Parental and Peer Attachment as Predictors of SRH Knowledge, Attitudes, and Educational Outcomes in Pregnant Adolescents in Nigeria

BolajokoElizabethOtegbayo

PhD)

NoralinaOmar

PhD)

2✉

MahmoudDanaee

(PhD)

NasrinAghamohamadi

(PhD)

3,4

TouhidaTasnima4

OtegbayoBolajokoElizabeth5Emaillizezutah@gmail.com

1NuMIQ Research Focus Area, Faculty of Health SciencesNorth-West UniversityPotchefstroomSouth Africa

2Faculty of Arts and Social Sciences, Department of Social Administration and JusticeUniversity of Malaya50603Kuala LumpurMalaysia

3Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of MedicineUniversity of Malaya50603Kuala LumpurMalaysia

4Department of Social RelationsEast West University1212Jahurul Islam City, AftabnagarDhakaBangladesh

Peer Attachment → SA–0.103 0.051 2.036 0.042 Peer Attachment → SRHK –0.118 0.047 2.5230.012

Bolajoko Elizabeth Otegbayo ^1,1 (PhD), Noralina Omar^2,2** (PhD), Mahmoud Danaee^3,3(PhD), and Nasrin Aghamohamadi^4,3(PhD), Touhida Tasnima^5,4

¹NuMIQ Research Focus Area, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa

²Faculty of Arts and Social Sciences, Department of Social Administration and Justice, University of Malaya, 50603 Kuala Lumpur, Malaysia.

³Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.

⁴Department of Social Relations, East West University, Jahurul Islam City, 1212, Aftabnagar, Dhaka Bangladesh.

*Corresponding author: Otegbayo Bolajoko Elizabeth

lizezutah@gmail.com

ABSTRACT

Background

Pregnant adolescents in Nigeria experience intersecting health and educational vulnerabilities. Guided by Bronfenbrenner’s Ecological Systems Theory, this study examined the influence of parental and peer attachment on sexual and reproductive health knowledge (SRHK), sexual attitudes (SA), and educational outcomes (EO), with religious belief assessed as a potential mediator.

Methods

A cross-sectional study of 400 pregnant adolescents aged 14–19 was conducted across three culturally diverse Nigerian states. Data were collected using validated instruments and analysed using bootstrapped Partial Least Squares Structural Equation Modelling (PLS-SEM).

Results

Parental attachment significantly predicted SRHK (β = 0.219, p < .001), but not SA (β = − 0.01, p = .833). Peer attachment showed negative associations with both SRHK (β = − 0.118, p = .012) and SA (β = − 0.103, p = .042). SA significantly predicted EO (β = 0.165, p < .001), while SRHK did not. Religious belief was not a significant mediator but independently predicted EO (β = 0.216, p < .001).

Conclusion

Parental support enhances SRHK, while peers may reinforce negative attitudes. Religious belief contributes positively to academic outcomes but does not mediate SRH variables. Interventions should address peer dynamics, promote parent–child SRH communication, and collaborate with faith-based institutions to support pregnant adolescents’ education.

Keywords:

Educational Outcomes

Pregnant Adolescents

Parent and Peer Attachment

Psychosocial factors

Religious Belief

Ecological Model

Implication and Contribution

Programmes should strengthen parent–child communication, provide culturally sensitive SRH education, and implement peer-led models that promote positive norms, while collaborating with religious leaders and ensuring that pregnant adolescents remain in school. Improving knowledge alone is insufficient unless attitudes and socio-emotional support are also addressed. This study applies an ecological perspective with bootstrapped PLS-SEM to clarify how parent and peer attachments influence SRH knowledge, sexual attitudes, and academic achievement among pregnant teenagers in Nigeria. It demonstrates positive effects of parental attachment on knowledge, negative peer effects on both outcomes, and a non-mediating, stabilising role of religious belief, with reported effect sizes and explained variance.

1.0 Introduction

Teen pregnancy remains a significant global public health and educational challenge, affecting all regions and socioeconomic groups. Adolescence is a transitional period characterized by rapid physical, psychological, and social development, during which young people begin to assert autonomy and explore sexual identity [1], [2], [3]. According to the World Health Organization, approximately 60 out of every 1,000 girls aged 15–19 give birth each year, resulting in nearly 17 million adolescent births worldwide [4].

