Socio-Cultural Barriers and Indigenous Strategies for Improving Health Literacy in High-Risk Pregnancy: A Systematic Review

High-risk pregnancy is a major contributor to maternal mortality worldwide, and inadequate health literacy exacerbates adverse maternal outcomes. Socio-cultural barriers often reduce the effectiveness of educational interventions designed to improve health literacy among high-risk pregnant women. This systematic review aimed to identify socio-cultural barriers affecting health literacy in this population and explore indigenous strategies for improvement. The review was conducted according to PRISMA guidelines, and PubMed/MEDLINE, EMBASE, CINAHL, Scopus, and Google Scholar were searched for studies published between ۲۰۲۰ and ۲۰۲۵. Qualitative, quantitative, and mixed-methods studies addressing socio-cultural barriers or culturally appropriate interventions were included. Eleven eligible studies were analyzed using narrative synthesis. The findings revealed barriers, including limited awareness of obstetric danger signs, language difficulties, low literacy levels, reliance on informal information sources, family dominance in decision-making, traditional beliefs, and distrust of healthcare providers. These barriers were prominent among ethnic minority and socioeconomically disadvantaged women. Effective strategies included culturally tailored education, mobile health programs, translated educational materials, peer support, community-based interventions, family involvement, home visits, and indigenous midwifery services. Addressing socio-cultural barriers through culturally sensitive, community-based, and family-centered approaches may improve health literacy,