"…Capital gets its first Female Condom Machine – an effective step towards women's emancipation…freedom of protection, freedom from STDs and, above all, freedom from embarrassment."
– Times of India, "Female condoms – freedom at last?"
Most would consider female condom vending machines in bars and night clubs a positive step toward increased access to safe sex technologies. But others would question the professed "emancipatory" qualities of the female condom. Over the last six months, the Center for Health and Gender Equity has interviewed experts involved in various aspects of global female condom availability, and several expressed skepticism regarding female condoms as a "liberating" tool for women.
They have reason to be skeptical. With roughly one female condom available for every 100 women in the developing world, and only five cents spent on female condom procurement for every U.S. dollar spent on male condom procurement, female condoms will not be freeing women from the risk of HIV infection, unintended pregnancy, or male-dependant prevention methods any time soon.
Lack of product investment, however, cannot be confused with product failure.
As the host of the Prevention Now! campaign, CHANGE regularly receives emails from organizations abroad requesting supplies of female condoms. Rather than suggesting product failure, these requests are evidence that an obvious need is not being met. Why do these organizations want female condoms?
- Female condoms are the only approved and available HIV prevention method designed for women to initiate and control.
- Studies have shown that making female condoms available in the same market as male condoms increases the overall number of protected sex acts and reduces the rate of STIs.
- In situations where one or both partners refuse to use a male condom, female condoms provide an additional, and sometimes preferred, prevention option.
- Female condoms can increase sexual pleasure: the non-latex products can be used with oil-based lubricants and massage oils; the fact that they can be inserted up to eight hours prior to intercourse means their use does not have to interrupt foreplay; and men have reported that its one-size-fits-all design increases pleasure and some women have found that the outer ring adds to their sexual stimulation.
If the problem is not the product itself, what will it take to ensure that female condoms provide women with freedom of self-protection as described in the Times of India article? This is one of several questions CHANGE sets out to answer in its new publication Saving Lives Now: Female Condoms and the Role of U.S. Foreign Aid. In particular, Saving Lives Now seeks to answer what more the U.S. government, as the largest donor to the global fight against HIV/AIDS and international contraceptive and condom supplies, should do to ensure that female condoms reach their full prevention potential.
Saving Lives Now does not assert that increased global access to female condoms alone will simultaneously empower the world's women to take control of their sexuality and end the global AIDS crisis. As the report points out, female condoms are not the perfect method for everyone. But as we develop programs that provide women with information about female condoms, how they work, and how to negotiate their use, we take an important step toward guaranteeing comprehensive, good quality reproductive and sexual health services that foster human rights, empowerment, and a full range of prevention choices for every woman.
Saving Lives Now documents the political and financial roadblocks preventing female condoms from achieving their full potential as a tool for women's empowerment and a method for curbing HIV infections.
For example, since 2002 USAID missions have been able to access male and female condoms for HIV prevention at no cost to mission budgets. However, since 2006 U.S.-funded HIV prevention programs in the 15 PEPFAR focus countries have not been eligible for no cost male and female condoms. Given that female condoms can cost as much as U.S. $0.80 per unit compared to male condoms that cost roughly U.S. $0.035 per unit, there is a severe disincentive for missions within PEPFAR focus countries–the countries most heavily impacted by HIV–to incorporate the higher-priced female condom into prevention programs.
Successful female condom marketing and programming is essential to the product's acceptability among users. Experts interviewed for the report acknowledge that while PEPFAR has provided essential support to combating global AIDS, the program's prevention policies have stifled efforts to normalize female condoms. While the U.S. has increased procurements of female condoms nearly eight fold since 2003, PEPFAR's emphasis on abstinence and fidelity has divested programs of funds necessary to market and promote female condoms to the general public. As a result, female condoms are being shipped to countries but not used.
While male condoms are familiar to large portions of the general public, female condoms are not, and their acceptability will remain tragically low as long as this is the case. U.S. global HIV prevention policy is not simply siphoning money away from programming and advertising for female condoms. It stigmatizes their use by targeting messages around male and female condoms to sex workers, men who have sex with men and intravenous drug users–already highly stigmatized populations in many societies–while excluding condoms from prevention messages aimed at youth and married couples.
The freedom to make decisions about safe sex remains elusive for the majority of the world's women. Female condoms will not and cannot be used by everyone, but for some they are the ticket to safe sexual practices. However, until national governments and donors, particularly the U.S., remove restrictive and ideologically driven policies preventing access to female condoms, the freedom to make such decisions will continue to evade women. Eliminating obstacles within prevention policies is only the first step. Donors and governments must demonstrate increased political will for providing women with access to an HIV prevention method designed for their use by significantly increasing financial investments for female condom procurement, programming and reliable distribution networks. The cost of ensuring that women and their partners enjoy the benefits of female condoms greatly exceeds current commitments, but the price of inaction, paid in lost or debilitated lives, is many times more costly.