Abstract
INTRODUCTION: Adolescent pregnancy is a significant public health concern in Rwanda, particularly in urban districts such as Nyarugenge. Emergency contraceptive pills (ECPs) remain underutilized among day-scholar female adolescents due to limited knowledge and practical skills. This study assessed knowledge and skills related to ECPs among female adolescents aged 13–19 in Nyarugenge District, Kigali City, and examined the influence of age, educational level, and religious affiliation on their ability to correctly understand and use ECPs. METHODS: A descriptive cross-sectional study was conducted in 2025 among 388 day-scholar female adolescents aged 13–19 from eight randomly selected secondary schools in Nyarugenge District, Kigali City. Data on knowledge and practical skills regarding emergency contraceptive pills (ECPs) were collected using a structured, pre-tested, and validated questionnaire. Descriptive statistics summarized frequencies and proportions. Ethical approval, informed consent, and assent were obtained. RESULTS: Among 388 female adolescents, 64.2% reported awareness of emergency contraceptive pills (ECPs); however, only 37.0% demonstrated accurate knowledge, and 8.0% possessed the practical skills to use them correctly. The majority (93.6%) could not identify any ECP type, and only 6.4% knew where to access them. Misconceptions were common, with 57.0% uncertain about effectiveness and 31.4% viewing ECP use as irresponsible. CONCLUSION: Despite moderate awareness, knowledge and practical skills regarding ECPs were critically low among adolescents. Integrating school-based education with community outreach and targeted reproductive health programs is essential to improve adolescent preparedness and responsible ECP use. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12905-026-04341-1.