The Adolescent and Youth-Friendly Health Services (AYFHS) program in Ghana aims to improve access to reproductive and sexual health services for young people. However, despite its importance, low utilization rates persist. Existing studies report various barriers, but there is a lack of synthesized evidence on AYFHS utilization and the specific barriers in Ghana. This gap limits the development of targeted interventions. Therefore, this study systematically reviews the prevalence and barriers to AYFHS utilization in Ghana to inform context-specific solutions. This review adhered to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Four main databases (PubMed, Web of Science, JSTOR, and Scopus) were searched for relevant papers. Papers (peer review and grey literature) on Ghanaian adolescents and young people aged 10–24 years, published online in 2010–2023 and published in English were selected for the review. Finally, 11 records were included in this systematic review and meta-analysis. Six studies were conducted in the Ashanti region, with most being cross-sectional surveys. Sampling methods varied: three used purposive sampling, one combined purposive and convenience sampling, and another used both purposive and stratified sampling. Random and multi-stage stratified sampling were used in other studies. The overall prevalence rate of AYFHS utilization in Ghana was 42% (CI 24%- 60%). Education and financial constraints significantly affected AYFHS access. Religious beliefs, limited education, financial constraints, negative attitudes, and a lack of parental consent deter its use. Facility-related issues like medicine shortages, long waiting times, and confidentiality concerns acted as barriers. Cultural, religious, and educational norms impact decisions to use AYFHS. To enhance utilization and align with Sustainable Development Goal Three (ensuring good health and well-being for all), culturally sensitive interventions, improved access, comprehensive sex education, and awareness campaigns are vital.