Knowledge, acceptance, and utilization of female condoms among female students in tertiary schools in the Hohoe municipality, Ghana

The female condom is the only commonly available method that affords women and girls more control in protecting themselves from sexually transmitted infections, as well as unintended pregnancies. Despite its efficacy, global utilization remains low. This study assessed the knowledge, acceptance, and utilization of female condoms among female tertiary students in the Hohoe Municipality, Ghana. A cross-sectional study was conducted among 422 female students from four tertiary institutions in the Hohoe Municipality. A three-stage stratified sampling method was used to recruit respondents, and data were collected using structured questionnaires mounted in the Kobo Collect software. Data was exported to Stata version 17.0 for analysis. Descriptive and logistic regression analyses were performed, with statistical significance set at a p < 0.05 at 95% confidence interval. Our study found that out of the 422 female tertiary students recruited, with a mean age of 22.77 years (SD ± 2.47). A majority of participants ( n = 373, 88.39%) reported having heard of the female condom, and 290 (68.72%) correctly stated that it is primarily used to prevent both pregnancy and sexually transmitted infections. Overall, out of the 422 respondents, the majority ( n = 319, 75.59%) were considered knowledgeable about female condoms. Overall, most ( n = 254, 60.19%) of the respondents showed high level of non-acceptance of female condom, out of 422 respondents. Overall, out of 422 respondents, majority ( n = 365, 86.49%) of the respondents demonstrated high level of non-utilization of female condom. Regarding sexual partnerships, students without a sexual partner were 50% less likely to use the female condom compared to those who had a partner (aOR = 0.50, CI: 0.26–0.95, p = 0.030). Furthermore, acceptance showed a strong positive association: respondents who accepted the female condom were 7.70 times more likely to utilize it compared to those who did not (aOR = 7.70, CI: 3.01–20.04, p < 0.001). Knowledge of female condoms was high among tertiary students in Hohoe, yet acceptance and utilization remained low. Utilization was significantly associated with having a sexual partner and acceptance, with acceptance showing the strongest association; religion showed no significant association after sparse categories were regrouped. Interventions should prioritise strategies that build acceptance and engage sexual partners, alongside continued education, to close the gap between knowledge and practice.