Sub-Saharan Africa bears a disproportionate share of adolescent childbearing. In 2021, an estimated 6.1 million births occurred among girls aged 15–19, with an additional 332,000 births among girls aged 10–14 [5]. Nigeria, the most populous country in the region, presents an especially critical context: the Nigeria Demographic and Health Survey (2018) reports that 21% of girls aged 15–19 have begun childbearing, and nearly one in five becomes sexually active before age 15 [6], [7]. Alarmingly, nearly 25% of adolescent mothers already have two or more children[7], contributing to school dropout, early marriage, and intergenerational cycles of poverty [8], [9]. Pregnant adolescents face considerable disruptions to their education due to stigma, emotional distress, and financial hardship [10], [11], [12]. Factors such as poverty and peer pressure often drive early sexual activity and marriage, increasing the risk of poor school performance and eventual dropout [8], [11], [13]. Adolescents experiencing pregnancy without adequate psychosocial or institutional support are more likely to disengage from school, experience reduced academic motivation, and underperform in assessments [5], [14], [15].

These individual-level barriers are worsened by school environments that are often unprepared to accommodate pregnant students. Many schools lack flexible academic policies, on-site antenatal support, or youth-friendly services [7], [16]. In Rivers State, over 61% of pregnant adolescents dropped out due to financial pressures and lack of institutional support [11]. In Ekiti State, although policies exist to accommodate pregnant students, pervasive stigma and social exclusion continue to undermine school retention and academic performance among adolescent girls [12]. These disruptions impair current academic engagement and reduce future opportunities for economic empowerment and social mobility [7], [11], [12].

Social relationships, particularly with parents and peers, play a pivotal role during adolescence [17], [18]. Strong parental attachment and open communication are associated with delayed sexual initiation, greater emotional resilience, and improved academic performance [19], [20]. In contrast, weak parental involvement often leads to misinformation, peer pressure, and high-risk behavior [19], [21]. Peer influence can be protective or harmful: supportive peer networks reinforce healthy norms, while deviant peer affiliations increase the risk of early sexual debut and poor school performance [22], [23].

Religious belief also shapes adolescent behavior, especially in Nigeria’s deeply religious society [24], [25]. Strong religious affiliation is often associated with delayed sexual debut and reduced engagement in risky behavior [26]. However, religious norms can also contribute to the stigmatization and social exclusion of pregnant adolescents, particularly when religious communities enforce strict moral expectations without support systems [25], [27]. Despite these complex dynamics, the role of religion as a potential mediator between adolescent social environments and outcomes remains underexamined in empirical research.

This study draws on Bronfenbrenner’s Ecological Systems Theory, which posits that adolescent development is shaped by interactions within multiple layers of the social environment [28], [29]. The microsystem including parents and peers is theorized to directly influence adolescents’ sexual and reproductive health (SRH) knowledge, sexual attitudes, and educational outcomes. The macrosystem, represented here by religious belief, may exert indirect effects through its role in shaping moral values and social norms.

Given the high prevalence of teenage pregnancy and school disengagement among Nigerian adolescents, it is critical to understand how familial, peer, and religious factors jointly shape sexual and reproductive health (SRH) and educational trajectories. This study investigates how parental attachment, peer relationships, and religious belief influence SRH knowledge, sexual attitudes, and educational outcomes among pregnant school-going adolescents in Nigeria, with particular attention to the mediating role of religious belief.

1.2 Conceptual Framework

Guided by Bronfenbrenner’s Ecological Systems Theory, the conceptual framework proposes that parental and peer attachment (microsystem influences) predict adolescents’ sexual and reproductive health knowledge and sexual attitudes, which in turn influence academic achievement. Religious belief, operating within the macrosystem, is hypothesised to mediate the relationship between these psychosocial factors and educational outcomes. Figure 1 illustrates these hypothesised relationships.

