THE FACTS
Why female condoms should be accessible for all
Let the facts speak for themselves, because seeing all facts and figures on the importance of female condoms in relation to the MDGs, the acceptability rates, the effectiveness of female condom programming will take away the prejudices on female condoms.
The conclusion after reading the facts is that political and financial support is urgently needed to make female condoms accessible for all!
1. The global facts:
- It is a fact that more women than men are affected by the HIV epidemic. In sub-Saharan Africa 61 percent of adults and 75 percent of young people infected with HIV are female.
- AIDS is a leading cause of mortality worldwide, with an estimated 2.1 million deaths in 2007.
- Investment in primary prevention will reduce the number of new HIV infections, and so reduce the cumulative growth in the numbers of people needing anti-retroviral treatment.
- UNFPA estimated that there are around 215 million women worldwide who would like to limit or space the children they have, but who are not using any form of contraception.
- WHO estimates that in developing countries more than one-third of all pregnancies are unintended.
- A fifth of those unintended pregnancies are aborted, more than half by unsafe means.
- Unsafe abortions cause five million women to be hospitalised each year, and account for 13 per cent of maternal deaths.
- The global contraceptive prevalence has increased to 64 percent in 2005; it remains low in sub-Saharan Africa at just 21 per cent
2. Link between female condoms and the Millennium Developmend Goals (MDG’s)
MDG Target 1 – Reduce by 1/2 the number of people living on $1 per day
Falling fertility rates in low income countries have been correlated with a decline in poverty. Provision of reproductive health services and supplies helped reduce fertility by 43 percent in developing countries from 1965-90. These vital contraceptive supplies are now under-funded by hundreds of millions of dollars annually.
MDG Target 3 – Promote Gender Equality and Empower Women
Studies find an increased sense of power for negotiation of safer sex, and a greater sense of control and safety during sex, among women using female condoms. This is particularly the case where women learn about female condoms as part of an empowerment process. As such, female condoms are a tool which can assist in women’s empowerment.
MDG Target 4 – Reduce by 2/3 the mortality rate among children under 5
Almost 11 million children under 5 die each year, mainly in developing countries. Infant mortality rates can decrease by as much as 45 percent when births are spaced more than 2 years apart. The use of methods of family planning is critical to successful birth spacing and increased infant survival.
MDG Target 5 – Reduce by 3/4 the maternal mortality ratio
In industrialised countries a woman has only a 1 in 4,000 chance of dying in pregnancy or childbirth over the course of her lifetime; in the developing world, that risk increases to 1 in 60. The use of contraceptives to ‘space’ births is also a critical factor in reducing maternal mortality, yet 123 million women who want to use contraception are unable to do so.
MDG Target 6 – Halt and begin to reverse the spread of HIV/AIDS
The link to reproductive health supplies – 5 million people were infected with HIV in 2003. Actions to prevent HIV are 28 times more cost effective than treatment. Female and male condoms are currently the only product able to prevent sexually-transmitted HIV. Yet on average, just 4.6 condoms are available per year to each African man.
3. Dual protection of condoms, the facts:
- Condoms – male and female – are currently the only available technology which gives users simultaneous protections against pregnancy and STI’s including HIV.
- Throughout the developing world an individual has easier access to anti-retroviral treatment than getting a reliable supply of female condoms.
- For every two people who are put onto anti-retroviral, another five new HIV infections occur.
- Long experience of family planning shows that increasing the choice of methods available leads to increased uptake and more consistent and continued contraceptive use.
4. Availability of female condoms, the facts:
- From 1993 to 2005 the only female condom manufacturer was the Female Health Company.
- FC1 is now being replaced by FC2, those are the only two female condoms with WHO pre qualification
- Dr. Reddy female condom has not yet fulfilled all the requirements of the WHO pre-qualification procedure. It is approved with a CE approval for use throughout Europe and many other countries. Around five million were sold commercially between 2003 and 2007.
- The Dahua woman’s condom is under development and is seeking funding for trails to gain approval. It will be on the commercial market in 2010.
- Only 0.24 per cent of all condoms produced are female-condoms.
