We are deeply disturbed by Time magazine’s article, “The Battle in Uganda Over Female Condoms,” which disparages the female condom without grounds. It is irresponsible and out of touch with the realities of women’s lives to suggest that the only available woman-initiated method of HIV prevention, the female condom, should not be top priority. Women account for half of the world’s population, and more than 60 percent of people living with HIV in the world’s most-affected region, sub-Saharan Africa. We are not a niche market.
Time’s main critiques of the female condom are its price, the learning curve involved in using female condoms correctly, and what the article describes as “deep skepticism from the people who would use it.” The article also suggests that providing women with choices may lower the effectiveness of programs. However, if we have learned anything from year and years of investments in family planning programs it is that adding even one method to available choices dramatically increases usage, and therefore protection.
Our experiences with women all over the have shown just the opposite of skepticism when it comes to the female condoms. We have seen that when female condoms are appropriately introduced, women use them and demand more of them. For example, in Cameroun, we work with the Society for Women and AIDS in Africa (SWAAC), which has been distributing free female condoms since 2004. SWAAC has built a strong and steadily increasing demand, in both rural and urban settings in just a few short years. Even in isolated areas, the demand is so pressing that traditional healers, mostly older men, have trekked through the jungle for days to distribute the condoms. Yes, you have read that right: older, traditional men walking for days to give away female condoms. SWAAC biggest challenge now is keeping enough female condoms in stock to meet the demand. To hear more about our experience meeting these men, click here.
To point about the learning curve, yes, women require education and support to learn to use female condoms correctly. In fact, in that respect female condoms are like nearly every other method of HIV prevention and contraception: you have to be taught how to use these tools. The article goes on to criticize female condoms for being “big and baggy.” Could it be because they are designed to protect a part of the anatomy that is not small? Yes, it is also the part of the anatomy that births babies so let’s just say it takes a sizeable piece of plastic to ensure full coverage. It is true that many women are not yet as familiar or comfortable with female condoms as they are with male condoms, which is understandable. Only one female condom is distributed for every 700 male condoms so most women have never seen a female condom, much less had the opportunity to use one. How about we agree to give every woman a chance to use a female condom and let her decide for herself if they are purchase worth making?
Finally, Time critiques the cost-effectiveness of female condoms. Really what they mean, however, is the cost. When used correctly, female condoms have been shown to reduce the likelihood of contracting a sexually transmitted infection (STI) or becoming pregnant to less than 3 percent, so the issue isn’t effectiveness, it’s cost. But it true, a female condom will run you $2.50-$5 whereas a male condom costs only $0.50-$1. However, what policymakers need to understand is that for many women it isn’t a simple either/or choice that can be made on the basis of cost. When a woman cannot convince her partner to wear a male condom either because he is violent, intoxicated, ignorant, or because he just doesn’t want to, the female condom provides her with essential protection she can initiate herself. Rather than dismissing the utility of female condoms because their cost, we need to be working to reduce manufacturing and distribution costs.
In March, the Food and Drug Administration approved a new and improved model of female condom, which is thinner and lighter and is expected to be up 30 percent cheaper. As more women learn about and become comfortable with female condoms, we expect a steadily increasing demand and further drops in price. This is good news, and we should be advocating for the widespread use and distribution of female condoms at every opportunity.
For more information on female condoms, read Saving Lives Now: Female Condoms and the Role of U.S. Foreign Aid (link auto-downloads a PDF) produced by CHANGE, and watch our video about female condom demand and distribution.