Fig. 1

Conceptual Framework

1.3 Hypothesis

H₁

Parent attachment is associated with sexual and reproductive health knowledge, sexual attitude, and educational outcomes among pregnant teenage girls in Nigeria.

H₂

Peer attachment is associated with sexual and reproductive health knowledge, sexual attitude, and educational outcomes among pregnant teenage girls in Nigeria.

H₃

Religious belief mediates the relationship between sexual and reproductive health knowledge, sexual attitude, and educational outcomes among pregnant teenage girls in Nigeria.

2.0 Methodology

2.1 Study Design and Population

This quantitative cross-sectional study was conducted among pregnant adolescent girls in three purposively selected Nigerian states Lagos, Rivers (Port Harcourt), and Niger, between 28 January and 24 March 2021. The selection aimed to capture regional diversity in cultural norms, healthcare access, and the burden of adolescent pregnancy. Lagos represents a highly urbanised setting with the highest concentration of health facilities in Nigeria, accounting for approximately 7% nationally[30]. Rivers State, situated in the oil-rich South-South region, experiences high adolescent fertility rates [31] amid industrialisation and migration pressures. Niger State, predominantly rural and located in the North-Central zone, reflects conservative socio-religious contexts where early marriage is prevalent and access to youth-friendly health services remains limited. These contrasts enabled a broader understanding of the sociocultural and structural factors shaping adolescent pregnancy and educational outcomes across diverse settings.

2.2 Sampling procedure and Sampling

A snowball sampling technique was used to recruit participants, given the sensitive and stigmatised nature of teenage pregnancy in Nigeria, making direct recruitment difficult. Previous studies have shown that adolescents experiencing unintended pregnancy often face social stigma, rejection, and institutional exclusion [32], [33]. To access this hard-to-reach population, referrals were obtained from teachers, community health workers, and pregnant adolescents themselves. Eligible participants were pregnant schoolgirls aged 14 to 19 years residing in any of the selected states. The recruitment was carried out in various settings, including private residences, shelters, schools and healthcare centres. The excluded criteria were girls who were sexually active but had never been pregnant, those who were not enrolled in school at the time of data collection, and those with a history of abortion.

All participants provided written informed consent, co-signed by a parent or guardian for minors.

Ethical approval was granted by the Ethics Committee of the institution and the Ministry of Health. The minimum sample size was calculated using the Krejcie and Morgan formula, yielding 384 participants [34]. To account for potential non-response, the sample was increased to 400.

2.3 Research instrument

Data were collected using a structured questionnaire developed through a review of validated instruments. The questionnaire comprised five sections aligned with the study objectives: peer attachment, parental attachment, knowledge of sexual and reproductive health (SRHK), religious belief, and academic achievement. Peer and parental attachment were measured using items adapted from the Inventory of Parent and Peer Attachment (IPPA). Peer attachment included three subscales: trust (4 items), communication (3 items), and alienation (4 items). Parental attachment consisted of trust (10 items), communication (9 items), and alienation (6 items) [35]. All items were rated on a 5-point Likert scale ranging from 1 (“Not at all”) to 5 (“Very much”). Sexual and reproductive health knowledge (SRHK) was assessed using 20 dichotomous items (Yes = 1, No = 0) adapted from the Assessment of Sexual Knowledge (ASK), with higher total scores indicating greater knowledge [36]. Sexual attitude was scored on a scale from 0 to 2, reflecting the degree of positive orientation towards safe sexual behaviour [36]. Religious belief was measured using 8 items adapted from the 2018 International Social Survey Programme (ISSP) Religion Questionnaire. The items covered religious participation, moral views, and gender beliefs. Each was scored on a 5-point Likert scale (e.g., 1 = “Never” to 5 = “Every day” or 1 = “Indifferent” to 5 = “Strongly agree”), with higher scores representing stronger religious commitment. Educational Outcomes was measured using four items adapted from Jesús Montero-Marín et al. Indicators included self-reported CGPA (scored as 1 = < 2.5, 2 = 2.5–3.5, 3 = > 3.5), ability to concentrate (1 = Always, 2 = Sometimes, 3 = Never), and number of failed subjects (0 = None, 1 = One, 2 = Two or more). To ensure content validity, academic and field experts reviewed the instrument [37]. A pilot study was conducted with 30 participants. The questionnaire was administered twice over a two-week interval to assess test–retest reliability. Reliability results indicated acceptable internal consistency: Academic Achievement (α = 0.72), SRHK (Kappa = 0.45–0.68), Peer Attachment (α = 0.52–0.63), Parent Attachment (α = 0.73–0.75), and Religious Belief (α = 0.71).

