Beyond knowledge: violence as a structural determinant of adolescent sexual and reproductive health in Angola

Background: Evidence on adolescent sexual and reproductive health (SRH) in Angola remains scarce, particularly among younger adolescents who are frequently excluded from research. Context-specific data are needed to understand how SRH knowledge translates into behaviours and how structural factors shape adolescents’ ability to act on this knowledge. This study aimed to describe SRH knowledge, behaviours, exposure to violence, and structural vulnerabilities among adolescents aged 11–17 years in Benguela Province, Angola. Methods: We conducted a school-based cross-sectional study in October 2024 among 382 adolescents from urban (n = 282) and rural (n = 100) settings in Benguela Province, selected through systematic random sampling. A culturally adapted questionnaire assessed key SRH domains, including knowledge, sexual behaviours, contraceptive use, menstrual health, pregnancy and abortion, and experiences of sexual and gender-based violence (GBV). Data were analysed using descriptive and bivariate statistics to characterise patterns by sex and residence. Results: Nearly all participants demonstrated adequate SRH knowledge (98.7%). However, only 18.1% reported using any contraceptive method, with pronounced gender disparities, particularly in urban settings (urban boys 34.0% vs. urban girls 7.7%; p < 0.001). Overall, 29.0% reported having engaged in sexual intercourse, and 8.1% reported risky sexual behaviours, including inconsistent condom use during sexual intercourse. Nearly half of adolescents (45.8%) reported experiences of sexual or GBV, with forced sexual acts disproportionately affecting boys, positioning violence as a key constraint on adolescents’ sexual and reproductive agency. Menstrual-related barriers were widespread, affecting 63.5% of urban girls and 80.3% of rural girls, and included missing school or daily activities. Unintended pregnancy was reported by 2.4% of participants, and all reported abortions occurred in urban settings. Conclusions: Despite near-universal SRH knowledge, adolescents face substantial barriers to adopting protective practices. Widespread exposure to violence emerges as a central structural determinant, operating alongside restrictive gender norms, limited access to youth-friendly services, and menstrual health challenges to constrain adolescents’ ability to act on existing knowledge. Improving adolescent SRH in Angola will require moving beyond information-based strategies toward integrated, gender-responsive approaches that combine education with accessible services, menstrual health support, and comprehensive violence-prevention efforts.