CHAPTER 1

INTRODUCTION

1.1 Background to the Study

An internal condom (also known as a femidom or female condom) is a barrier device that is used
during sexual intercourse as a barrier contraceptive to reduce the probability of pregnancy or a
sexually transmitted infection (STI). The female condom is a thin, soft, loose-fitting sheath with
a flexible ring/frame or ring/foam disc at the closed end. They typically come in various sizes.
For most vaginas, a moderately sized condom is adequate; women who have recently given birth
should try a large size first. The inner ring or foam disc at the closed end of the sheath is used to
insert the condom inside the vagina and to hold it in place during intercourse. The rolled outer
ring or poly frame at the open end of the sheath remains outside the vagina and covers part of the
external genitalia (Geter & Crosby, 2021).

The female condom was developed in the late 20th century. A primary motive for its creation is
the well-documented refusal of some men to use a condom because of loss of sensation and the
resulting impact on the hardness of the man's erection, and by its implication that the male could
transmit sexually transmitted infection. Its protection against sexual transmitted infection is
inferior to that of male condoms. Internal condoms can be used by the receptive partner during
anal sex (Gallo et al., 2022).

There are many items that determine the attitude of women of childbearing age toward female
condom; such items could be viewed from socio-economic factor, cultural factors, community
norms, religious affiliation, gender role and effectiveness of the services. Family planning is the
methods that enable couples to determine when to have their baby. There are a number of
available family planning methods; the ones that are commonly in use include hormonal, barrier,
and sterilization methods. Family planning also known as birth control is most usually applied to
couples who wish to limit the number of children they want to have and to control the timing of
pregnancy and spacing of their children (Parkins, 2022).

1
Family planning involves when and how many children couples intend to have and the use of
birth control techniques to implement such plans, so that they can give utmost care to the
children, financially, psychologically and socially. According to WHO, (2022) family planning
is a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes
and responsible decision by individuals and couples in order to promote the health and welfare of
family groups and thus contribute effectively to the social development of a Country (Frost et al.,
2019).

However, family planning is used as a synonym for child spacing or birth control. Family
planning may encompass sterilization as well as pregnancy termination. It also includes raising a
child with methods that require significant amount of resources namely: time, social, financial
and environment. Family planning measures are designed to regulate the number and spacing of
children, within a family, largely to curb population growth, and ensure each family has access to
limited resources (Sonfield et al., 2022).

The attitude of women of childbearing age toward the use of female condom can be applied to a
wide range of sexual and reproductive health decision. It focuses on whether to seek or avoid
pregnancy, or space the period between two pregnancies, what family methods to be used, and
whether to continue or switch methods in family planning (Cleland et al., 2021). It is usually
thought that community and culture affect a person’s attitude towards the use of female condom,
desire for the gender of children, pressures to have children and whether or not female condom
accords with customs and religious beliefs (Bailey et al., 2022).

Female condom helps couples and individuals realize their basic right to decide freely and
responsibly when to have children, as well as how many children to have. The use of
contraceptive methods results not only to improvements in health-related outcomes but also
advance educational and economic outcomes, especially for girls and women. More specifically,
the use of contraceptives can save an estimated 2.7 million infant deaths and the loss of 60
million healthy lives globally each year. Similarly, contraceptive use can prevent at least 25% of
all maternal deaths by preventing unintended pregnancies and unsafe abortions and also protect
against sexually transmitted infections (Raja et al., 2022).

2
Delayehu et al., (2019) conducted a study on knowledge and attitude towards the use of female
condom among women of reproductive age in emerging regions of Nigeria. Despite recent
improvements in the use of contraceptives amongst married women in Nigeria, the utilization
rates are still far below the national figures in the emerging regions of the country. Therefore,
there is a need to assess the level of knowledge and attitudes towards family planning, and
associated factors among reproductive-age women in the four emerging regions of Nigeria.

A community-based cross-sectional study was conducted among 2891 reproductive-age women

from 01 to 30 June, 2019. The data were collected by open data equipped tablets with kit
software using structured questionnaire. The collected data were exported to STATA version 14
for analysis. Knowledge and attitude were assessed using tools containing 12 and 9 questions,
respectively. Mean scores were used as cut-off points. Internal consistency of the tool was
checked using Cronbach alpha coefficient, and it was 0.87 for knowledge and 0.78 for attitude
questions. Bivariate and multivariate analyses were done, and statistical significance was
declared at p-value ≤ 0.05. Less than half, 1254 (43.4%), of the participants had good knowledge
and 1511 (52.3%) had favorable attitude towards female condom. Positive predictors of good
knowledge of family planning were: from Okpe Community in Delta State residence, older age,
high level of education, being Christian and merchant, high household monthly income, and
listening/watching radio/TV. On the other hand, high family size and ideal desired children were
negative predictors. For a favorable attitude, the positive predictors include older age, high level
of partner education, listening/watching radio/TV, being from BG region and having a good
knowledge of female condoms. Desiring high number of ideal children and being a student by
occupation were negatively associated with a favorable attitude.

