Perceptions and factors influencing accessibility and acceptability of the female condom among women in Kiambaa division, Kiambu district, Kenya
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dvocacy of the female condom emerged in the context of growing evidence that heterosexual intercourse was placing women at increased risk of HIV infection. Since the approval of the Female Condom (FC) in the United Kingdom and the United States of America in 1992 and 1993 respectively more than 90 developing countries have introduced the FC to the public. The study objectives were to identify the perceptions of the women in Kiambaa Division towards use of the FC, to establish their experiences with use of the FC and to establish the factors that influence accessibility and acceptability of the FC among the same group. This was a cross-sectional survey in which the calculated sample size (n) was 289. Data was collected using interview schedules and Focus Group Discussions. Quantitative data was analyzed statistically while thematic techniques were used to analyze qualitative data. The study revealed that the perceptions that influenced acceptability of the FC are; the FC is difficult to use (x2=71.36, df=2, p<0.05), the FC is uncomfortable to use (x2=81.022, df=2, p<0.05) , the FC is associated with prostitutes (x2=152.57, df=l, p<0.05), the FC reduces sexual pleasure (x2=4.461, df=1, p<0.05), use of FC means no trust to partner, (x2=59.47, df=2, p<0.05) and the Male condom (MC) is better than the FC (x2=127.02, df=l, p<0.05). There were four experiences that were found to influence acceptability of the FC which include; FC is difficult to use (x2=71.36, df=2, p<0.05), FC reduces sexual pleasure (x2=4.461, df=1, p<0.05), FC is uncomfortable to use (x2=81.022, df=2, p<0.05) and MC is better than FC (x2=127.02, df=1, p<0.05). High cost of the FC combined with lack of FC's in the local market were found to be significant factors that influenced accessibility of the FC (x2=11.916, df=2, p<0.05). Together with perceptions and experiences other factors that were found to be significantly influencing acceptability of FC among women of reproductive age include; high cost of FCs (Chi square=11.916, df=2, p<0.05), Spouse/partner consent (x2=3.026, df=2, p<0.05), preference of other contraceptives (x2=57.934, df=2, p<0.05), marital status (x2=3.875, df=1, p<0.05), FC's capacity to prevent HIV and other STIs (x2=22.124, df=2, p<0.05)and level of education (x2=2.390, df=2, p<0.05). The study concluded that there are wide spread perceptions that influenced uptake of the FC among women in Kiambaa Division, MC was more preferred than the FC, absence of the FC in the local market and high cost of the FC were two factors that influenced its accessibility, there were wide spread social-cultural and economic factors that influenced acceptability of the FC and the FC is not being effectively utilized among the same group (prevalence of use: 10.4%).This study recommended the Government of Kenya through the Ministry of Health to; allocate or source funds for implementation of a long term FC promotion program, identify and address weaknesses in the FC supply chain, subsidize the price of FC, target men in the promotion of FC and review lessons learned from findings of studies carried out in the global community on utilization of FC and use these findings as a basis to develop a strategic plan that will ensure effective utilization of the FC.