The female condom: It's safe, so why won't they wear it?

SUNDAY VISION

By Carol Natukunda

The female condom was introduced in the 1990s. Although a recent survey shows that 80% of the respondents had knowledge about the condom, uptake remains low at a paltry 3%. So why are women reluctant to use the condoms despite the clear advantages? 

If it is not on, it is not safe,” goes the catch phrase that is burning up the airwaves with controversy. You have young women sitting in a salon, talking about everything from looking good to taking charge of their lives through the female condom. 

The campaign follows a 2012 behavioural study carried out by the Uganda Health Marketing Group (UHMG) and the United Nations Population Fund (UNFPA), which reveals that the female condom is unpopular due to several misconceptions.

The study showed that knowledge about female condoms was high (80% of respondents), but uptake remained low (3% of respondents).

“I have never seen a female condom, but even if I saw it, I do not think it is for me. It might make you hate sex altogether. I hear that it makes a lot of noise and makes sex artificial... At least a male one,” said a youth during a focus group discussion in

Katakwi district.

“Most men and women say using a female condom is disgusting,” a community leader in Katakwi interjected.

“A female condom cannot be used by a woman who has a small vaginal opening; you need a big opening if it is to enter,” another woman in Oyam district told the researchers.

According to Dr Ismail Ndifuna, the UNFPA senior programme officer on reproductive health, there were a number of explanations for these uncharitable views.

One explanation is that the first female condoms distributed in Uganda (FC1) were of a different quality than the ones being distributed today.

“They were made of material which many women disliked mainly because it could make squeaking noise during sex. The female condoms which we promote today are the improved FC2, which address the concerns women shared about the first condom,” Ndifuna says. 

trueWhy the new campaign

The sole purpose of the campaign, Ndifuna says, is to dispel the myths surrounding the female condom.

“Just like any new product on the market, women needed to get to know that the female condom exists. Many people were simply not familiar with the female condoms like it is with the male condoms,” he says.

The campaign also comes at a time when, despite heavy investments in HIV prevention in Uganda, the country is still registering an increase in HIV infections. In fact, the HIV prevalence increased from 6.4% in 2006 to 7.3% in 2011, according to the Uganda Demographic Health Survey (UDHS). 

The UDHS report also shows that one in three married Ugandan women (34%) wish to delay childbirth or space their children, but cannot access contraceptives. In addition, only 31% of women and 19% of men reported using a condom during their last sexual intercourse, according to the 2012 AIDS Indicator Survey. 

 “Condoms provide dual protection against sexually transmitted diseases, including HIV and unintended pregnancies,” Ndifuna says. 

“Contraceptive prevalence is low in Uganda and one reason for this is the many myths and misconceptions that are thriving in the communities. This is why it is so important to reach out to people with accurate, reliable information, which is what we are doing with the ‘If it is not on, it is not safe’ campaign,” Ndifuna adds.

Empowerment

From a gender perspective, proponents argue that the female condom has the added advantage that it can be initiated and controlled by women. 

“Promoting the female condom is a way to empower women and improve their sexual and reproductive rights, including a woman’s right to choose when, how often and with whom she has children,” Ndifuna says.  

A female legislator who prefers anonymity, argues that women lack the ability to negotiate for safe sex. “The main issue was the desire for women to be able to tell the man, ‘fine, if you are not going to put on yours, then let us use mine,” she says. 

Lea Bwanika, a behaviour change officer at UHMG agrees: “By the age of 18, six out of 10 women and five out of 10 men are sexually active. Currently, two in 10 girls aged 10 to 19 years are either pregnant or have given birth. Condoms are the only contraceptive method that can protect a person from both sexually transmitted infections and unplanned pregnancies,” he says. 

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Criticism

But critics argue that the campaign is inconclusive. “We are assuming that a female condom will allow the woman to negotiate, which is not true. What are chances that the man will not put the pressure on the woman to remove the condom?” asks Cissy Nakitto, a community health worker in Nabweru sub-county, Wakiso district.

With so many HIV/AIDS prevention messages and myths about contraceptives, some stakeholders are also asking questions: why invest in a product that faces deep scepticism from the people who would use it?

Female condoms, originally introduced in the early 1990s around the globe, have struggled to gain widespread acceptance because they are more expensive and less familiar than male condoms — they are big and baggy and a lot of women simply fear or even feel odd when they use them. 

“It requires one to be guided on how to use them. How do you insert it?” asks Nakitto, adding: “Some people think that by openly telling young people to use condoms, it is a go ahead for them to have sex.”

No need for alarm 

The campaigners insist that they are not telling young people to use condoms, rather they are making them aware about the benefits of making an informed choice. They further stress that there is no evidence to show that condom promotion increases sexual activity. 

“If young people want to engage in sexual relations, they are likely to do so regardless of their knowledge and access to condoms.

But with a condom, they are able to protect themselves. What we advocate is to ensure that young people access age appropriate education and information on sexuality and reproductive health issues, so that they are able to say no to sex when they are not ready and able to protect themselves,” Ndifuna stresses.

He also says before the health ministry and other partners started promoting female condoms, they educated health workers and service providers about how to use them. 

“We still need to educate women about the benefits of the female condom, the most important being that it is the only dual protection method that can be initiated and controlled by women.

We distribute female condoms through a number of civil society partners and we are getting positive feedback. Women and men are curious about the commodity and it moves fast,” he says.

Access to information vital

Prof Vinand Nantulya, the chairperson of the Uganda AIDS Commission, says it is the responsibility of parents, teachers and leaders to provide information and sexuality education, as this will help prevent unplanned pregnancies, sexually transmitted infections and HIV.

He stresses that part of the commission’s HIV prevention strategy is to ensure that everyone — including young people — have access to relevant information. 

“We are saying if you cannot abstain, or be faithful, then use a condom,” Nantulya says, adding that the current campaign was cleared by the Uganda AIDS Commission’s HIV/AIDS message clearing and harmonisation committee. 

Bwanika also stresses that the campaign is about both the male and female condoms among young people aged 18 to 34 years.

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