Abstract
<title>Abstract</title> <p>Introduction Africa has the highest incidence of unwanted adolescent pregnancies and related maternal and neonatal morbidity and mortality globally. However, progress in reducing this public health challenge remains limited. Many interventions have produced limited effects. This scoping review synthesised evidence on interventions addressing unwanted adolescent pregnancy in Sub-Saharan Africa, notably about their effectiveness, implementation barriers and enablers. Methods A scoping review was conducted following the PRISMA-ScR guidelines. Searches were performed in Google Scholar, MEDLINE, Scopus, EMBASE, CINAHL, Cochrane Library, and Web of Science for studies published between January 2020 and March 2025. Eligible studies included peer-reviewed articles and reports published in English that examined interventions addressing unwanted adolescent pregnancy in Africa, their effectiveness, and implementation barriers and enablers. Data were extracted using a predesigned tool and synthesised descriptively and narratively. Selected constructs of the Consolidated Framework for Implementation Research (CFIR) guided data organisation and synthesis. Results Thirteen studies were included, comprising randomized controlled trials, a case study, a cross-sectional study, a programme evaluation, and systematic reviews conducted across several Sub-Sahara African countries. Interventions ranged from single-component over multi-component to multi-sectoral programmes, the latter incorporating educational, economic, health, and socio-cultural components. Most multi-component interventions reduced adolescent pregnancy and childbirth, particularly those combining educational support, economic strengthening, Sexual and Reproductive Health (SRH) education, and Youth-Friendly Health Services (YFHS). Educational support, including free or subsidized education, school fees, scholarships, and conditional support for school attendance, emerged among the most effective intervention components. Key implementation barriers included low participation in programme activities, inadequate financial support, sociocultural norms discouraging contraceptive use, stigma surrounding adolescent SRH services, healthcare provider discomfort, and weak leadership and monitoring systems. Enablers included stakeholder engagement, peer support approaches, age-appropriate SRH education, incentives for participation, improved access to YFHS, and strong multi-sectoral collaboration. Conclusion Multi-component, and contextually tailored interventions appear more effective in reducing unwanted adolescent pregnancy in Africa than narrowly focused approaches. Interventions supporting girls’ education and adolescent-friendly SRH services showed the greatest potential for effectiveness. Sustainable reductions in unwanted adolescent pregnancy require multi-sectoral strategies addressing sociocultural, economic, and health system barriers while engaging adolescents, families, communities, healthcare providers, and policymakers.</p>