Knowledge, awareness, support networks, and service utilization of sexual and reproductive health and rights among Indonesian adolescents

Abstract

BACKGROUND:

Sexual and reproductive health and rights (SRHR) services play a critical role in the well-being of adolescents and young adults. In Indonesia, gaps in knowledge, gender disparities, and access barriers hinder the effective utilization of these services. This study aimed to explore the sociodemographic factors, knowledge levels, awareness, and determinants influencing SRHR service utilization among Indonesian adolescents and young adults.

MATERIALS AND METHODS:

A cross-sectional online survey was conducted among adolescents and young adults aged 13–24 years across Indonesia from September 13 to October 27, 2024, involving 849 participants. The survey collected data on sociodemographic profiles, knowledge and awareness of SRHR, sources of information, and service utilization patterns. Convenience sampling was employed, with the data analyzed using descriptive and inferential statistics to identify key predictors of SRHR service utilization.

RESULTS:

The study found that females, urban residents, and individuals aged 20–24 years were more likely to participate in SRHR services. Despite higher awareness, significant knowledge gaps were identified, particularly among males regarding contraception and fertility. The primary sources of SRHR information were mothers and digital platforms, while healthcare professionals and educators played a limited role. Knowledge levels were a strong predictor of service utilization, with older adolescents exhibiting lower service usage due to stigma and self-reliance tendencies. Urban-rural disparities in service access were also noted, although these differences diminished after controlling for resource availability.

CONCLUSION:

The study highlights critical factors influencing SRHR service utilization, including knowledge gaps, gender disparities, and support networks. Recommendations include developing gender-sensitive educational programs, investing in digital health solutions, addressing stigma, and improving service access in underserved areas. By implementing these strategies, policymakers can enhance SRHR outcomes and promote health equity among Indonesian adolescents and young adults.

Introduction

Sexual and reproductive health and rights (SRHR) encompass the fundamental rights of individuals to access comprehensive sexual and reproductive health (SRH) services, education, and information, ensuring that they can make informed and autonomous decisions regarding their sexual and reproductive well-being.[1] For adolescents, SRHR is particularly significant due to the developmental stage they are in, which requires not only physical health care but also support for their mental, social, and emotional well-being.[2] Adolescence is a critical period where decisions about SRH have long-lasting implications. The World Health Organization and the United Nations Population Fund have established frameworks that emphasize the necessity of providing adolescents with the right to access SRH services, make informed decisions about their bodies, and receive the support they need to exercise their rights without discrimination.[3,4]

In Indonesia, adolescents make up a significant portion of the population, with those aged 10–24 accounting for approximately 22% of the total population.[5] Despite this, Indonesian adolescents face numerous challenges related to SRH, exacerbated by sociocultural factors, limited access to healthcare, and insufficient education. The prevalence of early pregnancies among adolescents is a critical concern, with many lacking the necessary information and resources to prevent unintended pregnancies.[6,7] In addition, unsafe abortions remain a common practice, particularly in rural areas, contributing to maternal health complications and fatalities.[8] The incidence of STIs among adolescents is also rising, compounded by insufficient education and limited access to prevention services.[9] These issues underscore the urgent need for comprehensive SRH education and services that are specifically tailored to the needs of Indonesian adolescents, especially considering the societal taboos that often hinder open discussions on sexual health.[10]

The knowledge and attitude toward SRH among Indonesian adolescents are highly variable, with many adolescents lacking accurate information about contraception, STIs, and reproductive rights.[11,12] However, research on awareness of sexual and reproductive rights in Indonesia remains limited.[13] Factors such as education, cultural norms, and access to media significantly influence adolescents’ understanding of SRHR. In rural or more conservative regions, adolescents often have limited exposure to comprehensive sexual education, which leaves them vulnerable to making uninformed decisions.[14] While formal education systems could play a vital role in disseminating accurate information, sex education is often inadequate, inconsistent across schools, and lacks trained educators.[15] Informal sources, such as peers and social media, also contribute to adolescents’ knowledge but can sometimes perpetuate misinformation.[9] Consequently, these gaps in knowledge and education may lead adolescents to engage in risky sexual behaviors that negatively affect their health and well-being.

