Female Condom Access, Use Low in Asia-Pacific

Despite being
available in Asia as early as 1995, the female condom remains surprisingly
underused in the region. While this can be said of global north countries
as well, failed attempts to promote higher usages in countries like
Vietnam, Thailand and Indonesia are a reflection of narrowly-perceived
target groups, high costs and lack of political will. 

Available in Europe since 1992 and approved by the US Food and Drug

in 1993, the female condom is currently used in public health programs
in 108
and is
commercially marketed directly to consumers in ten countries. Yet, for
the Asia-Pacific region, in ten years since its introduction, less than 1 million
female condoms

had been distributed amongst a population of close to 1 billion women
of reproductive age. At the 7th
International Congress on AIDS in Asia and the Pacific
, held in Japan in 2005, it was recognized
that both demand and political will needs to be built. As is a pertinent
problem around the globe, this demand must be met by access.

So the question
remains: Are low rates of usage a problem of access, demand or both?
Demand may be affected by problems with the condom itself. Some women
cite difficulties in insertion, the size of the condom and its visual
appearance as well as challenges in negotiating with male partners as
reasons to explain its lack of acceptability. On the other hand, while
there has been a range of promotional programs to increase support and
use for the female condom in such countries as South
, Ghana, and Brazil, with support from UNAIDS and Governments,
this uptake has not been matched in the Asia region.

Rather, in
countries like Thailand and Vietnam the focus has largely been on female
sex workers, this approach already creating stigma around the female
condom’s use. In a trial conducted in Vietnam in 2000, under a joint UNAIDS and World
Health Organization initiative
481 women in districts around Hanoi were invited to use the female condom.
Among the 428 women who actually ended up using the condom, more than
half affirmed that female condoms were acceptable and 230 said they
would continue to use them if they were provided free of charge, or
if they could buy them at a suitable price. Unfortunately, one of the
study’s recommendations was giving priority to sex workers and women
with STIs in order to help them prevent the spread of STIs and HIV/AIDS,
ignoring the interests of all women who might choose to use the female
condom if it was more readily available. In Vietnam, where sexual violence
including marital rape remains a pressing issue, the value of the female
condom for women’s ability to protect themselves against unwanted
pregnancy should not be understated.

Similarly in
other countries, distribution and cost are blamed for low female condom
use. In Indonesia, which Family
Health International

ranks the lowest in terms of condom usage in Asia, the strong patriarchal
culture and sporadic approach to promoting condoms are blamed for the
low usage. In an attempt to address rising rates of HIV in Indonesia, the government ran a trial
of female condoms in selected areas of Papua

in August 2006. In response to the initial success, the government launched
a national female condom program in February 2007. Yet, six months later,
local groups in the Papuan provincial capital, Jayapura, criticized
the poor distribution and high cost of the female condoms at 15,000
rupiahs, or US$1.60 for a pack of two.

some activists in Indonesia have criticized the female
condom, arguing that it is "once again, putting the burden on women."
Rather than seeing it as a tool for empowerment, these activists fear
women will be blamed when HIV infections remain uncontrolled in ten
years time. They also insist that campaigns continue to call on men
not to have unsafe sex with sex workers rather sending the message that
men should not have sex with their wives without using condoms.  

Of course,
the higher price of the female condom over the male condom remains an
obstacle. Though the newer FDA approved version of the female condom
is 30 percent less expensive than its predecessor, prices still ranging
from US$1.40 to US$2.10 for consumers, considerably higher than the
male condom and out of the price range for many women. However, economies of scale suggest that the price will decrease
as demand increases, which will allowing the female condom to be a tool
for empowerment that it was initially seen to be. Further research must
also be undertaken. In 2004, the Guttmacher
, calling
for a renewed commitment to research on the acceptability and implementation
of female condom programs, highlighted the short-term nature of many
studies on female condom use, with only a few studies tracking use beyond
six months. 