5. Benefits of female condoms:
- Condoms – male and female – are currently the only available technology which gives users simultaneous protection against pregnancy and STI’s including HIV.
- Women are in control when they use them. The use of male condoms often has to be negotiated over and over again and relies on the cooperation of men. Female condoms have to be negotiated only once. Qualitative studies find an increased sense of power for negotiation of safer sex, and a greater sense of control and safety during sex, among women using female-condoms.
- Female condoms have the advantage of no side effects, are reversible forms of contraception, and can be used without seeking a health-care provider.
- Synthetic female condoms have a soft, moist texture which feels natural during sex. For men the sensation is closer to that of sex without a condom, because female condoms do not fit tightly around the penis as male condoms do.
- Synthetic female condoms (FC2 and Women's Condom) are not damaged by oil based lubricants nor affected by changes in temperature and humidity, so they can be safely stored almost anywhere. (Unlike latex condoms (Cupid and WOW of Medtech).
- Some female condoms (FC2) can be inserted several hours before the sexual act takes place, so foreplay does not need to be interrupted.
- Studies report a high satisfaction rate by both women and men who have used the female condom. Originally, the demand came mostly from women, but we see the number of male consumers increasing.
- Effective female-condom programming also enables women, men and health professionals to gain a better understanding of women’s bodies and a greater ability to discuss sexuality and safer sex.
6. Current costs of and spending on female condoms:
- The average price of the FC2 is $0,73. If procured in large quantities the price can be reduced to about $ 0,55 (or even less).
- Female condoms (provided in addition to male condoms) enables an additional ten percent of protections. This additive effect makes female condoms cost-effective in comparison to male condoms.
- Around $10 billion funding was available for responding to HIV globally in 2007, a forty-fold increase in a decade. The total funding on female condoms in 2007 has been no more than 0.3 per cent of the total funding for responding to HIV.
7. Obstacles for female condom use:
Failure to promote and increase the production of female-condoms is due to: ignorance, culture, denial, “poverty” and conservatism.
- Ignorance causes poorly informed decision makers to rely on media stereotypes regarding female condoms rather than scientific studies.
- Culture creates a sometimes explicit bias to female condoms; the personal beliefs and values of individuals often prevail over an evidence informed policy guidance.
- Denial allows sceptics to argue that the female-condom is just an expensive condom that still requires negotiation. Moreover, it permits ignorance towards the men who don’t like to use male condoms, and prefer female-condoms.
- 'Poverty' and the claim that female-condoms are not affordable are the most publically acceptable reasons for failing to make female-condoms accessible. Yet with more investment in research & development in female condoms and demand creation programmes, this ‘poverty’ is more of a failure to find money for female-condoms.
- Conservatism has led to psychological discomfort for some regarding women taking control of their bodies and their sexuality through the use of the female-condom.
- Failure to scale up long-term female condom programming has resulted in short term fund trials, pilot programmes and studies that have a low quality of programming and frequently leave countries out of stock of female condoms. Large-scale female condom programmes that invests in supply-chain management and demand creation will be able to make a difference.
8. Recommendation for change:
We call upon all policy makers, decision makers and civil society activist to:
One: Create visible global leadership through the collaboration of UNAIDS, UNFPA, and donor and development organizations. Use this global leadership to promote female-condoms as a contraceptive and a prevention method against STIs including HIV. Moreover, work together to raise the female-condom distribution rate and lower the cost.
Two: Incorporate the female-condom within the gender and health policies of UN agencies and international donor agencies. Incorporation of such would significantly boost investment.
Three: Support female-condom research and development because one size fits all does not apply to contraceptives and condoms. By increasing the types of female condoms, demand will increase and that will make the price of the female condom go down.
Four: Create comprehensive long-term integrated female-condom programming. National governments, civil society organizations, and the private sector should collaborate to create programming and thus work to make female condoms available to all women and men.
Five: Reduce the price of female-condoms.
This can achieved by creating demand, investing in new designs, encouraging the not-for profit production of female-condoms, and guarantee quality by transparent pre-qualification procedures.
