Adolescents' knowledge and perceptions of sexual and reproductive health rights and access to services in the Greater Banjul Area, the Gambia.

Introduction: adolescents in the Gambia face significant challenges in accessing sexual and reproductive health (SRH) services, hindered by sociocultural barriers, inadequate education, and systemic limitations. Despite representing a significant proportion of the population, limited research addresses the sociocultural and institutional factors shaping their SRH awareness and access. This study bridges these gaps by assessing adolescents' knowledge, perceptions, and access to SRH services while identifying the associated barriers and determinants in the Greater Banjul Area. Methods: this cross-sectional study included 424 secondary school students aged 15-19 years in grades 10 and 11 of selected private and public schools. Data were collected using structured questionnaires and analyzed with descriptive statistics, chi-square tests, and logistic regression. Results: revealed that only 34.2% of participants were aware of SRH rights, and only 12.7% had attended formal SRH training. Knowledge gaps were evident, with only 24.1% aware of contraception rights and 23.6% understanding consent rights. Barriers associated with these findings included lack of information (41.5%), cultural taboos (34.9%), and fear of judgment (22.9%). Only 22.4% accessed SRH services, mainly in public clinics (8.3%), with a satisfaction rate of 15.1%. Logistic regression showed public school students had less access (AOR = 0.320, 95% CI: 0.190-0.539, p < 0.001) and fewer barriers (AOR = 0.253, 95% CI: 0.107-0.601, p =0.002). Conclusion: this study emphasizes the need for age-appropriate SRH education, expanded youth-friendly services, and community engagement to reduce cultural barriers and improve equitable access for Gambian adolescents.