Moreover, Indonesian adolescents have access to several systems of support, including family, peers, schools, and healthcare professionals. However, these support systems are often fragmented, and cultural taboos surrounding sexual health may prevent open communication within families or communities.[16] Adolescents may feel uncomfortable discussing sexual health issues with their families due to fear of judgment or reprisal.[17] Schools, while a potential venue for SRH education, are often limited by policies that restrict the teaching of comprehensive SRHR, especially in more conservative regions.[18] Non-governmental organizations (NGOs) and community-based organizations play an essential role in providing SRHR education, counseling, and services, but these efforts are often constrained by limited resources, logistical challenges, and cultural barriers.[13] These barriers hinder the effectiveness and reach of support networks, leaving adolescents without the guidance they need to make informed decisions about their SRH. Despite the presence of these support systems, significant gaps remain in ensuring that adolescents receive consistent, comprehensive, and culturally sensitive guidance on SRH.

Access to SRH services for adolescents in Indonesia remains inconsistent. While urban areas generally have better access to healthcare services, rural areas face significant barriers, including geographic isolation, cost, and a lack of adolescent-friendly services.[6] Family planning, reproductive health clinics, and HIV/STI prevention programs exist, but their reach is often limited, and adolescents may encounter difficulties in utilizing these services.[13,19] The stigma surrounding adolescent sexuality further deters many from seeking help, as adolescents may fear being judged or having their privacy violated.[17] These barriers are compounded by the lack of adolescent-specific services that address the unique needs of this age group, leading to gaps in care and missed opportunities for prevention and treatment. As a result, many adolescents continue to experience negative health outcomes related to SRH, such as unintended pregnancies, unsafe abortions, and STIs. Therefore, it is essential to develop and implement strategies that expand adolescent-friendly SRH services, address sociocultural stigmas, and ensure equitable access across diverse geographic and socioeconomic contexts.

Although Indonesia has established several policies aimed at improving adolescent SRH, significant gaps remain in both the legal and policy frameworks. National policies, including reproductive health laws and youth-specific healthcare programs, seek to address these issues, but their implementation is often inconsistent across regions.[20] Legal barriers, such as the legal age for marriage and societal expectations, continue to pressure adolescents into early marriages and sexual activity, despite efforts to provide protective measures.[21] While the Indonesian government has made strides in integrating reproductive health services into primary healthcare, challenges remain in ensuring that these services are universally accessible, inclusive, and sensitive to the cultural context of different regions.[22] Furthermore, adolescents from marginalized groups often face additional barriers to accessing services, highlighting the need for policies that are more inclusive and aligned with international standards for adolescent SRHR.[13,23]

The importance of assessing the knowledge, awareness, support networks, and service utilization related to SRHR among Indonesian adolescents cannot be overstated. Such an assessment is critical to identifying gaps in current health systems and formulating more effective interventions. Existing research on adolescent SRHR in Indonesia is limited, and a deeper understanding of the barriers and facilitators to accessing SRHR services will help inform the development of targeted, accessible, and culturally appropriate interventions. This research is essential not only for improving the health outcomes of adolescents but also for empowering them to make informed decisions about their SRH, thereby enhancing their overall well-being and future opportunities. Addressing the SRHR needs of adolescents will have far-reaching benefits, not only in terms of individual health but also in contributing to broader public health goals in Indonesia.

This paper aims to assess the knowledge, awareness, support networks, and service utilization related to SRHR among Indonesian adolescents. By identifying gaps in education, healthcare access, and social support systems, this paper seeks to provide evidence-based insights for developing culturally sensitive, adolescent-friendly interventions.

Materials and Methods

Study design and setting

The data presented in this paper is derived from a larger survey aimed at evaluating the impact of a social media campaign on SRHR in Indonesia. This study employed a cross-sectional online survey design, conducted nationwide from September 13 to October 27, 2024. In this paper, we specifically examine adolescents’ knowledge, awareness, support networks, and utilization of SRHR services in Indonesia.

Study participants and sampling

We utilized a convenience sampling method, targeting adolescents aged 10–24 years who were residing in Indonesia during the survey period. Participants were recruited through social media announcements, primarily shared via WhatsApp groups and Instagram. The WhatsApp groups comprised representatives from NGOs engaged in adolescent-focused initiatives across Indonesia. These representatives were requested to disseminate the survey announcement within their respective networks and share the survey flyer on their Instagram accounts to enhance outreach and participant engagement. Additionally, the survey information was actively promoted on Instagram to expand participant reach nationwide and ensure a diverse and heterogeneous respondent pool.

