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Why Don’t More People Use Female Condoms?

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I first heard about the female condom in 2006. I was in Seattle to see what was happening at the Bill and Melinda Gates Foundation. One of the many impressive projects it was supporting was at PATH, a non-profit organization that was developing and promoting a new female condom. The sad, age-old reason: the health of millions of women around the world is threatened by irresponsible men.

Worldwide, about 33 million people have HIV/AIDS and half of them are women. Over three hundred thousand preventable sexually transmitted infections (STIs) are spread globally each year. It is well-established that condoms can prevent the spread of HIV and other STIs. But male condoms are vastly underused, especially in the developing world, where about 3 out of every 4 cases of HIV/AIDS is spread through heterosexual contact, mostly within marriage or long-term relationships. In the United States, almost 1 in 3 new infections occurs through high-risk heterosexual sex (sex with a partner with HIV or at high risk for HIV). Since men do not reliably use condoms, scientists developed one that can be worn by women.

The FC Female Condom – effective in preventing STIs and pregnancy – was approved by the FDA in 1993. The first version consisted of a soft but strong polyurethane sheath about the same length as a male condom but with flexible rings at each end. One ring was at the closed end of the sheath and was used for insertion and to help anchor the condom in place. The other end remained outside the vagina and partially covered the external genitalia (vulva). That version didn’t catch on in the U.S. – partly because it was more expensive (up to $15 for a 3-pack) and noisier than the male condom. A representative of the company told me today that a newer, less expensive version, the FC2, ($6.40 for a 3-pack retail, 82 cents a condom for the public sector) was approved in March, 2009. Right now, it is only available commercially in the U.S. at CVS stores in Washington, D.C. but it is being increasingly distributed in the public sector (e.g., clinics, health departments, NGOs). The company’s main distribution is in developing countries via organizations like UNAIDS and UNFPA. PATH – the organization I visited in Seattle – has created its own version of the female condom and is introducing the product into low-resource settings.

Worldwide use of the female condom has slowly increased since 2005, when only 14 million were available. That year, the United National Population Fund (UNFPA) launched the Global Female Condom Initiative and by 2008 female condom distribution reached 35 million in 93 countries – still only a fraction of the more than 10 billion male condoms distributed worldwide every year.

One of the major hurdles to its acceptance in developing countries is that the female condom was stigmatized by its initial use to prevent infection among sex workers – even though it did lower the risk of STIs. But in 2005, a United Nations initiative successfully marketed it as a contraceptive rather than primarily linking it to HIV/STIs prevention. In Zimbabwe, the country where the programs were the most successful, most men were ok with the contraception reason and use of the female condom jumped from one million to over 5 million by 2008.

The female condom can help women gain control over their own bodies and protect themselves from infection and death – and it needs more political, social, and financial support. As Patricia Coffey, MPH, PhD, Senior Program Officer at PATH told me, there needs to be “increased investment for 1) research and development, 2) market development in low-resource settings and 3) increased advocacy for inclusion of female condoms into family planning and HIV/STI prevention and treatment programs worldwide.”

Marketing geniuses routinely sell us all sorts of things we don’t need. Here’s a product the world desperately needs. Does anybody out there have any suggestions about how we can solve the barrier to entry of this highly effective barrier to entry?

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