Current status of the female condom in Africa
Deniaud, F.
Sante 7(6): 405-415
1997
ISSN/ISBN: 1157-5999 PMID: 9503499 Document Number: 273497
This work discusses the female condom and the context of women's lives in sub-Saharan Africa, analyzes results of studies on acceptability conducted in Africa, and assesses the prospects for future use of the method in Africa. Studies have been conducted throughout the world on the efficacy, tolerance, and acceptability of the female condom. The two studies of contraceptive effectiveness, carried out in England, the US, and Latin America, showed it to be about as effective as other barrier methods. Both studies had high dropout rates. The female condom has been demonstrated to be effective in vitro against transmission of HIV and sexually transmitted diseases, but evidence of efficacy in vivo remains limited. The high prevalence of HIV infection in eastern and central Africa and its rapid spread in parts of western Africa, and the growing desire of African women to space or limit births, indicate a need for protection that could be met by the female condom. The subordinate position of African women at all levels limits their ability to negotiate on sexual topics, including contraception. 10 of the 15 studies of acceptability of the female condom, carried out in 9 sub-Saharan African countries between 1990 and 1996 and compiled by the World Health Organization, were reviewed. The studies were limited by small sample size, selective recruiting, lack of consistency in methods and analysis, and a tendency to ignore dropout rates and motives. Despite the limitations, the studies found female condoms to be acceptable to certain groups of women, especially prostitutes. Acceptability was established more rapidly among prostitutes, although large proportions reported the method to be unacceptable to some of their clients. Results of acceptability studies were more variable among non-prostitutes. Acceptability among men has been insufficiently documented. Stereotypes and oversimplifications must not be allowed to hamper promotion of the female condom. It is recommended that further study of the contraceptive and disease prevention efficacy of the female condom be conducted and that availability and accessibility of the method be increased for African women.