Background <p>Adolescence is a critical stage of development characterized by physical, emotional, and psychological changes, making reproductive health an essential aspect of overall well-being.</p> Objective <p>To assess the level of knowledge, attitude, and practice towards reproductive health among secondary school girls.</p> Methods <p>A cross-sectional study was done in Tanta governmental secondary schools for girls, Gharbia governorate, Egypt including 460 students using a probability sampling technique. A pre-designed self-administered questionnaire was used to collect data about their knowledge, attitudes, and practice towards reproductive health, and factors affecting it.</p> Results <p>The findings revealed that only 14.6% had fair knowledge, while 85.4% had poor knowledge. None of the participants had good knowledge. The attitude score showed that 62.0% had a positive attitude. Regarding practice, 46.8% had fair practice, 50.2% with poor practice, and only 2% had good practice. Higher education levels of fathers and mothers were significantly associated with better knowledge scores among participants (<i>p</i> &lt; 0.05). Practice score was significantly associated with participants whose mothers were housewives demonstrating better reproductive health practices (<i>p</i> &lt; 0.05).</p> Conclusion and recommendations <p>The study revealed gaps in knowledge about reproductive health, with positive attitudes and poor practices that were affected by parents’ education and mothers’ working conditions. To bridge reproductive health gaps, schools should incorporate comprehensive educational programs, train teachers, and organize interactive workshops to enhance awareness. Establishing youth-friendly reproductive health centers and offering confidential counseling services, supported by outreach campaigns, can help reduce stigma and improve service access. Also, we recommend providing reproductive health education to adolescents, parents, including both housewives and working mothers.</p>