The study revealed that significant number of women had poor knowledge and attitude towards
female condom. Multiple socio-demographic factors contributed to knowledge and attitude of
female condom. It has been observed that many couples, especially women who are directly
exposed to risk of unwanted pregnancy, do not utilize available family planning services. Thus,
the attitude of women toward family planning is not encouraging; it is this underutilization of
family planning that the researcher seeks to find out what may be responsible for the attitude of
women of childbearing age towards the use of female condom (Finochar et al., 2021).

1.2 Statement of the Problem

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Reduction in population growth is believed to improve the country’s prospects for economic
development which in turn is believed to enhance a county’s ability to improve the lives of the
citizens. In the case of Nigeria, there is the rapid growth of population according to population
figure. There is no such socio-economic issue that is grave and pressing than that of the
population growth.

Thus, to save the country from such grave problem it is essential that the population growth
should be planned and well checked. The increasing growth of Nigerian population without a
commensurate rate of economic development has become a serious problem requiring urgent
solution.

Despite the population attention family planning has gained and its importance to the society
they are still underutilized. It is believed as observed by scholars that certain items influence the
attitude of citizens of childbearing age toward family planning services utilization especially
female condom. This study thus focuses attention on investigating the attitude of women towards
the use of female condom among in Amadi-Ama Health Centre in Port Harcourt City Local
Government Area Rivers State.

1.3 Aim/Objectives of the Study

Generally, the aim of the study is to investigate the attitude of women towards the use of female
condom among in Amadi-Ama Health Centre in Port Harcourt City Local Government Area
Rivers State. Specifically, the study will be guided by the following objectives:

1. To examine the level of knowledge of women of child bearing age towards the use of female
condom in Amadi-Ama Health Centre in Port Harcourt City Local Government Area Rivers
State.

2. To identify the attitudes of women of child bearing age towards the use of female condom in
Amadi-Ama Health Centre in Port Harcourt City Local Government Area Rivers State.

3. To identify solutions to the attitude of women of child bearing age towards the use of female
condom in Amadi-Ama Health Centre in Port Harcourt City Local Government Area Rivers
State.

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1.4 Research Question

The study provided answers to the following questions:

1. What is the level of knowledge of women of child bearing age towards the use of female
condom in Amadi-Ama Health Centre in Port Harcourt City Local Government Area Rivers
State?

2. What are the attitudes of women of child bearing age towards the use of female condom in
Amadi-Ama Health Centre in Port Harcourt City Local Government Area Rivers State?

3. What are the solutions to the attitude of women of child bearing age towards the use of
female condom in Amadi-Ama Health Centre in Port Harcourt City Local Government Area
Rivers State?

1.5 Significance of the Study

The result of this study as envisaged will be of great assistance to women of child bearing age,
who are at the receiving end of consequences of usage of female condom.

This research work will also be of help to newly married women and their partners who have no
knowledge about the use of female condom. It will help to equip them with skill on how to avoid
unwanted pregnancy.

It will create awareness and exposure among couples on the need for child spacing and the
number of children they can care for in terms of education.

The study will also be significant to policy formulators and executors regarding the effective use
of female condom.

Finally, the research will be significant to reproductive health researchers as it may serve as a
reference material.

1.6 Scope of the Study

The scope of the study is as follow:

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  Attitude of women toward the use of female condom
 Amadi-Ama Health Centre
 Port Harcourt City Local Government Area
 Rivers State

1.7. Operational Definition of Terms

The following key terms have been defined for classification.

Family planning: It is the decision made by couples to bear the number of children they will be
able to care for and to have them.

Attitude: This refers to the behaviour of women toward family planning neither positive nor
negative which influence their usage.

Women of Childbearing Age: This means the period women’s menstruation starts to the period
of puberty to menopause.

Knowledge: It refers to the degree of familiarity and understanding of family planning and
available family planning services.

