Female condom, a scarce commodity
It has been 20 years since the first female condom came on the market but over 13 years since Malawi launched it, as the only female-initiated preventive measure against unplanned pregnancies and sexually transmitted infections, including HIV.
Female condoms remain largely marginalised and inaccessible in Malawi even when studies show that there is some high level of awareness and acceptability in the country.
Nevertheless, most Malawian women cannot use it because it is neither available to them nor do they have the knowledge on how to use it.
Factors such as pricing, lack of funding, high illiteracy rate, cultural and religious belief exacerbate the low use of female condoms.
At only K50 a man gets a three pack of condoms while at the same price a woman gets a pack of two female condoms.
In contrast, the male condom enjoys wider promotion and accessibility, despite the fact that its use in achieving safer sex almost entirely depends on the cooperation of the male sexual partner—a thing which poses problems in the HIV and AIDS pandemic fight as well in sexual and reproductive health for women in general.
The predominantly patriarchal society that Malawi is does not help matters either as women often than not find themselves bowing down to male pressure. Lack of open and free talk about sexual health has only worsened the already bad situation.
Few places that offer women a relaxed environment where they can freely and openly share experiences while building relationships with each other are hair salons.
According to PSI Malawi, hair salons, barber shops, drug stores and pharmacies provide easy access and allow easy training of providers—a hair dresser, barber, drug store owner of pharmacy in the correct use of CARE female condoms and how to impart this knowledge to customers and how to answer questions related to the product.
Population Services International Malawi Country Representative Sarah Gibson says the chosen points of distribution have achieved the intended purpose of supporting exchange of detailed information to support successful use of CARE female condoms.
The female condom, commonly referred to as FC was first piloted in Malawi in 2000 by Family Planning Association of Malawi (FPAM).
Eight years later, PSI Malawi, with the support of United Nations Population Fund (UNFPA) and the Ministry of Health in 2008, launched the CARE Female Condoms, a branded, social-marketed female condom.
Promotion of the female condom, CARE included, has not been impressive. It is therefore little surprising that out of the five salons visited, none of them stocked condoms and most of the people interviewed have heard about it but have never seen the condom before.
Gibson said currently her organisation is struggling to promote market as well as distribute the CARE female condom because of lack of funding.
“We are currently struggling to secure funding for this important, female operated HIV prevention method. This means that our ability to communicate more widely is limited and this impacts negatively the level of information about CARE female condoms among the general population,” she said.
Despite it being the only available female initiated method that provides dual protection against unplanned pregnancies and STIs including HIV, few women in Malawi are aware of its existence.
The few that are aware of it mostly do not have adequate information and knowledge on how to correctly use it. This coupled with its inaccessibility and the cost of the female condom, makes it difficult for women to bargain for safer sex.
A random visit in some salons and some pubs in Ndirande and Limbe revealed the extent to which a female condom remains a scarce commodity in Malawi.
While others knew about it, others have simply heard about it but have never seen it.
“I know a female condom but we don’t stock them because nobody asks for them. Why stock a product that won’t be bought,” said a barman who works for Mbiya Pub in Ndirande Township.
However, he was quick to say that they have male condoms in abundance.
Hasima Salon in Ndirande Township gets an average of 10 customers in a day. The owner who boasts that business has been really good, just like the barman, expressed ignorance of female condoms.
“I have heard that there are condoms for women but I would not lie I have never seen them,” said owner of Hasima Salon in Ndirande Township who didn’t want her name mentioned but had no problems mentioning the name of her salon.
Hasima salon gets an average of ten clients a day. The owner of the salon says is more than willing to stock the condom as long as there is enough information on how to use it.
PSI says although men are not the main target of their communication activities, they are key partners in the promotion of female condoms.
Gordon Mataya, a man in his early 30s concur with PSI saying men need to take and support the promotion of the female condom as the underlying benefits not only benefit women but men as well.
Mataya said he has no problem in using either male of female condom as long as they agree with his partner.
“I understand that the female condom has to be inserted even hours before intercourse. This to me makes them more formal than their male counterparts meaning they are best suited for stable, long-term relationships where both partners know when they would engage in sex,” he said.
He however said that the time it takes to put on a female condom may not work well with what he called “hit and run” or one night stands.
“Male condoms are kind of spontaneous and well suited for hit-and-run and one-night-stand scenario. So whether I would use either of the two would depend on prevailing circumstances. The key thing is that both partners should be okay with whatever protection method they choose to use,” Mataya said.
It is clear that there is a high level of acceptability for female condom, what remains to be put in place are proper promotion, marketing and distribution mechanism to ensure easy access nationwide.
Apart from that, the knowledge gap needs to be addressed as PSI says, through adequate funding, political will and change of mindset without which, this important product will remain a scarce commodity in Malawi which is also working hard to reduce HIV prevalence rate.