Why female condoms should be accessible for all
Let the facts speak for themselves. All facts and figures will take away any existing prejudices about female condoms: 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 1.8 million deaths in 2010.
- Investment in primary prevention will reduce the number of new HIV infections, and thus 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 how many 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
- Long experience shows that increasing the choice of family planning methods leads to increased uptake and more consistent and continued contraceptive use
- Throughout the developing world an individual has easier access to anti-retroviral treatment than to female condoms.
- For every two people who are put onto anti-retrovirals, another five new HIV infections occur.
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 the age of 5 die annually, 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 215 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
2.7 million people were infected with HIV in 2010. Actions to prevent HIV are 28 times more cost effective than treatment. Female and male condoms are currently the only product available to prevent sexually-transmitted HIV. Yet on average, just 4.6 condoms are available per year to each African man.
3. Availability of female condoms, the facts:
- From 1993 to 2005 the only female condom manufacturer was the Female Health Company.
- FC1 is replaced by FC2.
- The FC1, FC2 and the Cupid Condom are WHO pre-qualified
- 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 available via the private sector in China, and is in the process of WHO pre qualification. The Woman's Condom will be more widely available in the coming years.
- Only 1 per cent of all condoms distributed worldwide are female condoms.
4. 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.
5. Current costs 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.
- A study found that a Washington DC female condom program has saved over 8 million dollar in health costs in three years.
6. 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 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 female condoms.
- 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.
7. Recommendation for change:
We call upon all policy makers, decision makers and civil society activists 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 of female condoms.
Two: Incorporate female condoms 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 available, demand will increase, making the price of female condoms 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 for all.
Five: Reduce the price of female condoms. This can be 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.