Implementation of Health Education and Promotion of Healthy Behaviors Among Unmarried Pregnant Adolescents: A Qualitative Systematic Review

Abstract

Adolescent pregnancy outside marriage remains a persistent global health challenge because it not only increases maternal and neonatal morbidity but also disrupts education, social participation, and long-term opportunities for young women. The need to address these challenges through health education and promotion is urgent, as unmarried adolescents face stigma, family rejection, and limited access to healthcare, all of which undermine their ability to adopt clean and healthy living behaviors. The purpose of this review was to synthesize recent qualitative evidence on the implementation of health education and promotion strategies that support healthy behaviors among unmarried pregnant adolescents. This study employed a systematic qualitative review design, screening 1,183 articles published between January 2023 and March 2025 in PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar, and applying inclusion criteria for qualitative and mixed-methods studies as well as relevant books and guidelines published between 2020 and 2025. After removing duplicates and exclusions, 40 studies were analyzed using the CASP checklist for quality appraisal and thematic synthesis to generate descriptive and analytical themes. Results indicated that five major domains emerged: stigma-sensitive education, peer and school-based interventions, digital or mobile health reinforcement, group antenatal care, and adolescent-friendly service delivery. These approaches were shown to increase empowerment, improve antenatal attendance, reduce psychosocial stress, and enhance daily practices such as nutrition, hygiene, and self-care, although challenges of sustainability, cultural adaptation, and disaggregation by marital status persisted. In conclusion, integrated and context-sensitive interventions combining peer education, digital reinforcement, and group antenatal care are recommended to strengthen resilience, foster agency, and ensure equitable health outcomes for unmarried pregnant adolescents across diverse settings.