The female condom: the international denial of a strong potential.

The female condom: the international denial of a strong potential.

The female condom has received surprisingly little serious attention since its invention in 1984 (and Food and Drug Administration approval in 1993). Given the numbers of women with HIV globally, international support for women's reproductive and sexual health and rights and the empowerment of women, and, not least, due to the demand expressed by users, one would have expected the female condom to be widely accessible 16 years after it first appeared. This expectation has not materialised; instead, the female condom has been marginalised in the international response to HIV. This paper asks why and analyses the views and actions of users, providers, national governments and international public policymakers, using an analytical framework specifically designed to evaluate access to new health technologies in poor countries. The authors argue that universal access to female condoms is not primarily hampered by obstacles on the users' side, as is often alleged, nor by unwilling governments in developing countries, but that acceptability of the female condom is problematic mainly at the international policy level. This view is based on an extensive review of the literature, interviews with representatives of UNAIDS, UNFPA and other organisations, and a series of observations made during the International AIDS Conference in Mexico in August 2008.

No stone is unturned and no one escapes through unscathed in this searing analysis of the failure of the female condom to gain traction as a woman-initiated method for HIV prevention. Among the critical contributing factors are: minimal investment in research and development by global public policy makers, resultant price monopolies that see the price of the female condom at least 25 times that of the male condom, ambivalence on the part of WHO to recommend washing and reuse, lack of active promotion by UNAIDS (in contrast to male circumcision) contributing to low demand, stock-outs, underproduction with no economies of scale, and frustrated demand. Marginalisation of the female condom as a new prevention technology began shortly after its introduction 16 years ago. Much could be done to address the points raised in this critique if there were the political will at all levels to do so. One small thing that you the reader can do is to always use the phrase ‘male and female condoms’ rather than simply ‘male condoms’ or ‘condoms’ when you are referring to barrier protection. However, what is really needed now is active reconsideration of the strategies that have led to the female condom being unavailable and unaffordable despite acceptability in studies in a variety of cultural settings.