Female condom use could vastly reduce the number of unwanted pregnancies and sexually transmitted diseases, including HIV. So what’s stopping women from using them? Lucie van Mens, of the Universal Access to Female Condom Joint Programme and Ilze Smit, of the World Population Foundation, consider the issues.
The female condom has been around for fifteen years. Today it is the only female-initiated prevention method that provides double protection – against pregnancy and disease. Yet the female condom is still not widely promoted or used. In a world where 200 million women have no access to contraceptives and one third of all pregnancies are unintended (and many unwanted) this is unacceptable. In sub-Saharan Africa where 61per cent of all new HIV infections are among women, this is indefensible.
Female condoms have several advantages over the male condom. Firstly women are in control over when they use them. The use of male condoms often has to be negotiated by women over and over again and relies on the cooperation of men. Female condoms have to be negotiated only once. If partners agree, women can simply apply the female condom to themselves every time they have sex. They can be inserted several hours before the sexual act takes place, and foreplay does not need to be interrupted.
The female condom is also highly acceptable to people. UNAIDS and WHO published a report in 1997 called The Female Condom: An Information Pack. Forty one studies of the female condom showed acceptance levels ranging from 41 per cent-95 per cent. In 2006 another study by Vijayakumar et al reviewed 60 acceptability studies and concluded that research on the female condom should move away from assessing acceptability. In other words, most people find the female condom acceptable to use.
In spite of its advantages and good characteristics, the female condom has been neglected as a reliable prevention method. This might be for a variety of reasons. The product suffers from a bad image, but so did male condoms when they first came onto the market, so there is a need to present the product in a positive light, with good marketing and appealing packaging. There is also currently a lack of variety in female condoms. The best known types are FC1 and FC2 made by the Female Health Company. The FC1 and FC2 are similar in shape and have both an inner and outer ring. The main difference is that FC1 is made of polyurethane, which can produce a ‘crispy’ noise. The FC2 is made of nitrile, a ‘silent’ fabric. The production process for the FC2 is also cheaper, making it a better product.
In order for women to have the choice to use female condoms, supply chains need to function well. Female condom programmes implemented up until now tend to run out of stock quickly after, or sometimes during, programmes. If women cannot rely on the availability of the product at the time they need it, they will lose interest. There should be more choice of products so that women can get the female condom that suits them, that fits best, and that they personally find easiest to use. More female condoms need to be available on the market. However any new health product needs to meet the quality control standards set up by the World Health Organization, a complex and costly process.
The Female Health Company’s condoms are the only products to have obtained this status and this has led to a near monopoly of the market. Finally, the cost of the female condom is currently too high. The procurement price for the female condom is up to 15 times higher than the male condom. This is partly because of the current limited market for female condoms, so increasing demand will inevitably bring down the price.
It is estimated that around 10 million Euros are needed for the development of a new low-cost female condom. This is a lot of money, but compared to investments in prevention methods such as microbicides and vaccines, the investment is relatively low.
Meanwhile, although new products are needed, there are still things we can do as donors and agencies to promote the use of female condoms in women’s sexual and reproductive health programming.
Lucie van Mens is coordinator of the Universal Access to Female Condom (UAFC) Joint Programme, employed at Oxfam Novib and Ilze Smit is advocacy officer of the UAFC Joint Programme at the World Population Foundation (WPF).
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