounded this discomfort: in many communities across the Awi Zone, sexual topics are considered inherently private or even improper for parent-child conversation, and parents fear that raising them will be interpreted as encouraging early sexual activity. A third barrier was more prosaic but perhaps more tractable: many parents simply lack the knowledge themselves, having never received formal sexual education, and feel unqualified to answer questions they cannot confidently answer for themselves.

The public health stakes of this silence are considerable. Decades of research have established that open parent-adolescent communication about sexual and reproductive health is associated with delayed sexual debut, reduced risky sexual behavior, lower rates of teenage pregnancy, and better uptake of health services. In Ethiopia, where teenage pregnancy carries significant risks of obstetric complications, school dropout, and intergenerational poverty, and where HIV and other sexually transmitted infections remain persistent concerns among young people, the family represents a uniquely trusted and continuously accessible channel of prevention. When that channel is blocked, adolescents do not stop needing information; they simply obtain it from sources that may be inaccurate, stigmatizing, or absent altogether.

The authors of the study argue that their findings point toward concrete intervention strategies. Because higher grade level and maternal literacy both facilitate communication, programs that keep girls in school and expand adult literacy, particularly for mothers, are likely to yield secondary benefits for adolescent sexual health. Because shame and cultural unacceptability are the leading barriers, interventions must be culturally sensitive rather than confrontational, working through trusted community structures, religious institutions, and parent associations to normalize gradual, age-appropriate conversation. And because many parents lack basic knowledge themselves, parent-focused education sessions, rather than adolescent-only programs, may be essential to equip families to serve as reliable first sources of information. The researchers conclude that such culturally tailored interventions addressing shame and building parental knowledge are urgently needed in the Awi Zone and in comparable settings across Ethiopia.

Published as an open-access article in BMC Public Health, the study received no external funding, obtained ethical approval from the Institutional Review Board of Injibara University’s College of Medicine and Health Sciences, and followed the Helsinki Declaration throughout, including written informed consent from adult participants and parental consent plus adolescent assent for minors. Its unusually high response rate, dual quantitative and qualitative design, and pretested instruments strengthen confidence in the central finding: in this corner of Northwest Ethiopia, the conversation that could protect adolescents is happening in fewer than a quarter of homes. Closing that gap, the evidence suggests, will require not just information campaigns but a patient reshaping of what families believe they are permitted to say to one another.

Subject of Research: Parent-adolescent communication about sexual and reproductive health among high school students in Awi Zone, Northwest Ethiopia

Article Title: 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

Article References: Laikemariam, M., yazew, A., Wondie, Y., Egziabherfenta Tadele, A., Molla, A., & Fentie, E. (2026). 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. BMC Public Health. https://doi.org/10.1186/s12889-026-29435-1

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29435-1

Keywords: parent-adolescent communication, sexual and reproductive health, adolescent health, Ethiopia, Awi Zone, high school students, teenage pregnancy, HIV prevention, maternal literacy, health communication, public health, mixed-methods study