The big questions: how does it feel and what does it cost?

No one wants to use a product that feels uncomfortable, so a variety of studies have been done on how users and their partners feel about female condoms. The results of this research have varied from place to place and from study to study, but the overall finding is that the female condom is acceptable to many women and men. This is especially true when they are already familiar with the male condom. While many men preferred the male condom, few reported finding the female condom uncomfortable.

In one large study of almost 600 urban and rural women in South Africa, 84% of the women said they would use the female condom in future. 47% of these same women said their partners either liked it or had no problems with it.

Practice makes it easier

One overall finding of testing is that a little practice makes a great difference in how women feel about female condoms. Package instructions suggest women try it three times before deciding whether they like it or not. The most frequent complaint about the condoms themselves was that they seem too long and a little difficult to insert the first time. Some women reported discomfort with the rings. These problems were reduced or solved by repeated use.

Not just physical

Acceptability does not only depend on physical feeling. In several studies, it was found that women who feared that they were at a high risk of STD infection seemed more inclined to accept the female condom. A group of female sex workers tested in France said they felt reassured with a female condom because they knew that polyurethane is stronger than latex and therefore felt confident there would be no breakage. At the same time, another group of sex workers in Zimbabwe worried that the look of the part of the female condom that stays outside their vagina might "turn off" their clients.

The right price

Even if more manufacturers enter the market, the female condom will probably always cost more to produce than the male condom. Polyurethane is more expensive than latex, and more of it is used. As well, the manufacturing process itself is more costly even when large numbers are being produced.

When left entirely to commercial markets, the price of female condoms in developing countries is between US $2 and $3. This is much too high for the populations who are most likely to benefit from it. A study in Zimbabwe found that women were prepared to pay a maximum of 25 Zimbabwe cents (US $0.03) for female condoms. In comparison, male condoms were sold at around 15 Zimbabwe cents.

Recently, UNAIDS surveyed organizations in developing countries in order to estimate demand at different prices. Data from 60 countries suggest that there is global demand for female condoms at a widely affordable price. Demand was estimated at 7 million for 1997 and 13 million for 1998.

Selling at a public sector price

To make female condoms more affordable, UNAIDS has negotiated a programme with the producer of the female condom, the Female Health Company, based on a guaranteed purchase price for public sector agencies in developing countries. This price for 1997 is below US $1 and may decrease further in coming years if sales continue to increase. Even with an affordable price, information campaigns will be needed to educate women about the female condom. Men must also be targeted with information since their cooperation is needed for widespread acceptance.

Training will also be needed for health workers and counsellors so that they can introduce the female condom to potential users in a positive and empowering way. And distribution channels will have to be established. These will include family planning clinics and distribution points, but should also include private sector clinics, pharmacies and school-based clinics.

The female condom