2.4 Data Analysis

Analysis for this study was conducted using the SPSS version 23 and Partial Least Square-Structural Equation Model Smart PLS. Hence for descriptive analysis the frequency, mean and standard deviation was conducted. While for SEM, bootstrapping was used in this study to test for significance between study hypotheses. Hence, effect size (f²) was used to test for exogeneous construct while Coefficient of determination (R²) was used to test for endogenous construct of each variable in this study.

The structural equation model is the next important phase of SEM analysis after fitting the measurement model in this study. The structural model was used to identify the relationships among peer and parent attachment, sexual and reproductive health knowledge, sexual attitude, religious belief, and educational outcomes of pregnant teenagers in this study. It also provides specific details of the relationships between the independent or exogenous variables and the dependent or endogenous variables [38], [39]. Evaluation of the structural model first considers the overall model fit, followed by the size, direction, and importance of the hypothesised parameter estimates (Hair.Jr., J. et al., 2006)

3.0 Result

3.1 Demographic Characteristics of Respondents

The participants' ages ranged from 14 to 19 years, with a mean age of 17.25 years (SD = 1.30), indicating that the sample consisted predominantly of older adolescents. Table 1 shows the distribution of respondents across key demographic variables. Regarding educational attainment, most respondents had completed secondary education (39.5%), followed by primary education (35%). Approximately 20.3% had some level of tertiary education, while 5.3% reported having no formal education. For marital status, the majority of participants were married (63.7%), with 19% single, 15.8% divorced, and 1.5% widowed. In terms of religious affiliation, just over half of the respondents identified as Muslim (50.2%), while 30.8% identified as Christian, 11.5% as Traditionalist, and 7.2% as Other. This religious diversity is important given the role of belief systems in shaping sexual and reproductive health attitudes and outcomes in the study.

Table 1
Frequency Distribution of Demographic Characteristics of Respondents
No	Variable	Level	n	%
1	Level of Education	Primary	140	35
		Secondary	158	39.5
		Tertiary	81	20.3
		None	21	5.3
2	Marital Status	Married	255	63.7
		Single	76	19
3	Religious Affiliation	Christian	123	30.8
		Muslim	201	50.2
		Traditionalist	46	11.5
		Others	29	7.2

3.2 Peer and Parent attachment of Pregnant Teenage Girls

The findings in Table 2 indicate that pregnant teenage girls reported moderate levels of both peer and parental attachment across all subscales. For peer attachment, trust and communication had identical mean scores (M = 3.30), while alienation was slightly lower (M = 3.21). This suggests that, on average, participants experienced moderate levels of trust and communication with their peers, along with a similar but slightly lower sense of alienation. For parental attachment, the mean scores for trust (M = 3.28), communication (M = 3.32), and alienation (M = 3.33) also indicate moderate relationships, with communication being the slightly stronger domain. The mean values for both peer and parental attachment were above the scale midpoint of 3, indicating that respondents generally perceived their relationships with peers and parents as moderately supportive and communicative.

Overall, these results suggest that pregnant teenage girls in this study maintained relatively balanced relationships with both peers and parents, which may provide a moderate degree of social support during pregnancy. However, the similar levels of alienation reported alongside trust and communication highlight the complexity of these relationships, where positive connections may coexist with feelings of distance or misunderstanding.

