This review shows that there are multiple drivers of South Africa’s high levels of teenage pregnancy. The evidence shows that in order to reduce unplanned teenage pregnancies a multi-pronged approach is needed at both structural and individual level: gendered norms and gender inequalities between girls and boys need to be addressed to enable girls to have autonomy and decision-making over their own bodies. Furthermore, poverty, race-based inequalities and living in rural areas are additional factors that drive unplanned teenage pregnancies and need to be tackled.

In addition, on an individual level, although teenagers reported having relatively high levels of basic knowledge of how to prevent unplanned pregnancies, sexually transmitted infections and HIV, it was evident that this knowledge is often superficial and many girls’ reported not really knowing how to apply the knowledge and frequently “just not using contraceptives”. In other words correct and consistent contraceptive use was low. Furthermore, there were very low levels of knowledge around dual protection, emergency contraceptives, PEP and limited understanding of fertility and conception. Finally, access to contraceptives was difficult for teenagers, especially younger ones. Barriers to access included: clinic locations, costs, clinic hours, contraceptive choices and in particular the poor knowledge and judgmental attitudes of health care workers.