To incentivize participation, the first 500 respondents received a reward of IDR 25,000 (approximately US$1.54), which could be redeemed as phone credits or e-money. Participants who agreed to take part accessed the survey through a link included in the announcements and completed an online self-administered questionnaire. Of the 971 responses collected, 849 were considered valid for analysis. The sample size was determined using OpenEpi Version 3 (https://www.openepi.com), with the assumption that 24.3% of adolescents accessed SRHR servicees,[24] a 5% margin of error, and a 95% confidence interval. Based on these parameters, the minimum required sample size was calculated to be 283.

Variables

The dependent variable in this study was the utilization of SRHR services, which was assessed by evaluating respondents’ engagement with various service components over the past 12 months.[24] These components included education, consultations, examinations, and treatments. Respondents who accessed at least one of these components were categorized as having “ever accessed” SRHR services. The independent variables encompassed a range of factors, including sociodemographic characteristics, knowledge of SRH, awareness of sexual and reproductive rights, and support networks for accessing SRHR information. Sociodemographic characteristics included age, place of residence, sex, educational attainment, and living arrangements.

Knowledge of SRH was assessed based on respondents’ understanding of contraceptive methods, human anatomy, pregnancy, and abortion, adopting measures from previous research.[25] This knowledge was dichotomized into “lacking” (≤80% of the total score) and “good” (>80% of the total score). Similarly, awareness of sexual and reproductive rights was categorized into “low” (≤median score) and “high” (>median score) based on methods used in prior studies.[26] Support networks for discussing SRHR issues were classified as “available” or “unavailable.” Respondents’ opportunities to ask SRHR-related questions were also explored, categorized as follows: “no opportunity,” “limited opportunities,” “preference not to ask despite having the chance,” or “full ability to ask all questions.” Additional variables measured included attitudes toward SRHR, assessed on a spectrum from neutral to supportive; access to SRHR information, which determined whether respondents had access to relevant resources; and the ability to exercise SRHR, which examined whether individuals reported being able to practice their rights. The ability to exercise SRHR refers to their capacity to make informed and autonomous decisions about their SRH while accessing necessary services, education, and protections. These independent variables collectively provided a comprehensive framework for understanding the factors influencing SRHR utilization.

Data collection and techniques

The data analysis in this study was conducted systematically using descriptive statistics, including frequencies and percentages, which were visually represented through graphs. To investigate the determinants of adolescents’ utilization of SRHR services in Indonesia, binary logistic regression analysis was performed. Two distinct models were developed for this purpose. Model I assessed the influence of sociodemographic characteristics on SRHR service utilization among adolescents. Model II extended the analysis by incorporating additional independent variables, such as SRHR-related knowledge, awareness, and support networks, to comprehensively predict the factors influencing service utilization. Both models were constructed using the ENTER method, which includes all selected independent variables simultaneously. Independent variables with a P value ≤ 0.05 in the multivariable logistic regression analysis were identified as significant predictors of SRHR service utilization. The strength of these associations was quantified using adjusted odds ratios (aOR) and reported with their corresponding 95% confidence intervals. All statistical analyses were conducted using RStudio, ensuring rigorous and reproducible results.

Ethical considerations

The study protocol received ethical approval from the Research Ethics Committee of the Faculty of Medicine, Udayana University, Indonesia (Certificate Number: 1950/UN14.2.2.VII.14/LT/2024). As an incentive, the first 500 participants who completed the questionnaire were awarded IDR 25,000 in phone credit.

Results

Sociodemographic characteristics of respondents

Table 1 presents the sociodemographic characteristics of the respondents. The survey included 849 participants, the majority of whom were aged 20–24 years (73.38%), resided in urban areas (49.35%), and identified as female (71.38%). Regarding educational attainment, nearly half of the respondents (45.58%) had completed senior high school, a pattern that was similarly reflected in the educational levels of their fathers (44.99%) and mothers (40.05%). Additionally, the findings indicate that the majority of respondents (80.21%) lived with their nuclear families.

Table 1.

