Hunt is on for elusive female condom
More than a decade after it was introduced, the humble female oondom remains a mystery to most South African women.
Now a small NGO is building a case against the government to force the health department to share information about what it has done to bring the female condom into the light.
The female condom is the only female-initiated method that offers protection against both pregnancy and sexually-transmitted diseases.
And although numerous studies have shown high acceptability of the product, irregular supply has prevented it from becoming mainstream.
In South Africa questions have been raised about the tender process. Condom importers say that tender documents favour one company, the United States-based Female Health Company, which supplies the most commonly available female condom, the FC2.
Last week The Times reported that local condom importer Black Circle had sent lawyers’ letters to the minister of health, demanding a review of the specifications for new tenders. This is nothing new to the Thohoyandou Victim Empowerment Programme (TVEP), which has been working since January on a national inquiry into the procurement, distribution and social marketing of the female condom in South Africa.
TVEP advocacy officer Tian Johnson is incensed by what he sees as the government’s lack of transparency and engagement on the issue. “Why isn’t there a clear, easy flow of information?” he asked. Johnson said the report should be complete by the end of the year and that the group will ask the government for a “plan of action” for improving access to the female condom.
“We will make recommendations to government based on that report, which can be backed up by legal action if they are not taken up.” South Africa is one of the largest distributors of female condoms in the world, but the numbers are very low—about 3.5-million were distributed last year.
In contrast, more than 350-million male condoms are distributed annually. Pricing is certainly a barrier to increasing the number of female condoms in circulation. Male condoms cost about R1 each, whereas female condoms cost between R6 and R7 a piece. And resistance to the method goes further than that.
“Globally there was always this concern: What if people prefer this method and it’s more expensive?” asked Mags Beksinska, technical adviser at the maternal, adolescent and child health research cluster at Wits University. But advocates say that in a country with high HIV prevalence, it’s a programme worth pursuing.
‘Research has shown that if you add female condoms to a male condom programme, you get more condom users overall,” said Beksinska. One way to bring down the price of condoms is to increase competition by upping the number of products on the market.
A wider variety of products could also increase acceptability of the female condom to women. But because only one product—the FC2—is approved for bulk buying by the World Health Organisation (WHO), there is little in the way of choice or competition. Different types of female condoms are slowly coming on to the market.
The Reddy condom, which has a sponge instead of an inner ring, has taken off in India and parts of Europe, and a new type of female condom known as the Path is being tested in South Africa. But these variants are unlikely to get picked up by donors and governments unless they have a WHO stamp of approval. Until then, only an increase in demand will bring down prices. But irregular supply stymies demand for the product.
Dave Nowitz, product marketing director at the Society for Family Health (SFH), said supply chain management was a key problem when the SFH ran its social marketing programmes for the female condom. “Every time we seemed to get things going, we’d run out of stock,” said Nowitz. This discouraged women from sticking with the product.
“If you’re going to do it, you’ve got to do it properly and that means selling them at a reasonable price and making sure there is an ongoing supply,” he said.
Braiding hair, keeping safe
In Zimbabwe a novel social marketing programme run by Population Services International (PSI) is bringing messages about the female condom to women in a secure setting—hair salons. “There’s a trust relationship between clients and the hairdresser.
They are more open to what you say,” said Tarisa Wenzira, one of the 2 000 hairdressers PSI trained to demonstrate the correct use of female condoms and answer clients’ questions about them.
Wenzira said she talks to her clients while braiding their hair. Her clients, who often have to stay in their chairs for a few hours, are a captive audience. “I’ll say: ‘Have you heard about Care?’ and they’ll ask: ‘What is Care?’ Then you start explaining,” she said.
Care is the brand of female condom supplied to hairdressers by PSI. The hairdressers sell the discreetly packaged female condoms, which are often mistaken for soap, at their salons for a small profit.
Wenzira makes about R30 each month this way, enough to buy a few groceries for her family. Last year more than a million female condoms were distributed in the country through the programme. According to PSI, there has been a 10% decline in HIV prevalence among adults in Zimbabwe in the past four years.