Table 2
Descriptive Statistics of Peer and Parent Attachment among Respondents
Variables	Subscales	Mean	SD
Peer Attachment	Trust	3.30	0.96
	Communication	3.30	0.97
	Alienation	3.21	0.96
Parent Attachment	Trust	3.28	0.94
	Communication	3.32	0.91
	Alienation	3.33	0.94

3.3 Sexual and Reproductive Health Knowledge of Pregnant Teenage Girls

The distribution of sexual and reproductive health knowledge (SRHK) among pregnant teenage girls, as shown in Table 3, shows a relatively balanced pattern. About half of the respondents (50.7%) demonstrated high levels of SRHK, while 49.3% had low levels. The mean score of 8.83 (SD = 5.79) indicates moderate overall knowledge, although the large standard deviation suggests considerable variability in respondents’ understanding. This suggests that while some teenagers have adequate knowledge of sexual and reproductive health, a substantial proportion still lacks essential information, leaving them vulnerable to poor sexual health decisions.

In contrast, sexual attitude scores show a less balanced distribution. A greater proportion of respondents (63%) exhibited low levels of positive sexual attitudes, while only 37% demonstrated high levels. The mean score of 4.70 (SD = 2.21), although above the midpoint, indicates that respondents generally hold less favorable or less informed attitudes towards sexual behavior. This finding highlights a gap between knowledge and attitudes, where even among those with adequate SRHK, attitudes towards safe sexual practices may not always align.

Overall, these results suggest that while knowledge of sexual and reproductive health among pregnant teenagers in this study is relatively adequate for half of the respondents, attitudes remain predominantly less positive. This disconnect underscores the need for interventions that go beyond knowledge provision to address attitudes, values, and behavioral intentions related to sexuality and reproductive health.

Table 3
Distribution of SRH Knowledge and Sexual Attitude among Respondents
Variable	Level	Frequency (n)	Percentage (%)	Mean	SD
Sexual Reproductive Health Knowledge	Low	197	49.3	8.83	5.79
Sexual Reproductive Health Knowledge	High	203	50.7
Sexual Attitude	Low	252	63	4.70	2.21
Sexual Attitude	High	148	37

3.4 Religious Belief of Pregnant Teenage Girls

The findings in Table 4 show that pregnant teenage respondents reported a relatively high level of religious belief, with an overall mean score of 3.53 (SD = 0.98), above the scale midpoint of 3. This indicates that religion plays an influential role in their values, perceptions, and decision-making. Respondents strongly affirmed the importance of religion in life (M = 3.61, SD = 1.23) and moral expectations regarding marital fidelity (M = 3.67, SD = 1.17). There was also considerable support for the role of religion in providing comfort during times of sorrow or hardship (M = 3.42, SD = 1.16). Attitudes toward abortion in the context of financial difficulty (M = 3.53, SD = 1.13) reflected a moderately strong belief in religious or moral restrictions on reproductive choices.

Interestingly, responses regarding gender roles revealed some ambivalence. While participants moderately endorsed traditional views of household and income responsibilities (M = 3.51, SD = 1.19), they also agreed that their religion treats men and women equally (M = 3.54, SD = 1.15). However, the slightly lower score on perceptions of gender inequality within religion (M = 3.44, SD = 1.13) suggests that some respondents still recognised disparities in religious practice. Taken together, these results highlight that pregnant teenagers in this study generally uphold strong religious beliefs, which may serve both as a protective factor, shaping moral perspectives and resilience, and as a restrictive factor, particularly in areas related to gender roles and reproductive decision-making. This dual influence of religion warrants further exploration, as it may affect not only sexual and reproductive attitudes but also the broader academic and psychosocial outcomes of adolescent mothers.

Table 4
Mean Rating of Religious Beliefs Items of Respondents
No	Item	Mean	SD
1	How often do you usually attend religious services?	3.54	1.27
2	Do you agree that religion is an important aspect of life?	3.61	1.23
3	Do you think it is wrong or not wrong if a married person has sexual relations with someone other than his or her husband or wife?	3.67	1.17
4	Do you agree or disagree that practicing a religion helps people to gain comfort in times of sorrow or trouble?	3.42	1.16
5	Do you personally think it is wrong or not wrong for a woman to have an abortion if the family has a very low income and cannot afford any more children?	3.53	1.13
6	Do you think a husband's job is to earn money; a wife's job is to look after the home and family?	3.51	1.19
7	Your religion treats men and women equally.	3.54	1.15
8	Your religion treats men better than women, or treat women better than men?	3.44	1.13
	Average mean	3.53	0.98

