The purpose of this study is to determine the understanding of reproductive health among parents and female adolescents with Down syndrome. This cross-sectional study involved 22 parents and 22 female adolescents with Down syndrome in Kuala Lumpur, Malaysia. The parents were required to fill up the socio-demographic information in questionnaire forms. Scores of parents and female adolescents according to the socio-demographic data, the relationship between the understanding of reproductive health among parents and female adolescents with Down syndrome were determined. The result showing that both parents and adolescents with Down syndrome scored the lowest on sexuality and sexual reproductive awareness. There was a significant relationship between the understanding and awareness of reproductive health among parents and female adolescents where r = 0.480, and p < 0.05. There was no relationship between time spent with child and understanding of reproductive health among parents and female adolescents with Down syndrome. Thus Special Education and Occupational Therapy programme on sexual and reproductive health should be part of activity of daily life skills for individual with Down syndrome.