Knowledge, attitudes, practices and behaviors associated with female condoms in developing countries: a scoping review

Women in developing countries are at high risk of HIV sexually transmitted infections and unplanned pregnancy. The female condom (FC) is an effective dual protective method regarded as a tool for womans empowerment yet supply and uptake are limited. Numerous individual socioeconomic and cultural factors influence uptake of new contraceptive methods. We reviewed studies of FC knowledge attitudes practices and behaviors across developing countries as well as available country-level survey data in order to identify overarching trends and themes. High acceptability was documented in studies conducted in diverse settings among male and female FC users with FCs frequently compared favorably to male condoms. Furthermore FC introduction has been shown to increase the proportion of "protected" sex acts in study populations by offering couples additional choice. However available national survey data showed low uptake with no strong association with method awareness as well as inconsistent patterns of use between countries. We identified a large number of method attributes and contextual factors influencing FC use/nonuse most of which were perceived both positively and negatively by different groups and between settings. Male partner objection was the most pervasive factor preventing initial and continued use. Importantly most problems could be overcome with practice and adequate support. These findings demonstrate the importance of accounting for contextual factors impacting demand in FC programming at a local level. Ongoing access to counseling for initial FC users and adopters is likely to play a critical role in successful introduction.