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 CHAPTER 2

LITERATURE REVIEW

This chapter shall review relevant literatures that have been reviewed by different authors under
the following sub-headings below;

2.1 Conceptual Framework

2.1.1 Concept of Female condom

2.1.2 Effectiveness of the Female Condom

2.1.3 Gender and Female Condom

2.1.4 Challenges to Use of Female condom

2.1.5 Benefits and Shortcomings of the Female Condom

2.1.6 Occurring issues and Factors hindering the use of Female Condoms

2.1.7 Modalities to increase the usage of Female Condoms

2.2 Empirical Studies

2.3 Summary of Literature Review

2.1 Conceptual Framework

2.1.1 Concept of Female condom

The Female condom, also known as Femidom, is a loose-fitting polyurethane sheath with two
flexible polyurethane rings one at either end. It is a contraceptive device inserted into the vagina
before sexual intercourse, and used by women to protect against both pregnancy and sexually-
transmitted infections (STIs), including HIV infection. It sits inside the vagina. The inner ring,
which is used to insert the condom, slides behind the pubic bone, and helps keep the female

7
condom in place. The outer flexible ring lies outside the vagina. It offers extensive barrier by
protecting the vagina, cervix and external genitalia (Mark et al., 2020).

The Female Condom is a new version of the original Female Condom (FC), which was approved
by the Food and Drug Administration (FDA) in 1993. It consists of a thin, flexible, nitrile
polymer (synthetic latex) sheath. It is less costly than the original product (Femidom) because of
the changes in material and the manufacturing process. Female condoms are available over the
counter; however, although the Female Condom is registered. The Female Condom and the
original Female Condom are designed and intended to be used only once and are both
manufactured by the Female Health Company, of Chicago, IL (Klein & Stubble, 2019).

2.1.2 Effectiveness of the Female Condom

While no barrier method is 100 percent effective, correct and consistent use of latex condoms
can reduce the risk of transmission of HIV, some other sexually transmitted infections (STIs) and
unintended pregnancy. As a contraceptive, the female condom compares favourably with other
barrier methods. A study in China that compared the contraceptive efficacy of the female
condom with the male condom showed better results with the female than the male condom, i.e.,
1.06 and 1.69 pregnancies per 100 women, respectively, over six months (Xu, Wu & Coa, 2019).
Studies in the United State and Africa on the correct use of the female condom, revealed
pregnancy rates of 2.6 in the United State and 9.5 in Africa (Farr et al., 2023).

Trussel (2020) found in United State study that within the first year of consistent and correct use,
about 5% of women relying on the female condom had unintended pregnancy, compared to 2%
for male condoms and 6% for the diaphragm. The female condom’s effectiveness is also rated
between 94% to 97% by United State Food and Drug Administration. Daniel Agbiboa (2021),
argues that the female condom has demonstrated to be highly efficacious in preventing
pregnancy, HIV transmission and other viral infections such as herpes and hepatitis. Estimates of
its contraceptive efficacy fall within the same range as those of other barrier methods: six months
failure rates for the female condom ranged from 0.8% (among 190 women in Japan who used it
correctly and consistently to 9.5% (among 115 women in three Latin American locations).
Laboratory studies have established that polyurethane is impermeable to small viruses, such as
cytomegalovirus, herpes virus, hepatitis B virus and HIV.

8
2.1.3 Gender and Female Condom

All along, the focus has been on women when it comes to family planning and reproductive
health issues. In high-prevalence settings, young women remain at unacceptably high risk of
HIV infection. In eastern and southern Africa, for example, young women (aged 15–24 years)
accounted for 26% of new HIV infections in 2016 despite the fact that they make up just 10% of
the population. Young women (aged 15–24 years) in western and central Africa and the
Caribbean respectively accounted for 22% and 17% of new HIV infections in 2019 (Global
AIDS Update, 2019).

Munthali et al (2019) in their study on the acceptability of female condoms in Luchenza, found
that unmarried young women reported inconsistent use or discontinuation of the use of female
condoms. Inconsistent use was most commonly attributed to partner objection – as cited by 30%
of the young women at 12-month follow-up and by Female Sex Workers who reported that their
clients distrusted unfamiliar methods. Other common reasons for discontinuation were lack of
perceived need for a barrier method, often due to belief in a mutually faithful partnership, or
desire for unprotected sex with a loved one.

