Abstract: Purpose To investigate sociodemographic determinants of reproductive health disparities and health education participation among Chinese female college students (CFCs). Methods A nationally representative sample of 1,013 students from 12 provinces (October to November 2024) completed validated questionnaires. Multilevel logistic regression analyzed clustered data (school-level ICC = 0.19). Results Significant associations were observed between sociodemographic factors education level, household registration, only child status, academic major and reproductive health outcomes (p < 0.05). Key findings include pronounced urban–rural inequities, with urban students demonstrating 4.3-fold higher HPV vaccination rates than rural peers (78.5% vs. 45.7%, aOR = 4.3, 95% CI: 3.2–5.8), alongside elevated dysmenorrhea prevalence among rural students (56.9% vs. 43.5%, aOR = 1.8, 95% CI: 1.4–2.3). Academic stressors significantly impacted health outcomes, as postgraduate students exhibited a 60% higher dysmenorrhea risk versus undergraduates (60.9% vs. 50.8%, aOR = 1.6, 95% CI, 1.2–2.1), while paradoxically, medical students showed lower HPV vaccination uptake than non-medical peers (58.0% vs. 74.3%, aOR = 2.1), attributed to clinical skepticism about vaccine safety. Furthermore, health education engagement was limited (46.1% participation), with 52.4% relying on online platforms for health information—highlighting critical gaps in institutional health promotion and digital misinformation risks. Therefore, addressing these multifaceted socioeconomic, educational, and structural barriers is essential for improving reproductive health equity in this population. Conclusion Multifaceted strategies addressing socioeconomic barriers, health education gaps, and digital misinformation are critical to improving reproductive health in female college students.
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