Systematic analysis of psychosocial determinants of adolescents’ sexual and reproductive health outcomes in South Africa

Abstract

Adolescents in South Africa face persistent sexual and reproductive health (SRH) challenges shaped by intersecting psychosocial determinants. This systematic review synthesises evidence on these determinants using a thematic synthesis of qualitative, quantitative, mixed-methods, and review articles to inform contextually grounded and equity-oriented SRH interventions. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420251069776), searches were conducted in PubMed, Scopus, Google Scholar, and Africa Journals Online for peer-reviewed studies published between January 2010 and May 2024. Thirty-one studies met the inclusion criteria and were analysed using thematic synthesis; all 31 were peer-reviewed journal articles. Six themes emerged: psychosocial determinants of adolescent SRH outcomes; social norms, gender power relations, and cultural beliefs; mental health and emotional well-being in SRH decision-making; effectiveness of policies and interventions; marginalisation and intersectional vulnerabilities; and pathways toward improved SRH outcomes. Peer influence and parent–adolescent communication strongly shape behaviours, while gender power imbalances and cultural taboos constrain protective practices. Mental health challenges are consistently associated with poorer SRH decision-making, yet mental health remains insufficiently integrated into SRH services. Despite progressive policy frameworks, healthcare provider attitudes and structural violence within health facilities continue to restrict access, especially for marginalised adolescents. To address these gaps, we propose the Intersectional Social Cognitive Ecological Model for Adolescent SRH (ISCEM-ASRH) to guide multilevel, equity-focused interventions; the ISCEM-ASRH is a theoretically informed synthesis intended to generate hypotheses for future empirical testing rather than a validated model.