2.1.4 Challenges to Use of Female condom

The following challenges have been identified:

Religion: Condoms are often viewed as meant for those who are promiscuous and condemned.
Several religious denominations discourage their flocks from using condoms as both a
contraceptive method and an HIV prevention method. Some religious organizations are silent on
issues relating to the use of condoms by their flock. Consequently, these religions may have
negative perceptions towards the use of condoms, both as contraception in family planning and
as a preventive measure against the spread of sexually transmitted diseases, and this may
negatively affect programmes that are aimed at reducing the spread of HIV/AIDS (Srikanthan &
Reid, 2022).

Availability: A substantial proportion of young women do not know where to get sexual and
reproductive health services in Ogun State Nigeria, no financial capacity to access services, or
are too embarrassed to seek care (Agha et al., 2019).
9
Culture: One cultural barrier to condom use is women’s position in society constrains their
ability to demand safe-sexual practices from their partners. In Malawi, women are often
subordinate to men both socially and economically. They are expected to have children and work
in the home or field. They have little negotiating power in their relationships and can be beaten
for not obeying their husbands wishes (Klein, & Berman, 2023).

Another cultural barrier in Oguta Local Government Area, Imo State to condom use was
associated with having multiple sexual partners as well as being perceived as unromantic or
displaying a lack of romantic involvement between a couple. Moreover, if a woman asks a man
to wear a condom it suggests that he or she has been unfaithful; a socially unacceptable
suggestion regardless of potential truth. Couples will not use condoms because it is seen as a sign
of being promiscuous. Whether or not one have multiple partners it does not change this concern
with maintaining the appearance of faithfulness (Nwachukwu et al., 2021).

2.1.5 Benefits and Shortcomings of the Female Condom

Vijayakumar et al., (2021) as stated in ‘The Female Condom’ benefits of using the female
condom have been identified to include the following: it provides an opportunity for women to
share the responsibility of using condoms with their partners; a woman may be able to use the
female condom if her partner refuses to use a male condom; it provides protection against most
STIs and pregnancy if used correctly and consistently, and it can be inserted in advance of sexual
intercourse so as not to interfere with the moment. The shortcomings are listed as the following:

The outer ring or frame is visible outside the vagina, which makes some women feel self-
conscious; The female condom makes some noises during intercourse (adding more lubricant can
lessen this problem); some women find the female condom hard to insert and remove; It has a
higher failure rate in preventing pregnancy than non-barrier methods such as the pill; and in
some countries, it can be relatively expensive and in limited supply.

2.1.6 Occurring issues and Factors hindering the use of Female Condoms

The awareness, knowledge, Utilization of female condoms is determined largely by the

information and sensitization disseminated per time to the target people in society. On many
occasions, the male condom has been vigorously projected as a contraceptive that could protect
10
against STIs which further underestimates the advantages of using a female condom as well.
There are daunting factors and issues which keep reoccurring that have hindered the use, of
female condoms among female youths in society. Some of the factors highlighted were the
unavailability, inaccessibility, and insertion problem of female condom devices among female
folk. Okunola et al (2021) exposed in their study that Nigerian female undergraduates declined
the use of female condoms due to sexual dissatisfaction, insertion difficulty, and personal
indisposition to it. Salawu & Adeyemi (2023) associated the low level of female condom usage
with the perception among the respondents that it might slip out during use, and the associated
noise it caused during sexual activity. Tobin-West et al (2023) submitted that there were
significant challenges in the use of female condoms among University students which include
the unavailability of the contraceptive, high cost, and difficulty in inserting the device. Mokgetse
& Ramukumba (2023) added that significant challenges against the usage of female condoms
among young women were the shape of the device, material composure, unavailability of the
device as well as lack of adequate information about the contraceptive. In a related development,
Usman et al (2019) highlighted that the high cost of the device, unavailability, and insertion
difficulty that they experienced over time had discouraged them from using the condom. Boraya
& Gachau (2023) also revealed in their Study that factors were associated with the marital status
of the user, the time frame between the time of insertion and actual use, attitude and negotiation
skill of the user to bargain with the partner to use it or not. Sekoni (2023) revealed that though
there was considerable awareness about the device among female students, they had declined the
use of the device because it caused them discomfort and other related issues; insertion problem,
and unavailability of the device. Gambir et al (2019) in a related study affirmed that there was a
perceived high-cost purchase of female condoms and the inability of the woman to make a
concrete decision that centers on the usage with their partner. Uchendu et al (2019) differently
found in their study that male domineering cultural norms, the misconception of poor sexual
satisfaction during sex, accessibility, and unavailability had caused the low patronage to use the
female condom. They added that shame and stigma associated with the purchase, partner
disapproval, and insertion problem have been highlighted as factors hindering the usage of the
device. Abari et al (2020) presented that thought there was an increase in awareness among
female undergraduate students it did not determine their compliance and acceptability level to
use the device. The respondents had rejected the use of female condoms due to health

11
implications, high cost of purchase, and difficulty to use, as well as the assumption by the
respondents that the partner should shoulder the responsibility of using them. In Oranu et al
(2020), they discovered that respondents had declined the usage of female condoms because it
reduced their pleasure during sex, the unreliability of the device, religious affiliation, and partner
indisposition to the idea.