Sociodemographic characteristics of respondents (n=849)

Sociodemographic characteristics		Frequencies (%)
Age groups
10–14 years old		73 (8.60)
15–19 years old		153 (18.02)
20–24 years old		623 (73.38)
Place of residence
Rural area		156 (18.37)
Semi-urban area		274 (32.27)
Urban area		419 (49.35)
Sex
Female		606 (71.38)
Male		243 (28.62)
Respondent’s current education
Elementary school		37 (4.36)
Junior High School		90 (10.60)
Senior High School		387 (45.58)
Diploma		82 (9.66)
Undergraduate and Postgraduate		253 (29.80)
Father’s educational attainment
I don’t know		19 (2.24)
Not attend school		23 (2.71)
Elementary school		120 (14.13)
Junior High School		131 (15.43)
Senior High School		382 (44.99)
Diploma		34 (4.00)
Undergraduate		126 (14.84)
Postgraduate		14 (1.65)
Mother’s educational attainment
I don’t know		19 (2.24)
Not attend school		35 (4.12)
Elementary school		147 (17.31)
Junior High School		158 (18.61)
Senior High School		340 (40.05)
Diploma		28 (3.30)
Undergraduate		114 (13.43)
Postgraduate		8 (0.94)
Who do you live with?
Living alone		102 (12.01)
Nuclear family		681 (80.21)
Extended family		66 (7.77)

Respondents’ knowledge about sexual and reproductive health

Table 2 summarizes respondents’ knowledge of SRH, focusing on contraceptive methods, human anatomy, pregnancy, and abortion. Only 24.26% of respondents had a good understanding of contraceptive methods, while only 7.18% of respondents had a good understanding of human anatomy, pregnancy, and abortion. In more detail, the knowledge levels are presented as proportions of respondents familiar with each SRH topic, disaggregated by sex and age group. Regarding contraceptive methods, the majority of male respondents (79.01%) were knowledgeable about male condoms, while most female respondents (80.36%) were familiar with contraceptive pills. In contrast, vasectomy was the least recognized contraceptive method, with awareness reported by only 16.87% of males and 17.66% of females. Age-wise analysis revealed that knowledge of contraceptive methods increased with age, a trend that was statistically significant (P < 0.05).

Table 2.

Respondents’ knowledge about sexual and reproductive health (n=849)

Sexual and reproductive health topics		Sex				P		Age groups						P
		Male		Female				10–14		15–19		20–24
		n (%)		n (%)				n (%)		n (%)		n (%)
Knowing the types of contraceptive methods
Coitus interruptus		124 (51.03)		253 (41.75)		0.014*		8 (10.96)		54 (35.29)		315 (50.56)		<0.0001*
Male condom		192 (79.01)		432 (71.29)		0.021*		18 (24.66)		106 (69.28)		500 (80.26)		<0.0001*
Female condom		63 (25.93)		168 (27.72)		0.595		10 (13.70)		38 (24.84)		183 (29.37)		0.013*
Contraceptive pill		146 (60.08)		487 (80.36)		<0.0001*		17 (23.29)		107 (69.93)		509 (81.70)		<0.0001*
Injection		136 (55.97)		479 (79.04)		<0.0001*		14 (19.18)		103 (67.32)		498 (79.94)		<0.0001*
Intrauterine device (IUD)		88 (36.21)		356 (58.75)		<0.0001*		11 (15.07)		63 (41.18)		370 (59.39)		<0.0001*
Implant		97 (39.92)		371 (61.22)		<0.0001*		7 (9.59)		68 (44.44)		393 (63.08)		<0.0001*
Spermicide		65 (26.75)		113 (18.65)		0.009*		8 (10.96)		29 (19.95)		141 (22.63)		0.054
Vasectomy		41 (16.87)		107 (17.66)		0.785		3 (4.11)		24 (15.69)		121 (19.42)		0.004*
Tubectomy		53 (21.81)		135 (22.28)		0.882		4 (5.48)		32 (20.92)		152 (24.40)		0.001*
Know when the male body is ready to bear children		120 (49.38)		246 (43.56)		0.124		16 (21.92)		62 (40.52)		306 (49.12)		<0.0001*
Know when the female body is ready to bear children		143 (58.85)		392 (64.69)		0.111		23 (31.51)		89 (58.17)		423 (67.90)		<0.0001*
A girl can get pregnant during her first sexual intercourse (yes)		174 (71.60)		436 (71.95)		0.920		27 (36.99)		114 (74.51)		469 (75.28)		<0.0001*
A girl can get pregnant during her period (yes)		57 (23.46)		77 (12.71)		<0.0001*		31 (42.47)		23 (15.03)		80 (12.84)		<0.0001*
Know when is the fertile period in a girl		54 (22.22)		192 (31.68)		0.006*		10 (13.31)		48 (31.37)		188 (30.18)		0.010*
Abortion is illegal (yes)		208 (85.60)		579 (95.54)		<0.0001*		60 (82.19)		142 (92.81)		585 (93.90)		0.001*

*P<0.05

The study also found that over half of the respondents, irrespective of sex, had knowledge of male and female anatomy. Furthermore, the majority of both male and female respondents were aware that a girl can become pregnant during her first sexual intercourse. However, only 12% of female and 23% of male respondents were aware that pregnancy is possible during menstruation. Additionally, a comparison between male and female respondents showed significant differences in knowledge related to the fertile period in girls and the illegal status of abortion in Indonesia (P < 0.05).

