Assessing Knowledge and Utilization of Female Condoms Among Undergraduate Female Students at Makerere University, Kampala: A Cross-Sectional Study

Abstract Introduction: Despite the effectiveness of female condoms (FCs) in preventing sexually transmitted infections, their use remains low. University students, at high risk for unsafe sex, need targeted interventions. This study assessed knowledge and utilization among female undergraduates to inform policies and strategies for improving accessibility and uptake in higher education institutions. Methods: A cross-sectional study was conducted among 246 undergraduate female students at Makerere University in March–April 2023. Participants were selected using simple random sampling. Data were collected through a structured, self-administered questionnaire covering demographic characteristics, FC knowledge, utilization, and barriers to use. Descriptive statistics were used to summarize the data, while logistic regression identified factors associated with FC knowledge and utilization. Results: Of the 246 participants, the mean age was approximately 25.8 years ± 4.6. While 76.8% had heard of female condoms, mainly through fellow female students (39.4%), only 10.6% reported having ever used one. Barriers included a perceived lack of flexibility (73.6%), insertion difficulties (56.5%), and inaccessibility (17.5%). Third-year students had significantly higher odds of FC knowledge than first years (aOR = 7.10, 95% CI: 2.12–23.73, p = 0.001). Compared to Protestants, Catholic participants were less likely to be knowledgeable about female condoms (aOR = 0.27, 95% CI: 0.10–0.74, p = 0.011). Similarly, participants from category, other religions also showed significantly lower knowledge (aOR = 0.05, 95% CI: 0.01–0.56, p = 0.014). Married students had significantly higher odds of FC use than single students (aOR = 6.25, 95% CI: 2.26-17.27, p = 0.000). Fourth-year students showed higher odds of FC use in bivariate analysis (OR = 6.29, 95% CI: 1.05–37.57, p = 0.044), but this was not significant in multivariable analysis (aOR = 1.95, 95% CI: 0.25-15.22, p = 0.525). Conclusion: The study showed significant gaps in knowledge and utilization of female condoms among undergraduate female students. Barriers included inaccessibility, difficulty of use, and religious beliefs. A comprehensive sexual health education through integrating family planning clinics and seminars , collaborations between universities and health organizations, and tailored interventions are needed to improve awareness, acceptance, and utilization of female condoms.