Financial Capability Program and Condom Use Among Sexually-Active Youth in the Ghana Youthsave Project

Background: Despite high level of knowledge about condoms, condom use remains low among sexually active youth globally, including Ghana. Although interventions that promote condom use have been implemented, few programs focus on building tangible strategies that may enable sexually-active youth to use condoms and reduce risk of acquiring sexually transmitted infections and unplanned pregnancies. To address gaps in research, we examine the effects of a financial capability program on condom use among sexually-active youth in Ghana.

Methods: A subset of sexually active youth (N = 957) in the YouthSave project was included in this study. The Ghana YouthSave study was a cluster-randomized experiment designed to test and evaluate the effects of financial capability on youth development outcomes, including sexual behaviors. The Ghana experiment was implemented in 100 schools; with 50 schools randomly assigned to treatment or control. Within treatment schools, 25 schools were randomly assigned to an in-school banking program, whereas the other 25 schools received marketing outreach. For this study, the main dependent variable referred to whether youth or their partners used condoms at their last sexual intercourse. We used multivariable logistic regression with cluster robust option to evaluate the effect of YouthSave on condom use.

Results: At follow-up, only 34% of youth reported using condoms at their last sexual intercourse. Fewer boys (47%) than girls (53%) reported using condoms. Multivariable results showed that treatment youth were 24% more likely to use condoms than control youth [95% CI 0.88–1.76]. Further, in-school banking youth were 58% [95% CI 1.08–2.29] and marketing-only youth were 2% [95% CI 0.67–1.54] more likely than control youth to report using condoms at last sexual intercourse.

Conclusions: Our findings add to an emerging body of research that highlights the importance of tangible financial strategies to facilitate and maintain behavior change. Access to financial resources such as savings might provide incentives that encourage and enable young people to change or maintain positive health behaviors. In addition to information and motivation, economic-focused programs such as YouthSave might be an important component of health strategies that promote consistent condom use among sexually-active youth in low-resource settings.