Respondents’ awareness about adolescents’ sexual and reproductive rights

Figure 1 reveals significant gender disparities in adolescents’ awareness of SRHR, with female respondents consistently demonstrating higher awareness across most domains. Females showed significantly greater awareness than males regarding the right to healthcare (81.9% vs. 71.2%, P = 0.001), the right to life (76.9% vs. 69.1%, P = 0.019), the right to information and education (78.2% vs. 70.4%, P = 0.016), and the right to freedom of thought (64.5% vs. 54.7%, P = 0.008). Similarly, females had higher awareness of the right to liberty (69.1% vs. 59.7%, P = 0.008), the right to privacy (74.9% vs. 68.3%, P = 0.05), and the right to decide the number and spacing of children (79.2% vs. 69.6%, P = 0.003).

Figure 1.

Respondents’ awareness about adolescents’ sexual and reproductive rights (n = 849)

Awareness of the right to consent to and equality in marriage also showed a substantial gender gap, with females at 76.2% compared to males at 64.6% (P = 0.001). Furthermore, females were more aware of the right to equality (71.1% vs. 63.4%, P = 0.027) and the right to benefit from scientific programs (72.9% vs. 64.6%, P = 0.016). However, awareness of the right to be free from violence or ill-treatment was not significantly different between genders (74.4% vs. 68.3%, P = 0.071). These findings underscore the need for targeted efforts to improve SRHR awareness among male adolescents while maintaining and enhancing awareness among females.

SRHR service utilization and respondents’ support networks in terms of access to SRHR information

The findings [Table 3] reveal that 40.64% (95% CI = 37.31–44.03) of respondents ever utilized the SRHR services during the last 12 months. Moreover, a substantial majority of respondents (81.39%) had access to relevant SRHR information, while 18.61% lacked such access. Among those with access (n = 691), mothers emerged as the most frequently cited source (18.67%), followed by school teachers (8.39%) and the internet, including websites, blogs, and social media (4.92%). Healthcare workers such as doctors, midwives, and nurses were identified as sources by only 3.18% of respondents, while friends (2.46%), television or radio (1.45%), and books or magazines (0.29%) were reported even less frequently.

Table 3.

Respondents’ support networks in terms of access to SRH information (n=849)

Variable		Frequencies (%)
In the past 12 months, have you accessed any sexual and reproductive health and rights (SRHR) services? (e.g., services related to health education, consultations, examinations, and treatments)
No		504 (59.36)
Yes		345 (40.64)
Having access to relevant SRHR information
No		158 (18.61)
Yes		691 (81.39)
Sources of SRHR information (n=691)
Mother		129 (18.67)
Father		8 (1.16)
Siblings		6 (0.87)
Friend		17 (2.46)
Healthcare workers (such as doctors, midwives, nurses)		22 (3.18)
School teachers		58 (8.39)
Information on television/radio		10 (1.45)
Books/magazines		2 (0.29)
Internet (websites, blogs, social media)		34 (4.92)
Who would you turn to if you need information about sexuality?
Mother		167 (19.67)
Father		12 (1.41)
Siblings		5 (0.59)
Friend		22 (2.59)
Healthcare workers (such as doctors, midwives, nurses)		27 (3.18)
School teachers		11 (1.30)
Information on television/radio		1 (0.12)
Books/Magazines		3 (0.35)
Internet (websites, blogs, social media)		100 (11.78)
Ability to exercise SRHR
No		164 (19.32)
Yes		685 (80.68)

When asked who they would turn to for information about sexuality, mothers again emerged as the predominant choice (19.67%), followed by the internet (11.78%). Other options, such as healthcare workers (3.18%), friends (2.59%), fathers (1.41%), school teachers (1.30%), and traditional media such as books or television, were rarely considered. Additionally, in terms of the ability to exercise their SRHR, approximately 80.68% of respondents reported having the capacity to make informed and autonomous decisions regarding their SRH while accessing essential services, education, and protections, while about 19.32% were unable to do so.