The above submissions on the factors hindering female condom usage have revealed the level of
acceptance, knowledge, and usage among female folk which by indication has put them on the
disadvantaged stage with the possibility of an increase in STIs-related issues. However, if efforts
are geared toward sex sponging the highlighted issues and factors, the incidence cases of STIs,
unprotected sex, and unwanted pregnancy among female youths would be reduced among the
youths.

2.1.7 Modalities to increase the usage of Female Condoms

Indisputably, the use of female condoms has not received the desired reception and patronage
among female youths like the male condom in society. The purpose of inventing the device for
use among female folk has not been fully achieved because some female youths still fall victim
to associated STDs/STIs and unwanted pregnancies. However, efforts can be geared towards
reactivating the campaigns on female condoms to bridge the gap of lapses that had been created
over time. The following ways can be employed by every stakeholder in society by ensuring that
female condoms are widely recognized and used by female youths.

Emphasizing Education: One of the reasons that have impeded the use of female condoms
among female youths was the lack of adequate education that would have brought about their
consciousness and knowledge about the usage of contraceptives. Education stands as one of the
viable strategies for getting female youths inundated with condoms. Proper education about
female condom (Ananga et al, 2019) gets them familiar with their usage and how well they can
control their sexual life, and protect their lives against any sexually transmitted diseases. While
employing educational means to sensitize them, the use of practical methods or materials to aid
teaching is also vital. Emphasizing education on female condoms makes female youths acquire
knowledge and usage, and keep a healthy life as well.

12
Ensuring availability and reduction in the price of the product: The non-availability of
female condoms in many health stores has resulted in a lack of knowledge, awareness, and usage
among many female youths. Ensuring adequate supply and availability (Mashanda- Tafaune &
Monareng, 2020) in health stores, and pharmaceutical outlets allow female youths to gain access
(Peters, 2019), and exposure to it while purchasing the device for use when desired. The
availability of the products enables people to patronage, accept and use it as desired. Indeed,
manufacturing companies have to produce more at a cheaper price like male condoms, while the
distribution channels have to be sustained for easy access, and availability to female folks.

Public promotion and local marketing: Male condoms had received extensive attention in the
past owing to wide publicity among the people. The female condom can also get similar attention
and publicity if there is a will and eagerness by concerned stakeholders to make it happen.
Promotion and local marketing of the female condom can do more in creating awareness,
acceptability, and usage among female youths who are vulnerable to getting infected with
sexually related diseases (Hoffman et al, 2020; Ananga et al, 2019). National or governmental
promotional campaign agencies and interventions (Wang et al, 2021) can help in this regard by
promoting female condoms among female youths. Such promotion and campaigns were
successfully carried out in countries such as South Africa, Ghana, Brazil, and Zimbabwe
(Hoffman et al, 2020. Artz et al (2020) believed that promoting female condoms in a positive
way such as through social marketing can make more women patronize it admittedly.

Enabling more information and use of media: Knowledge, awareness, and usage of female
condoms can be expanded through the use of mass media, social media, and getting people
informed always (Hutchison, 2023). When information is passed regularly among the people, it
creates consciousness, and knowledge about the contraceptive device in society, and importantly
the female youths. Making use of information and mass or social media gives wide and
consistent communication to people (Agha et al, 2022; Devanier et al, 2022; Choi et al, 2023).
The use of media helps to spread the information to a larger population while targeting the
proposed population.

Healthcare providers and attitudes of healthcare workers: Female condom usage,

knowledge, and acceptability can be taught and adequately communicated by healthcare
providers, counselors, and clinicians who are knowledgeable in health matters. They are capable
13
of teaching people how to access and use the female condom after they must have received
adequate training to do so (Mashanda-Tafaune & Monareng, 2023). Importantly, attitudes and
approaches employed by the practitioners go a long way in passing the right message about the
device which can result in commendable patronage and usage among female youths (Gollub,
2020; Devanler et al, 2022; Choi et al, 2023).

