Late one evening in a crowded Jakarta neighborhood, a 16-year-old scrolls through her phone long after her parents think she is asleep. The lights are off, the house quiet. Between homework videos and harmless memes, a link appears—shared by a classmate—pulling her into content she has never seen before, not in school, not at home, and definitely not in the kinds of conversations that happen in conservative families where sex is rarely discussed openly.

For millions of adolescents in conservative societies, this is how sexual decision-making begins: quietly, informally, and often without guidance.

A new scoping review published in BMC Public Health brings rare clarity to what drives premarital sexual behavior among adolescents living in these contexts—and what public health practitioners and educators can do about it. The study synthesizes evidence across 23 studies from Africa and Asia, mapping nine key risk and protective factors using the Theory of Planned Behavior (TPB) as a guiding framework.

Why This Matters for Public Health

Premarital sex remains deeply taboo in many conservative societies—whether due to religious norms, cultural expectations, or legal restrictions. Yet the review shows that premarital sexual activity is happening despite these norms, often in ways that elevate risk.

Reported prevalence ranged widely, from 4.2% to 69% depending on country and region. And while the numbers vary, the underlying drivers are strikingly consistent. The review organizes these drivers into the three pillars of the TPB:

1. Attitudes (knowledge, beliefs, religiosity)
2. Subjective norms (family influence, peers, partners)
3. Perceived behavioral control (external factors shaping one’s ability to control behavior)

This structure helps move the conversation beyond moral judgment and toward practical, evidence-informed interventions.

Key Insight 1: Knowledge and Religiosity Are Protective—But Not Enough

Studies consistently showed that adolescents with better sexual health knowledge were less likely to engage in premarital sex. Many teens simply do not understand:

• STI and HIV risk
• Pregnancy complications
• Declining condom use among peers
• The emotional and psychological impacts of unplanned sex (e.g., regret, shame, depression)

At the same time, religiosity—particularly participation in religious activities and strong personal beliefs—was associated with delayed sexual initiation.

But here is the critical nuance: Knowledge and religiosity work together but neither is sufficient alone.

Even in highly religious communities, boys in particular report higher rates of premarital sex, often influenced more by peers and digital media than by religious expectations.

Key Insight 2: Peer Pressure and Dating Relationships Drive Behavior

The review highlights a powerful and often uncomfortable truth: Peers, not parents, are the most influential voices for many adolescents.

Across seven studies, peer pressure shaped how normal or expected premarital sex seemed. Teens who believed “everyone else is doing it” were significantly more likely to engage in risky behavior.

Similarly, adolescents in romantic relationships—especially those pressured by partners—reported much higher likelihood of premarital sex.

This underscores a gap for public health programs: We often focus on parents and schools, but fail to address peer networks and dating norms.

Key Insight 3: Pornography Exposure Is the Most Consistent Predictor

The most striking finding from the review is the role of pornography. Across 14 studies, exposure to pornographic content emerged as the single most consistently reported factor associated with premarital sexual behavior.

This is especially urgent in conservative contexts, where:

• Digital literacy programs are rare
• Parents often assume abstinence solves the issue
• Adolescents seek information online because formal sex education is limited or taboo
• Social media platforms function as unsupervised spaces for sexual exploration

Combined with substance or alcohol use, also frequently reported, teens’ sense of control over decisions diminishes. This aligns with the “perceived behavioral control” domain of the TPB—external forces shape behavior more than internal intentions.

Key Insight 4: Families Matter—When They Are Able to Engage

Protective factors include:

• Strong family support
• Effective parental monitoring
• Open communication about values and expectations

But in many conservative societies, parents:

• Feel unprepared to talk about sexual health
• Fear that discussing sex will encourage it
• Work long hours (noted in some studies as a predictor of risk)
• Rely on religious messaging rather than evidence-based guidance

The review makes a key point:

Adolescents need both cultural values and actionable knowledge to navigate sexual decisions safely.

What This Means in Practice

Public health leaders, ministries, educators, and community organizations can translate these findings into concrete action.

For Local Health Departments

• Integrate culturally aligned reproductive health modules that respect local religious norms.
• Partner with religious leaders to co-deliver content—credibility matters for uptake.
• Include modules addressing digital sexuality, online risk, and pornography exposure.

For Schools

• Embed digital literacy into health or ICT curricula.
• Introduce peer education programs—shown to be effective in Southeast Asia.
• Train counselors to discuss relationships, consent, and boundary-setting.

For Community-Based Organizations

• Offer parent workshops about communication strategies that align with cultural expectations.
• Create safe, confidential spaces for adolescents—especially girls—to ask questions without fear.

For Ministries and Policymakers

• Update national adolescent health strategies to include:
  • Pornography exposure prevention
  • Social media navigation
  • Gender-specific interventions
• Address structural drivers such as gender inequities and stigma.

What’s Still Missing?

The review notes several research gaps:

• Limited evidence from rural communities
• Very little attention to LGBTQ+ adolescents
• A near absence of longitudinal studies that track behavior over time
• Inconsistent definitions of “premarital sex” across cultures
• Insufficient exploration of dating apps and influencer culture

These gaps represent opportunities for future research and funding.

A Closing Reflection

Adolescents in conservative societies face a complex landscape. They grow up surrounded by strong values about purity, family honor, or religious expectation—yet they also live in a digital world that exposes them to global norms in real time.

Understanding this tension is the key to designing public health interventions that work.

So here are three questions for readers in public health, education, and community engagement:

1. How might your agency better integrate cultural values with evidence-based sexual health guidance?
2. Where are your local blind spots—peers, digital media, or family engagement?
3. What would it take to shift from reactive concern to proactive, culturally aligned prevention?

The stakes are high—but so is the opportunity. With the right mix of cultural sensitivity, digital awareness, and evidence-driven communication, we can help adolescents make safer, healthier choices—without forcing them to navigate this terrain alone.