Factors associated with service utilization of sexual and reproductive health and rights

Table 4 provides insights into factors influencing the utilization of SRHR services among adolescents and young adults, as analyzed using two logistic regression models. The results highlight age, place of residence, knowledge levels, support networks, and access to information as critical determinants of SRHR service utilization. In terms of age, respondents aged 20–24 years were found to be significantly less likely to utilize SRHR services compared to the youngest group (10–14 years old) in Model II (aOR: 0.53, 95% CI: 0.29–0.95, P = 0.035). In contrast, no significant association was observed among the 15–19 years age group. The place of residence also plays a role in SRHR service utilization. In Model I, living in urban areas significantly increased the likelihood of accessing services compared to rural areas (aOR: 1.65, 95% CI: 1.12–2.44, P = 0.012). However, this association became non-significant after adjusting for additional variables in Model II. On the contrary, knowledge emerged as a strong determinant of SRHR service utilization. In Model II, respondents with good knowledge of contraceptive methods were 2.46 times more likely to utilize services (aOR: 2.46, 95% CI: 1.72–3.56, P < 0.0001), while high awareness of SRHR rights also significantly increased service uptake (aOR: 2.04, 95% CI: 1.26–4.29, P < 0.0001). In contrast, general knowledge related to SRH did not show a significant association.

Table 4.

Factors associated with service utilization of sexual and reproductive health and rights (n=849)

Variables		Model I				Model II
		aOR (95% CI)		P		aOR (95% CI)		P
Age groups
10–14 years old		1				1
15–19 years old		1.55 (0.86–2.79)		0.144		0.99 (0.52–1.86)		0.967
20–24 years old		0.97 (0.56–1.68)		0.919		0.53 (0.29–0.95)		0.035*
Place of residence
Rural area		1				1
Semi-urban area		0.91 (0.60–1.39)		0.675		0.94 (0.60–1.47)		0.787
Urban area		1.65 (1.12–2.44)		0.012*		1.39 (0.92–2.11)		0.122
Sex
Female		1				1
Male		0.87 (0.64–1.19)		0.384		1.04 (0.74–1.46)		0.826
Respondent’s educational attainment
≤Senior high school		1				1
University level		1.18 (0.86–1.63)		0.299		1.24 (0.89–1.74)		0.208
Father’s educational attainment
≤Senior high school		1				1
University level		0.88 (0.56–1.39)		0.592		0.81 (0.50–1.31)		0.390
Mother’s educational attainment
≤Senior high school		1				1
University level		0.99 (0.62–1.59)		0.970		1.01 (0.61–1.67)		0.968
Who do you live with?
Living alone		1				1
Nuclear family		1.40 (0.89–2.19)		0.139		1.18 (0.73–1.89)		0.495
Extended family		0.98 (0.50–1.92)		0.952		0.84 (0.41–1.72)		0.625
Knowledge related to contraceptive methods
Lacking						1
Good						2.46 (1.72–3.56)		<0.0001*
Knowledge related to sexual and reproductive health
Lacking						1
Good						0.89 (0.50–1.60)		0.704
Awareness related to sexual and reproductive rights
Low						1
High						2.04 (1.26–4.29)		<0.0001*
Support networks to discuss SRHR
No opportunity to ask questions						1
Only a few questions						1.70 (0.92–3.17)		0.092
Yes, but prefer not to ask						1.69 (0.90–3.17)		0.100
Able to ask all questions						2.32 (1.26–4.28)		0.007*
Attitude toward SRHR
Neutral						1
Supportive						0.83 (0.58–1.18)		0.292
Having access to relevant SRHR information
No						1
Yes						1.89 (1.22–2.94)		0.004*
Ability to exercise SRHR
No						1
Yes						1.07 (0.71–1.62)		0.748

*P<0.05; aOR: Adjusted Odds Ratio; 95% CI: Confidence Interval

Support networks for discussing SRHR also showed significant effects. Respondents who could freely ask all SRHR-related questions were over two times more likely to utilize services (aOR: 2.32, 95% CI: 1.26–4.28, P = 0.007). Access to relevant SRHR information further amplified service utilization. Respondents who had access to such information were significantly more likely to use services (aOR: 1.89, 95% CI: 1.22–2.94, P = 0.004). Conversely, other factors, such as attitudes toward SRHR, gender, living arrangements, and educational attainment (both of respondents and their parents), were not significantly associated with service utilization, suggesting that these variables may have less direct influence in this context.