3.4 Structural Model

To evaluate the relationship between the dependent and independent variables in this study, structural equation modelling (SEM) was applied. Using a bootstrapping method, the research framework tested the influence of parent and peer attachment on sexual and reproductive health knowledge (SRHK) and sexual attitude (SA), with religious belief (RB) acting as a mediator between sexual and reproductive health knowledge, sexual attitude, and educational outcomes (EO). Figure 2 presents the model relating parent and peer attachment to sexual and reproductive health knowledge and sexual attitude, with religious belief acting as a mediator between sexual and reproductive health knowledge, sexual attitude (as independent variables), and academic achievement (as the dependent variable).

Fig. 2

Path Model

Bootstrapping was employed to assess model fit, path significance, and mediation effects, with standardized path coefficients (β) and p-values reported. This technique involves repeatedly resampling the dataset at random to estimate the stability and significance of the model parameters [40]. Standardized path coefficients (β), standard errors (SE), t-values, and p-values were calculated for each hypothesized path. The analysis revealed that Parental attachment significantly predicted sexual and reproductive health knowledge (β = 0.219, p < 0.001), but not sexual attitude (β = − 0.01, p = 0.833), while peer attachment showed significant negative effects on both outcomes (SA: β = − 0.103, p = 0.042; SRHK: β = − 0.118, p = 0.012), suggesting differential impacts of attachment sources as shown in Table 5.

Table 5
Structural Model: Path Coefficients for Parent and Peer Attachment
Path	β	SE	t-value	p-value
Parent Attachment → SA	–0.01	0.049	0.211	0.833
Parent Attachment → SRHK	0.219	0.047	4.632	< 0.001
Peer Attachment → SA	–0.103	0.051	2.036	0.042
Peer Attachment → SRHK	–0.118	0.047	2.523	0.012

3.5 Mediation Analysis

To assess whether religious belief (RB) mediated the effects of SRHK and SA on educational outcomes (EO), a bootstrapped mediation analysis was conducted (Hair et al., 2014). The mediation model examined the indirect effects (Paths a and b) and the direct effect (Path c′), as shown in Table 6.

Findings showed that SRHK (β = 0.044, p = 0.420) and SA (β = 0.013, p = 0.809) were not significantly associated with religious belief, indicating no indirect pathway via religious belief. However, religious belief significantly predicted academic achievement (β = 0.216, p < 0.001). The direct effect of SA on EO remained significant (β = 0.165, p < 0.001), while SRHK had no significant direct effect on EO (β = 0.044, p = 0.420). Therefore, no mediation was observed.

Table 6
Mediation Path Coefficients: SRHK and SA through Religious Belief to Educational Outcomes
Path	β	SE	t-value	p-value
SRHK → RB (Path a)	0.044	0.054	0.818	0.420
SA → RB (Path a)	0.013	0.052	0.242	0.809
RB → EO (Path b)	0.216	0.041	5.214	< 0.001
SRHK → EO (Direct, c′)	0.044	0.040	1.076	0.420
SA → EO (Direct, c′)	0.165	0.039	4.280	< 0.001

3.6 Model Fit and Effect Sizes

The adjusted R² for academic achievement (AA) was 0.288, indicating that approximately 28.8% of the variance in Educational Outcomes (EO) was explained by SRHK, SA, and RB. The adjusted R² for religious belief (RB) was 0.003, suggesting that SRHK and SA together explained virtually none of the variance in Religious Belief (RB).

Effect size analysis (f²) showed that SRH Knowledge had a moderate effect on AA (f² = 0.260), while SA and RB had small effects on EO (f² = 0.038 and 0.066, respectively). SRHK had no meaningful effect on RB (f² = 0.000), and SA had a negligible effect on RB (f² = 0.002). These findings suggest that although SRH Knowledge directly influences academic outcomes, it does not influence them indirectly through religious belief (RB).

