Introduction: Adolescents in South Africa face significant sexual and reproductive health (SRH) challenges, shaped by various psychosocial determinants such as socioeconomic status, cultural norms, gender dynamics, peer influences, and mental health.
Purpose: This systematic review aims to consolidate existing knowledge, identify critical gaps, and inform the design of more comprehensive, equitable, and contextually resonant SRH interventions for South African adolescents
Method: Through a PRISMA-guided systematic review (PROSPERO Registration Number: CRD420251069776) of peer-reviewed articles, reports, and policy documents (2014-2024) from PubMed, Scopus, Sabinet, Google Scholar and other databases, we identified key themes using thematic analysis.
Results: Findings reveal that peer influence and parent-adolescent communication are critical determinants of SRH behaviours, while gender power imbalances and cultural stigma exacerbate risks. Mental health, particularly depression and trauma, significantly impacts SRH decision-making, yet integrated care models remain scarce. Existing policies show gaps in youth-friendly service delivery and disability inclusion, with successful interventions like mHealth, peer-led programs hindered by scalability challenges. A multi-level conceptual framework rooted in the Social Ecological Model and Intersectionality Theory is proposed to address systemic barriers.
Conclusions: This study underscores the need for culturally sensitive, gender responsive SRH programs that integrate mental health support and prioritise marginalised groups. By synthesising evidence from 29 studies, we provide actionable insights for policymakers, healthcare providers, and educators to improve adolescent SRH outcomes in South Africa.