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Failing women, withholding protection

2008 marks 15 years since the female condom was invented, and, disgracefully, 15 years of failing to make them accessible to the women who need them. Despite the absence of any other female-initated form of protection, and unprecedented rises in funding for the response to HIV, female condoms remain inaccessible, and their contribution remains untapped.    

The urgent need for access to female condoms is evident in the feminisation of the HIV pandemic, the large unmet need for contraception, and the pitiful progress towards meeting Millennium Development Goals 5 and 6 on maternal health and halting and reversing the spread of HIV.

Why provide female condoms, when male condoms are readily available, much cheaper, and provide a comparable level of protection?

·        Women who use female condoms report an increased sense of power for negotiation of safer sex, and a greater sense of control and safety during sex. Female condoms are a tool to assist women’s empowerment. It will be many years until women have any alternative female-initiated means of protecting themselves.

·        Providing both female and male condoms leads to more instances of protected sex and reductions in the incidence of sexually transmitted infections (STIs). Their additive effect, providing protection in instances which would not be protected by male condoms, makes them a cost-effective form of HIV prevention.

Studies have repeatedly shown high levels of acceptability for female condoms. Some users prefer them over male condoms, as they offer more flexibility regarding the timing of putting them on and taking them off, and have a more natural feel. However, many decision-makers remain sceptical that sufficient demand for them exists. Yet examination of female-condom projects reveals significant demand, even though it is often deliberately suppressed and unintentionally undermined by stigmatisation and being out of stock of the product. What is perceived as an issue of demand is actually one of supply. Expanding access to female condoms is held up not at the users’ end, but at the start of the chain: how much money donors and governments are willing to invest in buying female condoms, supporting female-condom programmes, and developing low-cost female condoms.

What is behind the failure to act comprehensively to create access to female condoms?  Responses from decision-makers to the female condom mirror the common reasons for not using a male condom: responses formed by ignorance, culture, denial, ‘poverty’, and conservatism. Added to this are overarching errors of a lack of leadership, a huge funding bias against existing forms of primary HIV prevention, failure to scale up programming, and failure to invest in strategies to lower the cost of female condoms.

Of course, some efforts have been been made in the past 15 years, which have accelerated since the launch of the United Nations Population Fund’s (UNFPA) global Female Condom Initiative in 2005. The rapid expansion of sales and free distribution in the few forerunning countries demonstrates the massive unmet demand for female condoms. But there is so much more to be done. Worldwide, in 2007, roughly 423 male condoms were produced for just one female condom. Female condoms currently have a unit cost about 18 times higher than male condoms.

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