Attitudes and views on Female Condom

The 2019 Nigeria National Condom Strategy uncovered some underlying problems related to the
use of female condoms. The problems are that some men refuse to use the female condom for
fear of multiple use and/ or reuse without adequate cleaning or “sperm harvesting” for black
magic. Some youths also believe that a device that is not worn by a man might not protect them.
To those who used the condom and discontinued its use pointed out attributes perceived as
“disliked” as large size, unattractive appearance, noise, reduced sensation, size, over- lubrication,
difficulty inserting, and discomfort from the internal ring.

Similarly, Thornburn (2019), reports that the majority of African American men in his study,
which examined attitudes and perceptions in relation to the selection of contraceptive methods,
with a focus on gender differences, displayed willingness to try the female condom. The findings
of a review conducted in the United State by Severy and Spieler (2020) revealed that many men
prefer the female condom to the male condom because it is less constricting, and makes sex more
pleasurable and more natural. In their review of studies on the female condom, (Vijayakumar et
al., 2021) revealed that female condoms are acceptable to many women, offering a useful
alternative to women who may desire to use dual protection methods. A later study revealed
another finding linked to sexual pleasure. The study found that while women recognized the dual
protection offered by the female condom, the fact that they liked it is linked to sexual
satisfaction. They mentioned that it can be inserted before foreplay, a positive factor also stated
by males during the focus group discussions in a study conducted in Zimbabwe among sexually
active women and men (Francis-Chizororo& Natshalanga, 2023). Respondents expressed the
need for more information regarding use and its effectiveness in prevention of sexually
transmitted diseases including HIV. Currently, there is a lack of published data relating to the
views of young men, who play such a critical role in fuelling the HIV epidemic, on prevention
methods such as the female condom. Gordon and Mwale (2023) in a case study on preventing
14
HIV with young people in Luchenza, argue that lack of knowledge about sexual practices and
their safety puts young people at risk of STIs and HIV, as well as unwanted pregnancy.

2.2 Empirical Review

According to further studies done by pleasure (Agbiboa, 2020) the acceptability of the female
condom among women other than prostitutes faces two obstacles: the reaction of the women’s
regular partner and attitudes to the device per se (appearance, difficulties or uneasiness
concerning its use). Some women seemed to like the female condom because it provides dual
protection against pregnancy and STIs without sacrificing sexually.

Gabriel et al., (2021) conducted a cross- sectional study on understanding female condom use,
acceptance, accessibility, awareness and knowledge among female public health students in a
Nigerian university. One hundred and ninety (190) female public health students took part in the
study. A self-administered questionnaire was used to collect the data between August and
December 2019. Data analysis was carried out using SPSS version 23. Overall percentage
awareness of female condoms usage in this study was 52.0%. Less than a quarter (22.4%)
reported having seen a pack of female condoms, while the remaining 77.6% of the participants
reported having never seen a pack of female condoms. In addition, the majority (87.4%) of the
respondents did not know whether a female condom interferes with sexual pleasure/sensation.
The majority of the respondents (77.4%) concurred that utilizing a female condom implies that "I
don't trust my partner". Concerning accessibility of the female condom, only 1.8% agreed that
female condoms is easily accessible while more than half (54.2%) are uncertain of the
accessibility. Our study revealed a low level of knowledge and utilization of female condoms,
and also limited access to the female condom as well as unsatisfactory acceptance and
suboptimal awareness level which were suggested by the overall percentages in the study.

Mark et al., (2022) conducted a study on knowledge, acceptance and utilization of the female
condom among women of reproductive age in Okochiri Community in Okrika Local
Government Area, Rivers State. A descriptive cross-sectional survey design was used and a total
of 380 females between the ages of 15 and 49 years were sampled from the Okochiri
Community. A self-administered structured questionnaire measuring the study items was used,
and frequencies, percentages and Chi Square tests were used to analyse the data. There is low

15
level of FC use among the women as less than half (48.4%) of the sample were aware of the FC.
It was further observed that 21.1, 21.8 and 11.1% of the sample reported friends, media and a
public lecture as their sources of knowledge of the FC respectively. It was also observed that
there is a low level of female condoms acceptance and utilisation, and also limited access to the
FC from nearby shops/pharmacies (1.8%) and health centres (7.4%).