Discussion

This study presents a comprehensive analysis of the key factors influencing the utilization of SRHR services among adolescents and young adults in Indonesia. It examines sociodemographic characteristics, knowledge levels, awareness, support networks, and other critical determinants shaping access to and use of these services. The findings provide essential insights for policymakers, educators, and healthcare providers, serving as a foundation for developing evidence-based interventions to enhance SRHR outcomes within this population.

The demographic profile of the respondents, primarily individuals aged 20–24 years, urban residents, and females, aligns with established trends in SRHR research. The predominance of female respondents may indicate gender-related differences in health-seeking behaviors and a higher willingness among women to engage in health-related surveys. Additionally, the concentration of respondents in urban areas underscores the relatively greater accessibility of SRHR services in these settings while also raising concerns about potential disparities in service provision for rural populations.[24] Furthermore, the majority of respondents reside in nuclear households, highlighting the significant role of the family as a support system and emphasizing the need for family-centered educational initiatives to enhance SRHR awareness and engagement.[25,26]

Gaps in knowledge regarding contraception and fertility remain significant, particularly in misunderstandings about vasectomy and the risks of pregnancy during menstruation. These findings underscore the urgent need for comprehensive sexuality education (CSE) that systematically addresses common misconceptions and less understood aspects of reproductive health.[27] Furthermore, gender disparities in knowledge are evident, with males demonstrating lower awareness of specific contraceptive methods such as contraceptive pills, injections, intrauterine devices (IUDs), and implants. This disparity highlights the importance of designing targeted educational interventions that are inclusive and tailored to different demographic groups to enhance effectiveness. These knowledge gaps align with global trends, reinforcing the need for culturally sensitive and gender-responsive educational approaches to close the reproductive health information divide.[28]

Gender disparities in awareness of SRHR, where females tend to be more informed than males, highlight both the success of targeted advocacy efforts and the ongoing need to engage men in awareness initiatives.[29] A study in Nepal demonstrated that involving men in SRHR programs contributes significantly to improved family planning outcomes, reductions in gender-based violence, and greater empowerment of women. However, persistent barriers—such as stigma, cultural norms, and financial constraints—must be systematically addressed to maximize the impact of these programs.[30] Additionally, the relatively equal levels of awareness across genders regarding the right to be free from violence indicate a broad recognition of this issue. Nonetheless, awareness alone is insufficient; concerted efforts are required to translate this knowledge into actionable protections and enforcement mechanisms. To achieve lasting progress, SRHR initiatives must prioritize gender-inclusive strategies that not only promote equality but also empower individuals of all genders to advocate for and exercise their rights effectively.[31]

The study highlights that mothers and digital platforms serve as the primary sources of SRHR information, reflecting shifting trends in knowledge dissemination. Digital platforms, particularly social media, have become the dominant information source among adolescents, consistent with findings from studies conducted in Jakarta.[32] Notably, this study identifies mothers as the primary providers of SRHR information, whereas fathers play a minimal role despite their equally important influence. The limited involvement of fathers and the general reluctance of adolescents to discuss reproductive health with their parents stem from cultural taboos, feelings of shame, and a lack of parental confidence in delivering SRHR education. These findings underscore the urgent need for targeted parental training programs to enhance their capacity to provide accurate and comfortable SRHR discussions within families.[33,34]

While familial and online sources play a significant role in adolescent SRHR education, the limited involvement of healthcare professionals and educators represents a missed opportunity to provide authoritative guidance. Cultural stigma surrounding SRHR services for adolescents continues to restrict access, fostering discriminatory attitudes that create discomfort and deter young people from seeking professional support. This highlights a critical gap in inclusive SRHR services. To address this issue, strengthening the role of healthcare professionals and educators through capacity-building initiatives and integrating SRHR education into school curricula can improve both the credibility and accessibility of information.[18] Additionally, with the increasing reliance on digital platforms, targeted investments in developing accurate, engaging, and youth-friendly content are essential to counter misinformation.[27,28] Evidence from Indonesia suggests that leveraging popular social media platforms for adolescent SRHR promotion effectively enhances knowledge and encourages healthier behaviors.[35] Furthermore, increasing adolescents’ motivation to engage with SRHR resources has been linked to higher utilization of health services, reinforcing the need for comprehensive and accessible interventions.[36]

