Comment: Condoms – One size doesn’t fit all

Global Female Condom Day on September 16 provides an opportune moment to reflect critically on what's still needed to increase female condom access and promote wider choice in sexual and reproductive health and rights in South Africa.

From the high rates of sexually transmitted infections and the numbers of unintended pregnancies, especially among young people, it is clear that the game plan for addressing the sexual and reproductive health needs of women and girls needs greater impetus from across sectors. 

Strengthened provision of and access to female condoms will not address all of these issues, but it will make inroads into ensuring that rights are realised and that greater choice is promoted. 

Female condoms have been in the country since 1998. Since then, distribution has grown and increased demand has lowered the price of the initial brand. 

However, the demand for female condoms is greater than the government has been able to supply. 

Women, heterosexual couples and, increasingly, men who have sex with men and who want to use female condoms report they are not able to find them in their communities. 

Encouragingly, recent policy developments and procurement tenders show that the government is prioritising the need to increase the availability of female condoms. 

The national strategic plan on HIV, sexually transmitted infections and tuberculosis, as well as the new fertility planning and contraception policy, both support enhanced female condom use and promote the need for reframing contraception and fertility planning with specific attention given to "dual protection" from unintended pregnancy and sexually transmitted infections. 

The plan also emphasises the increased procurement of female condoms up to a record high of 25-million units a year by 2016. 

New condoms available 
These policy developments coincide with an increase in the number of available product designs. 

For the past 15 years, only one type of female condom has been available and distributed through the public sector – the first-generation FC1, which was later replaced by the second-generation FC2. 

Today, three different types are, or will soon be, available in South Africa: FC2, Cupid and V (the Woman's Condom). 

V received the South African Bureau of Standards certification mark in May and will undergo test marketing in different sectors and distribution channels in 2014. 

The key to ensuring that greater strides are made to address the sexual and reproductive health and rights of women and girls is to ensure that they have greater choice in their decision-making. 

And although this is unfortunately not the reality for many women in South Africa, we are at least able to extend this to the products they may choose within the condom landscape. 

It is only in safeguarding the rights of all women – young and old, HIV positive and negative, married or single, and of diverse sexual and gender orientations – that choice becomes meaningful. 

The focus of Global Female Condom Day has also brought into question the need for female condoms when male condoms are largely available, acceptable and less expensive than female condoms. Simply stated, female condoms offer an additional option for protection when men will not or cannot use male condoms. 

More choice = safer sex
They are a complement to male condoms, not a replacement. 

A number of studies suggest that when female condoms are added to the method mix alongside male condoms levels of protected sex increase. In other words, you see more protected sex acts when both types of condoms are offered than through male condom distribution alone. Increasingly, female condoms are also used by couples engaging in anal sex.

But the female condom is not only about disease and pregnancy avoidance – it's also a way to enhance sexual pleasure, intimacy and conversation. Certain types of female condoms are made of a thin material that warms up to body temperature, helping couples to feel closer.

Some men also enjoy the fact that female condoms are not too tight or constricting and do not dull the sensation of sex. 

Marlene Wasserman (also known as Dr Eve), a female condom ambassador and well-known sexologist, says that, in her experience, women are pleasantly surprised by the ease of use and pleasurable feeling from female condoms. 

Dr Ashraf Grimwood, chief executive of public benefit organisation Kheth'Impilo, echoes these sentiments and adds: "They may also provide an opportunity to proactively engage men to talk about sex and desire with their partner."

In a country as complex as South Africa and one that celebrates and recognises the role of women, female condoms – as the only currently available female-initiated barrier method that provides dual protection – should be an integral part of the basket of sexual and reproductive health commodities. 

Given South Africa's evidence of poor women's health, with girls bearing the burden of unintended pregnancy and increasing rates of HIV infection and maternal mortality, it makes "people sense" for the government to expand its investment in these supplies. In the long run lives will be saved, women will be empowered and men should be engaged. 

According to Professor Carol Thomas, director of female health practice WomanSpace and a female condom ambassador: "You cannot compare the value of the price of a male condom with a female condom. A female condom offers women the ability to initiate their own protection from HIV and pregnancy and the potential to increase their sexual pleasure. It is a big win!"

It is clear that female condoms are in increased demand and provide a great option to improve in particular women's health. 

What is left is for the government to provide stewardship and lead in procuring the numbers and variety to ensure wide distribution across all the provinces. 

Let's hope that this time next year we will have another reason to celebrate. 

Kevin Osborne is health organisation Path's country director in South Africa; Marion Stevens is the co-ordinator of reproductive rights advocacy group Wish Associates; and Penny Parenzee is the Wish Associates treasurer and researcher



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