Artigo, (2023) conducted a study on knowledge, attitude and practice of condom use by women
of an impoverished urban area Ususu Community in Ahoada West Local Government Area,
Rivers State. An evaluative Knowledge, Attitude and Practice (KAP) household survey with a
quantitative approach, involving 300 women. Data collection took place between June and
August 2023, regarding the male condom, most women showed inadequate knowledge and
practice, and an adequate attitude. Regarding the female condom, knowledge, attitude and
practice items were unsatisfactory. Significant associations between knowledge/religious
orientation and attitude/education regarding the male condom were observed.

2.3 Summary of Literature Review

Literature review was basically on attitude of women toward female condom utilization in
Amadi-Ama Health Centre in Port Harcourt City Local Government Area Rivers State. From the
literature reviewed, it is obvious that identifying individuals’ attitudes towards the female
condom, completing missing information and correcting false information are important to be
able to provide an effective female condom service and for planning the training and consultancy
services to be given to the women. From the empirical studies, most findings revealed that the
attitude of women toward female condom utilization in Amadi-Ama Health Centre in Port
Harcourt City Local Government Area Rivers State is highly practice but most measures where
highly neglected. Several studies have been carried out on attitude of women toward female
condom utilization in Amadi-Ama Health Centre in Port Harcourt City Local Government Area
Rivers State so this research is to fill in the gap in literature in Amadi-Ama Health Centre of Port
Harcourt City Local Government Area, Rivers State.

16
 CHAPTER 3

METHODOLOGY

This chapter highlights the methods used for the study: “attitude of women toward the use of
female condom among women in Amadi-Ama Health Centre in Port Harcourt City Local
Government Area Rivers State”. The discussion was done under the following sections:

3.1 Research Design

3.2 Study Area

3.3 Population for the Study

3.4 Sample and Sampling Techniques

3.5 Instrument for Data Collection

3.6 Validity of the Instrument

3.7 Reliability of the Instrument

3.8 Method for Data Collection

3.9 Method of Data Analysis

3.1 Research Design

A descriptive design is adopted for the study. This design seeks to obtain information, attitude
and from the respondents about the research problem in order to provide answers to the research
questions.

3.2 Study Area

The study area is Amadi-Ama Health Centre in Port Harcourt City Local Government Area of
Rivers State. Amadi-Ama Health Centre is located in the Southeast flank of the Niger Delta,
between latitude 40 450N and latitude 40 550N and longitude 60550C and longitude 70 500E in

17
Rivers State, Nigeria. The Amadi-Ama Primary Health Center is a Public health facility, located
at Port-Harcourt, Port-Harcourt Local Government, Rivers State. It was established on 3/2/2009,
and operates on 24Hours basis. The Amadi-Ama Primary Health Center is licensed health
facility by the Nigeria Ministry of Health, with facility code 32/22/1/1/1/0014 and registered as
Primary Health Care Centre.

Services offered, if a hospital offers wide services, they will have more doctors and other
medical practioners on call. The higher the number of service offered, the bigger the hospital.

Facility Level, typically, Secondary and Tertiary hospital tend to be bigger than Primary Health
Centre. Onsite Laboratory and Pharmacy. The biggest hospitals tend to conduct all tests, and
have all materials they need within the hospital premises.

Amadi- Ama Primary Health Center has the following:

Number of Beds: 15, Services Offered: Cardiology, Gastroenterology, Dermatology,

Endocrinology, Pulmonology, Antenatal Care (ANC), Immunization, HIV/ AIDS Services,
Tuberculosis, Non Communicable Diseases, Family Planning, Accidents and Emergency,
Nutrition, Health Education and Community Mobilization, Gastroenterology, Pulmonology, and
Maternal and Child Health Clinic No, Obstetrics, Gynecology.

3.3 Population for the Study

The population of the study comprised 100 women of child bearing age in Amadi-Ama Health
Centre in Port Harcourt City Local Government Area. This has to do with the use of a subset to
represent the whole population Nwodu (2016).

3.4 Sample and Sampling Techniques

The sampling technique used for this work was the purposive, stratified random sampling
method. This has to do with the use of a subset to represent the whole population, a total of 20
breastfeeding mothers from the five (5) selected units in Amadi-Ama Health Centre in Port
Harcourt City Local Government Area of Rivers State.

18
3.5 Instrument for Data Collection

In this study the researcher will adopt primary instruments for data collection. In the primary
instrument for data collection, a well-structured questionnaire will be constructed by the
researcher in line with the research objectives. The questionnaire deal with attitude of women
towards the use of female condom among in Amadi-Ama Health Centre in Port Harcourt City
Local Government Area Rivers State and the questionnaire format covered yes and no pattern
that will be easy for respondents. The use of instruments produces better results using them to
analyze her result.