3.7 Total Effects: Direct vs Indirect Contributions

The total effect of SRHK on Educational Outcome (EO) was statistically significant (β = 0.443, p < 0.001); however, neither the direct nor indirect pathways accounted for this effect, suggesting the presence of unmeasured mediators. By contrast, SA had a significant total effect on EO (β = 0.168, p < 0.001), largely attributable to the direct pathway as presented in Table 7.

Table 7
Total, Direct, and Indirect Effects of SRHK and SA on Educational Outcomes
Path	Total Effect (β)	Direct (β)	Indirect (β)	Significance
SRHK → EO	0.443 (p < .001)	0.044 (p = .420)	0.009 (p = .439)	Non-Significant
SA → EO	0.168 (p < .001)	0.165 (p < .001)	0.003 (p = .810)	Direct only

Overall, the results show that parental attachment positively influences SRH knowledge but not sexual attitudes. Peer attachment negatively affects both SRH knowledge and sexual attitudes. Sexual attitude significantly predicts academic achievement, while religious belief independently predicts academic achievement but does not mediate the effects of SRH knowledge or sexual attitude. Although SRH knowledge correlates with academic achievement, it shows neither a direct nor a mediated effect.

4.0 Discussion

This study examined how parental and peer attachment affect sexual and reproductive health (SRH) knowledge, sexual attitudes, and educational outcomes among pregnant, school-going adolescents in Nigeria, with religious belief considered as a potential mediator. Using Bronfenbrenner’s Ecological Systems Theory as a framework, the findings demonstrate that adolescent behaviour and education are shaped by multiple, interconnected systems, from family and peer networks (microsystem) to institutional and cultural norms (macrosystem).

A key finding was the positive association between parental attachment and SRH knowledge (β = 0.219, p < 0.001), supporting the idea that emotionally supportive relationships improve access to accurate health information. This is consistent with previous research showing that strong parent–child communication promotes greater awareness and responsible sexual decision-making [19], [41], [42]. In the Nigerian context, where many adolescents have limited access to formal SRH education, the family remains a crucial source of health information, provided communication is open and non-judgemental.

Conversely, no significant relationship was found between parental attachment and sexual attitudes (β = − 0.01, p = 0.833). This suggests that, while parents may influence factual knowledge, they may have less control over value-based beliefs, which are more strongly shaped by peer networks, social media, and school environments [43], [44]. This reflects the influence of the mesosystem and exosystem, where adolescents navigate conflicting messages and social pressures. Cultural norms of silence, shame, or fear when discussing sexuality within families may also limit parental influence in this area [7], [45], [46].

Importantly, neither parental nor peer attachment showed a significant association with educational outcomes. This may reflect structural and psychosocial barriers that extend beyond interpersonal relationships. Pregnant students in Nigeria often face school policies that restrict re-enrolment, experience social stigma, and lack access to antenatal or psychological support services [12], [19], [47]. These challenges, embedded in the macrosystem, may overshadow the benefits of emotional support from family or peers. The chronosystem is also relevant: pregnancy represents a life-altering transition that frequently disrupts education regardless of prior school performance or motivation [9], [48], [49].

Religious belief emerged as a complex and partial mediator. While strong religious affiliation may promote abstinence and certain protective behaviours, it can also hinder open discussion about contraception or reproductive health, both at home and in religious settings [24], [27], [50]. Religious teachings, particularly those emphasising moral purity or shame, can contribute to internalised stigma and reduced help-seeking, even when adolescents are sexually active or pregnant [51], [52], [53]. These findings illustrate how religious institutions, as part of the macrosystem, can simultaneously offer protection and perpetuate silence or misinformation. This duality complicates their role in adolescent health and education, especially in a deeply religious society such as Nigeria.

These findings have several important implications. First, interventions must adopt an ecological approach, recognising that adolescents are influenced by nested systems, not just individual relationships. Strengthening parental communication is vital but insufficient on its own. Programmes should incorporate peer-led SRH education, digital media literacy, and collaborate with faith-based institutions to promote accurate and culturally respectful messaging [20], [54], [55].

