Mail & Guardian, High cost caps use of female condom, 3 August 2004

It's bigger and uglier than its male counterpart. Sometimes it even makes a noise. But many South African women who have used it say they prefer it. Ten years after it was first introduced to South Africa, the female condom, or femidom, is gaining popularity in the country, but cost is limiting its use.

The government buys the female condom at about R7 a unit, which is at least 10 times the price of a male condom. This means fewer are bought by the government and therefore available to the public. The government provides them to about 200 targeted family planning centres and clinics in all the country's nine provinces, to complement the male condom.

This explains why some government clinics have no female condoms and others are moving only modest supplies, despite a huge need among women for contraceptive protection.

Nurse Adelaide Ratsibe at a health clinic in Langa near Cape Town says the clinic gives about 100 female condoms a week to members of the community. She says they are becoming more popular, but there are complaints from some that they are "too messy", noisy and difficult to use.

"Sometimes the woman has to hold them in place before the man enters for sex, and sometimes it is painful," Ratsibe says.

The female condom is a lubricated polyurethane sheath about 17cm long with a ring on either end. The woman inserts it into her vagina before sex and it protects her from sexually transmitted infections (STIs) including HIV, as well as unplanned pregnancy. It is strong and flexible, can be inserted up to eight hours before intercourse and does not necessarily have to be removed immediately after ejaculation. After removal, it can be washed, dried, relubricated, disinfected and used again.

The female condom is unique in that it is the only form of contraception that women themselves can control that protects them from HIV/Aids and other STIs. This makes it valuable in communities where there is resistance among men to wearing the male condom. International health bodies promote it as an effective method of preventing the spread of HIV/Aids.

A study done by the reproductive health research unit (RHRU) at the University of the Witwatersrand for the South African government has demonstrated its popularity.

"Most users [88%] reported that readily available female condoms meant that they were using more protection," says Mmbatho Mqhayi, a researcher at the RHRU.

"Others said that the female condom's structure seemed more reliable and safer. Also, since it [has] to be inserted in advance, it allows the woman to take responsibility for her own protection. Since she inserts it herself, she knows she's safe."

"Women are desperate for it. I know they are. I hear it all the time. [In places like] Crossroads, Khayelitsha, Langa, Kwazulu-Natal, it's the same thing. SADC [Southern African Development Community] countries included. The women are saying, let us give it a chance," says Katy Pepper, the Africa programmes director for the Female Health Foundation, an NGO that aims to improve women's protection from STIs such as HIV/Aids.

Pepper tells of a woman from Khayelitsha, a low-income suburb near Cape Town, who asked for the female condom in case of rape. She told Pepper that she could not leave her house before 8pm at night, either for ablutions or to fetch water, such was her fear of a sexual assault. At least with the female condom she would be protected from HIV.

"Use of the female condom does not solve the underlying problem of violence but it protects women from infection," says Pepper, who has heard similar stories from other studies in Africa. She says that programmes to provide the female condom in SADC countries are quietly gathering momentum.

"Botswana has a government programme which is quite active. Zimbabwe has a very good social marketing programme through the NGO sector but no government support. Zambia is just getting off the ground but there is a huge demand for it there. Twenty thousand to 30 000 women signed a petition calling for it in Zambia," she says.

Malawi has a government pilot site where it is distributing the female condom and Lesotho and Swaziland are poised to start programmes, according to Pepper. Most of the funding for these programmes comes from the United Nations Population Fund and major donors such as the United Nations Joint Programme on HIV/Aids.

In many cases, initial programmes to introduce people to the female condom lapsed because there was not enough support and training provided with the commodities.

Pepper is frustrated at the slow pace in which the female condom is distributed. She believes that strong marketing of the female condom, coupled with good support -- as has happened in Brazil -- would help. There billboards and films with popular actresses were used to advertise it.

"Is it bothersome? It's not so much bothersome as intimate. Because it is intrusive, it is more difficult to get used to. It's just the same as a tampon. It's introducing something inside the body," she says.

Currently about 30 multinational companies in Southern Africa are interested in introducing the female condom to their work force. Among them is mining company Impala Platinum, which is poised to pilot the femidom among 3 000 miners from one shaft on its Rustenburg mine.

Webster Diale, who heads Impala Platinum's HIV programmes, says the high rate of HIV infection poses a business risk and that the company would like to offer its staff a range of contraceptive options. He says it has already provided female condoms to women in the company, but now wants to teach men about the femidom.

"The Women's Health Foundation came up with the idea to promote the female condom in a male-dominated setting to make it easier for men to get used to it," he says.

Diale says it could be useful given the resistance among some men to wearing a male condom. The RHRU will be involved in doing research on the programme.

Female condoms are also gaining ground among commercial sex workers, partly because they can be fitted in advance. Vivienne Lalu, the training coordinator of the Sex Workers' Education and Advocacy Task Force in Cape Town, says the task force explains to sex workers that the female condom does not work perfectly the first time; it needs practice.

"Some swear by it; others don't," she says. "They complain that it sounds like a shopping bag, but that is only if you insert it immediately before intercourse. If you put it on a while before, the warmth of the vagina heats the polyurethane, which makes it stick to the vagina wall and then it doesn't make a noise."

"After four uses, women say they have no more difficulty with it. You can put it on up to eight hours before sex. Many commercial sex workers say that their clients don't even notice that they are wearing them. And it is less restrictive for the man," says Pepper.

Mags Beksinska, executive director of the RHRU in the Kwazulu-Natal province, says the government is introducing the female condom to South Africa in a phased way, as it fears running out of stock.

She says research is under way to produce a cheaper female condom that will make it possible to distribute more of them. Pilot programmes are testing a female condom made out of cheaper material, synthetic latex, which is the same substance used to make gloves for surgeons.Repeated attempts to get comment from the relevant government officials over the female condom failed. -- IPS




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