3.6 Validity of the Instrument

In order to achieve the content validity of this study, the questionnaire will be structured to
reflect on the purpose of the study and specific objectives of the study. The questionnaire was
given to my supervisor for proper vetting. The corrections and contributions will be effected
before final production or printing of the questionnaire copies.

3.7 Reliability of the Instrument

The reliability of the instrument will be determined by employing the test and re-test method.
The instrument will be administered to a group of 15 respondents in Rumueme Health Centre but
outside the study. The copies of the questionnaire will be retrieve from them after sometime. The
questionnaire was re-administered to them again after two weeks the researcher will retrieve the
data and the data collected will be analyze using Pearson Product Moment Correlation (PPMC)
test and the reliability index.

3.8 Method of Data Collection

The questionnaire has two (2) sections; Section A and Section B. The section A comprises the
socio-demographic data of the respondents while section B comprises specific research
questions. The questionnaires will be distributed to respondents participating in the study. The
respondents then respond to the questions posed on the questionnaire according to the
instruction. Copies of the questionnaire will be directly delivered and retrieved on the spot, by

19
the researcher from the respondents. With the help of the service of research assistants to ensure
a high rate of return.

3.9 Methods for Data Analysis

The collected data will be first tally, coded and presented in frequency distribution table. The
researcher will use simple percentage to analyse the data collected in the questionnaire and it will
used to relate to the research questions.

20
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 School of Public Health

Rivers State College of Health

Science and Management Technology

PMB 5039, Rumueme.

Port Harcourt.

4th March, 2024

Dear respondent,

ATTITUDE OF WOMEN OF CHILD BEARING AGE TOWARDS THE USE OF

FEMALE CONDOM IN AMADI-AMA HEALTH CENTRE IN PORT HARCOURT
CITY LOCAL GOVERNMENT AREA RIVERS STATE

I am a final year student of Public Health Technology of the above mentioned institution
carrying out a research on the topic: “attitude of women of child bearing age towards the use of
female condom in Amadi-Ama Health Centre in Port Harcourt City Local Government Area
Rivers State. I would like to ask for permission to allow me conduct a questionnaire among
women of Child bearing age on the above topic. Please your co-operation in answering these
questions will be highly appreciated.

All information given is basically for academic purpose. It will be treated with strict
confidentiality. Thank you for your anticipated co-operation

Yours Faithfully,

Emeka Adaku Precious

(Researcher)

26
 QUESTIONNAIRE ON ATTITUDE OF WOMEN OF CHILD BEARING AGE
TOWARDS THE USE OF FEMALE CONDOM IN AMADI-AMA HEALTH CENTRE IN
PORT HARCOURT CITY LOCAL GOVERNMENT AREA RIVERS STATE.

Instruction: Tick the box which reflects your response in the questionnaire
below:

SECTION A

PERSONAL DATA

Age: (a) 15 years - 25years (b) 26years-35years

(c) 36 years-45 years (d) 46 years and above

Marital Status: (a) Single (b) Married

(c) Separated (d) Widowed

Occupation: (a) Employed (b) Unemployed

(c) Students (d) Traders

Educational level: (a) Non-formal education

(b) Primary education (c) Secondary education d) Tertiary education

Religion: (a) Christianity b) Islam (d) Others

27
 SECTION B: RESEARCH QUESTIONS

Research question 1: What is the level of knowledge of women of child bearing age towards
the use of female condom in Amadi-Ama Health Centre in Port Harcourt City Local
Government Area Rivers State?

S|N Item Yes No

1. Female Condom is also known as femidom
2. Female condom are inserted into female virginal
3. Female condoms helps to protect against infectious
4. Encourage sex satisfaction
5 Have plastic ring for easy penetration
Research question 2: What are the attitudes of women of child bearing age towards the use
of female condom in Amadi-Ama Health Centre in Port Harcourt City Local Government
Area Rivers State?
S|N Item Yes No
1. Trust my partner so I don’t use female condom
2. Never been exposed to female condom
3. Not attractive
4. Cumbersome to wear
5 Awkward to wear and remove
Research question 3: What are the solutions to the attitude of women of child bearing age
towards the use of female condom in Amadi-Ama Health Centre in Port Harcourt City
Local Government Area Rivers State?
S|N Item Yes No
1. Public promotion and local marketing
2. Availability and reduction in price of product
3. Emphazing education
4. Use of social media
5 Attitude of healthcare provider

28