The female
condom gives women more options and empowers them to have control over
their own lives. Interestingly, some studies have revealed that female condom has
opened the door for women to discuss sex with their partners. With global
efforts, including advocacy, program scale-up, public and private sector
investment, to overcome some of the negative perceptions and the very
real barriers to accessing the female condom, such as costs, women in
Asia can join others around the world who currently benefit from its

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  • http://musicfandata.blogspot.com/ invalid-0

    Thanks for the tutorial, it was very helpful.

  • invalid-0

    Ramona, Many thanks for the fine piece on female condoms in the A/P. I sent the email copied below today to colleagues in several UN and NGO agencies. I’d like to share it with you and others via this blog.

    Dear colleagues,

    In case any of you missed the excellent attached RH Reality Check piece on FC which focuses on Asia Pacific, here it is: http://rhrealitycheck.org/blog/2009/02/16/female-condom-access-use-low-asiapacific

    The article focuses on many of the FC concerns we have been discussing for years:

    • The deleterious effects of condom stigma—it’s real, it’s multifaceted and it undermines the success of male and female condom programming everywhere

    • Issues of female condom “high cost” (alas, once again confusing the questions of price and cost). Why does it seem that just for female condoms the world forgets that all of the HIV prevention interventions are SUBSIDIZED by donors and governments! Only a small percentage of FCs reach women and men in developing countries via the commercial sector; the vast majority are accessed via public sector programs that are subsidized. Many folks lament that the “FC costs too much” when in fact they meet very important, unique needs: it is a niche product that serves an underserved group and is never promoted to compete with male condoms.

    • Married women are at high risk: in many countries including Thailand, Cambodia, Vietnam among others, married women and their babies are at high risk and little is being done to address their needs in a focused and strategic way. I’ve seen first-hand the situation in Cambodia in 2005 where FC condoms were marginalized even as official data showed that women and their babies represented more than 40 per cent of the new HIV infections. PSI was not permitted to include FCs in its line of “OK” family planning products thus missing a valuable “dual protection” opportunity. According to DKT social marketing data for 2007, PSI/Cambodia sold in that year 28.8 million male condoms and 5,924 female condoms. Female condoms are not found on the PSI/Cambodia webpage. Nor are they mentioned on the PSI/Vietnam webpage even as PSI marketed in that country 76.6 million male condoms and only 5,000 female condoms.

    • Ref the Guttmacher report, the continuing tendency to support limited, short-term research studies and projects in relatively few countries.

    We would all like to see this regrettable situation change. As most of you know, the UNFPA is currently conducting a survey of more than 60 development partners (international agencies including SRH and social marketing) to learn more about their support for comprehensive male and female condom programming (CCP) in developing countries. The results should shed some light on the state of support for CCP in each low- and middle income country.

    Moving on from there, among the activities I hope we see coming soon is the development of a strategic global communications strategy for FCs that will address the deficiencies highlighted by the attached article and above.

    Best, Patrick

    Patrick Friel, PhD
    Reproductive Health HIV/AIDS Consultancy
    Tel 1-212-972-0912
    Mob 1-917-902-4240

  • http://www.majon.com/safeannounce invalid-0

    I wonder if the female condom will really ever become that popular amongst women. There are other easier ways of prohibiting birth like birth control pills of varying types. This seems so much easier that messing around with something weird like that.

  • http://www.scalewatcher.co.uk invalid-0

    I don’t know if female condoms are so important if we have condoms for males. Maybe I don’t understand the idea….

  • http://www.theleukemiaguide.com/history-of-leukemia invalid-0

    Ramona, I think it is because of lack of awareness on female condom. But, I agree with James, male condom are sufficient. I also don’t understand the idea of having female condom.

  • http://www.theleukemiaguide.com/history-of-leukemia invalid-0

    Also, it looks it is very difficult to wear. See this http://www.youtube.com/watch?v=mnyC_v0-DQ4