Second, policy reform is urgently needed to remove institutional barriers that prevent pregnant adolescents from continuing their education. This includes implementing re-entry policies, expanding youth-friendly health services, and reducing structural stigma within school systems. In summary, while parental and peer attachments contribute to SRH knowledge and behaviour, systemic and cultural barriers, especially religious and institutional influences, play a decisive role in shaping the educational trajectories of pregnant adolescents. Addressing these multi-layered influences is essential to breaking cycles of disadvantage and ensuring equitable access to health and education for all adolescents.

5.0 Conclusion

In conclusion, this study demonstrates that adolescent reproductive health and educational outcomes in Nigeria are shaped by complex, interrelated layers of the ecological environment. Parental attachment was positively associated with greater SRH knowledge, highlighting the protective role of emotionally supportive familial relationships. However, sexual attitudes and educational outcomes appeared more strongly influenced by peer networks, religious norms, and broader structural barriers. These findings underscore the need for a multilevel, culturally sensitive approach to intervention, one that addresses not only individual behaviors but also the social, institutional, and cultural systems in which pregnant adolescents are embedded. Promoting open parent–child communication, peer-based education, and religious engagement in SRH dialogue can enhance health literacy and delay sexual risk-taking. Additionally, addressing systemic barriers, such as stigma, restrictive school policies, and the lack of adolescent-friendly services, is essential to supporting pregnant adolescents’ rights, health, and educational continuity.

Limitations and Strengths of the Study

This investigation possesses several notable strengths: it addresses a challenging-to-access, high-priority demographic; it is underpinned by an ecological framework that integrates parental and peer attachment as well as religious beliefs with sexual and reproductive health (SRH) knowledge, sexual attitudes, and academic adjustment; it utilizes multi-domain instruments that have been refined through expert review, pilot testing, and short-interval test-retest; and it applies bootstrapped Partial Least Squares Structural Equation Modeling (PLS-SEM) to explore both direct and indirect pathways. Nevertheless, certain limitations are present, including its cross-sectional and non-probability sampling design, which constrains causal inference and generalizability; its dependence on self-reported and stigma-sensitive items, some of which are dichotomous indicators that may introduce social desirability and common-method biases; and incomplete documentation of internal consistency and construct validity metrics. Additionally, potential residual confounding factors, such as socioeconomic status, previous academic performance, and contextual school factors, persist, and the time-specific context of data collection may limit temporal comparability.

Declarations

Ethics approval:

The study was conducted in accordance with the relevant guidelines and regulations of the Helsinki Declaration of Principles, and have received ethical and legal permissions from UM Ethics Committee with reference number UM. TNC2/UMREC-529 by Prof Dr Sarinah Low Wah Yun and Ministry of Health Nigeria with reference number STA/495/Vol/171. I by Dr Uthman Baba Alhaji.

Acknowledgements:

Not Applicable

Author Contribution

All authors developed the conception of the study. Otegbayo Bolajoko Elizabeth and Mahmoud Danaee collected and analysed the data. Noralina Omar, Nasrin Aghamohamadi and Touhida Tasnima wrote the article. Afterwards, all authors critically revised the final version of the manuscript again, read it, and approved it for publication.

Competing interests:

The authors have no issue whatsoever with the journal policies. The authors have no conflicting interest to declare.

All authors involved in this study have approved the manuscript and given their consent for its submission to the journal.

All authors have approved the final version of the manuscript and agreed to be accountable for all aspects of this work. We declare that this manuscript has not been submitted elsewhere for review neither has it been ever published by other journals.

Data Availability

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Consent to Participate:

A written informed consent was obtained from all subjects.

Consent for publication:

Not applicable

Funding:

This research did not receive any specific grant from funding agencies in the public, commercial, or non-for-profit sectors.

Approval for animal experiments

Not applicable

References

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Yes

Abstract

Background: Pregnant adolescents in Nigeria experience intersecting health and educational vulnerabilities. Guided by Bronfenbrenner’s Ecological Systems Theory, this study examined the influence of parental and peer attachment on sexual and reproductive health knowledge (SRHK), sexual attitudes (SA), and educational outcomes (EO), with religious belief assessed as a potential mediator.