Several key determinants, including age, place of residence, knowledge levels, and access to information, play a critical role in shaping the utilization patterns of SRHR services among adolescents. While older adolescents tend to have higher levels of knowledge, they often exhibit lower service utilization rates. This paradox may be attributed to societal stigma, self-reliance, or a lack of youth-friendly services that cater to their specific needs.[16] These findings underscore the importance of age-specific interventions designed to address such barriers effectively. A systematic review emphasized the necessity of tailoring adolescent SRHR services to different developmental stages to ensure their availability, accessibility, and acceptability. Adolescence is a dynamic period marked by puberty, sexual initiation, and evolving health needs, requiring targeted interventions such as HPV vaccination, contraceptive education, and comprehensive sexuality education. Furthermore, while urban residency initially appears to be a significant determinant of service utilization, its impact diminishes when adjusted for resource availability. This suggests that disparities in access are more closely linked to the distribution of resources rather than geographical location alone. Consequently, policymakers should prioritize equitable resource allocation to bridge the urban-rural divide and ensure that all adolescents, regardless of residence, have equal access to essential SRHR services.[23]

Knowledge plays a crucial role as a strong predictor of service utilization, underscoring the significance of rights-based, comprehensive education in fostering health-seeking behaviors. Furthermore, the presence of strong support networks helps mitigate stigma and boost confidence, reinforcing the necessity of creating safe spaces where adolescents can openly discuss SRHR without fear of judgment. These findings align with global evidence, which highlights the critical interplay between informed decision-making and supportive environments in enhancing individuals’ willingness and ability to seek essential health services.[21,23,24,27]

Limitations and recommendations

This study has several limitations. Selection bias arises from convenience sampling, which may not represent Indonesia’s adolescent population, particularly those with limited internet access, leading to an overrepresentation of urban, tech-savvy individuals. Recruitment through NGOs may further skew responses toward adolescents already engaged in SRHR programs. Response bias is another concern, as self-selection may favor those more interested in SRHR, potentially overestimating awareness and service utilization, while social desirability and recall biases could lead to overreporting and inaccurate responses. Geographic and demographic biases may result from social media-based recruitment, underrepresenting rural adolescents and favoring older respondents. Additionally, platform-specific bias may exclude individuals not active on Instagram or WhatsApp, further limiting diversity in the sample.

To address gaps in SRHR among adolescents in Indonesia, several recommendations are proposed. First, gender-sensitive educational programs should be developed to address knowledge gaps, misconceptions, and the unique needs of diverse groups. These programs should provide accurate, comprehensive information while considering the challenges faced by different populations. Healthcare providers, educators, and community leaders should be empowered to take active roles in SRHR education and advocacy, creating a supportive environment and promoting awareness within local communities.

In addition, investing in digital health solutions is crucial for disseminating accurate, youth-friendly SRHR content, helping combat misinformation and ensuring that adolescents have access to reliable information. Efforts should also focus on reducing urban-rural disparities by improving infrastructure and expanding the availability of SRHR services in underserved areas, ensuring equitable access for adolescents in rural and remote regions. Finally, targeted interventions for older adolescents are necessary to address stigma, enhance self-efficacy, and encourage service utilization. By implementing these strategies through innovative and inclusive approaches, SRHR outcomes can be significantly improved, contributing to health equity among Indonesian adolescents. Prioritizing education, equitable access, and stakeholder engagement will provide all adolescents with the necessary resources and support to fully exercise their SRHR.

Conclusion

This study highlights critical factors influencing SRHR service utilization among adolescents in Indonesia, including gaps in knowledge, gender differences, and the role of support networks. Despite higher awareness, service utilization remains low, especially among older adolescents, due to stigma and self-reliance tendencies. The study emphasizes the importance of gender-sensitive education, the growing role of digital platforms and family networks in information dissemination, and the need for equitable resource distribution to address urban-rural disparities. Recommendations include developing comprehensive, inclusive educational programs; empowering healthcare providers and community leaders; investing in digital health solutions; and creating safe spaces to improve access and service utilization. By implementing these strategies, policymakers can enhance SRHR outcomes and promote health equity among Indonesian adolescents.

Author’s contributions

The idea for the study was conceived by NPAH, who also analyzed the data. NPAH took the lead in drafting the manuscript. NPAH, MK and PPJ critically reviewed the manuscript and approved its final version. All authors made contributions to the article and gave their approval for the submitted version.

Declaration of patient consent

Participation in the study was entirely voluntary, with strict measures to ensure anonymity. Prior to completing the online questionnaire, participants provided digital informed consent.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Center for Public Health Innovation (CPHI) of Udayana University.