Background: Adolescents and young women represent a critical population in global health policy, yet their needs are often subsumed under broader maternal health agendas. While international frameworks such as CEDAW, the ICPD Programme of Action, the Beijing Platform for Action, and the Sustainable Development Goals have emphasized equity and rights, their translation into adolescent- and youth-sensitive policy remains inconsistent. Methods: We conducted a systematic review of 48 national and international women’s health policies and frameworks published from the 1990s to 2020s, following PRISMA 2020 guidelines. Documents were mapped for contextual features and thematically analyzed to identify patterns in financing, service delivery, equity, and adolescent/youth health priorities. Results: Policies reflected an evolution from maternal survival toward rights-based and life-course approaches, shaped by global frameworks. High-income countries integrated equity and adolescent rights more explicitly, while low- and middle-income countries were constrained by donor-driven priorities and limited fiscal space. Across contexts, adolescents and young women were inconsistently prioritized—acknowledged in some cases (e.g., Sri Lanka, Ghana, Australia) but rarely operationalized into enforceable protections, dedicated financing, or adolescent-friendly services. Persistent barriers included hidden costs, stigma, confidentiality gaps, and weak accountability mechanisms. Conclusion: Despite progress in global commitments, adolescents and young women remain underrepresented and underserved in health policies, in part because their health needs are not sufficiently distinguished. Strengthening adolescent health requires enforceable entitlements, ring-fenced financing, youth-friendly service standards, and participatory governance. Without these measures, policies risk remaining symbolic rather than transformative, leaving adolescents vulnerable to preventable health risks and inequities.