Recent reports on high abortion and HIV infection rate have reignited the debate on female condom use. The survey released last month showed that there were 464,690 abortions. According to the study by the African Population and Health Research Centre, Rift Valfew people and especially women knew about the female condom.
Some did not even have a clue there existed such a condom. Since 1993, when the first female condom was introduced, debates have ranged on the low uptake by women. The 2003 Kenya Demographic House Survey shows very few women in Kenya have ever used it (only 0.3 percent of women aged 15–49 years).
Some of arguments has been the cumbersome nature and the price — a female condom costs five times more than the male one. The other reason for the low uptake is the belief that traditionally, most women are not in a position to negotiate for safe sex. In a study in 2003 of VCT centres, counsellors reported that most clients believed female condoms were ‘not as good’ as male condoms, and had little or no knowledge or experience of them.
Counsellors’ knowledge, too, was largely based on hearsay and constrained by lack of experience and many had doubts about the product. A search for behaviour change communication materials on the female condom among NGOs revealed that they are virtually nonexistent. When the female condom first hit the market, it was met with intense excitement and curiosity, particularly among potential users, says Suzie Nyambane, a gender activist.
“The invention was nothing short of genius, it could serve as a contraceptive to prevent an unwanted pregnancy, and also protect partners from sexually transmitted diseases, particularly HIV,” she says. Research shows that the female condom is the only product to date, that simultaneously protects a woman from pregnancy and sexually transmitted infections (STIs), including HIV.
However, years down the line, not only is the uptake of the female condom low but it hardly features as a real option for many women. As a result, the duel protection product remains largely under utilised. While advocates for the female condom claim that the low distribution of the product and failure to integrate it in the health system is to blame for the low uptake, potential clients claim that the cost is prohibitive (about Sh200) and the quality poor.
While it is common to find condom dispenser for the male condom, it is rare to find one for the female condom. Further, it would appear that this disparity arises right from the point of manufacture. According to the United Nations Population Fund (UNFPA) in 2005 there were only 13.9 million female condoms in distribution worldwide, and six to nine billion male condoms. At the heart of this low uptake are several issues.
“But it is no secret that power is skewed in favour of men in as far as negotiating for safe sex is concerned. Particularly within the patriarchal African society where men have sex when they want, with whom and as often as they like,” says Suzie Nyambane, a gender activist in Kenya.
According to a researcher with Population Council, most women would rather their male sex partners use condoms. In addition, most men say they would not want their sex partners to put on the female condom. “In fact, most of them show some sort of disdain at the thought of a female condom,” says Christine Njoka who works with an NGO working with sex workers.
Njoka says most women complain about the material. In some instances, the material used in manufacturing the female condom has been deemed to be an overly poor choice. “First, the female condom is a lot more expensive than the male condom. This condom was supposedly meant to empower women, yet we know in Africa, women are poorer than the men,” says Nyambane.
She notes that the female condom is also bulky and difficult to insert. “The female condom is noisy, and it feels like a glove. Women have complained that it com- promises stimulation because it acts as a barrier in every sense,” one time user explains.
“The primary focus ought to improve the product itself, women are not using the female condom because it is unavailable, or that there are fewer female condoms as compared to the male condom, women won’t use the female condom simply because it is noisy, uncomfortable, compromises sexual pleasure and so on,” says Stacy Omollo, a community health worker in Nairobi.
While the male condom is easy to wear, many say that it is not so with the female condom. “In fact, you may have to wear the female condom in anticipation of a sexual encounter, which may or may not happen because perceptions are that the decision to have sex and when to, largely remains the prerogative of men,” she says.
According to Omollo, the female condom has done little, ‘if anything’ to empower women in the bedroom. Nonetheless, Omollo explains that improving the quality and lowering the cost of the female condom will only have addressed part of the problem. “There are many social barriers; cultural is- sues that make people shy away from the female condom should be part of the solution,” she says.
Over the years, improvements have been done on the female condom. According to Population Council, that does research on sexual and reproductive health, the new generation of female condom, known as FC2, has several advantages over the original model and has also been shown to be effective in preventing both pregnancy and STIs, including HIV and Aids.
In a research on the uptake and effective use of female condoms in 2006, the council noted: “In order for female condom efforts to translate into a population-level effect, they must be used widely and consistently; they should augment—not replace—the level of protection achieved by male condoms.”
The Kenya National HIV and Aids Strategic Plan (NACC 2005) and the National Condom Policy and Strategy (MOH/NACC 2001) ac- knowledge that female condoms are a useful female-initiated strategy, and give priority to ensuring adequate, high-quality, national sup- plies and accessibility. Implementation of these policies however is complex. However, it remains to be seen if women, and men will eventually embrace the female condom. - By JOYCE CHIMBI