Long road to Female Condom Republic

Officially sanctioned, but by no means commonly used, female condoms have taken their place in the anonymity of most women’s minds.

This fact is best illustrated at Namphungo Trading Centre in the area of Traditional Authority (T/A) Juma in Mulanje district. Records at Namphungo Health Centre indicate that, while the number of the youth who sought Sexual Reproductive Health (SRH) Services rose from 60 to 600 between June 2013 and June 2014, there was a pronounced gap between the quantity of male and female condoms, respectively, demanded by the youth.

No wonder, the number of male condoms distributed increased from 400 [before 2013] to 2, 100 per month, while the number of female condoms distributed increased from zero to an average of 80 condoms per month. This are the records that a team of Media Aids and Health Watch members found when they toured the area in November 2014.

Compared to Lilongwe, however, Mulanje’s female population may be described as ‘progressive’. Joneha [Network of Journalists Living with HIV] Newsletter indicates in its August 2014 edition that the women of Kalamula Village in T/A Chitukuta, Lilongwe, have been shunning female condoms altogether.

The newsletter quotes one of the area’s community nurses, Mercy Chamvula, as saying that, while the health facilities in the area runs out of male condoms more often than not, female condoms are always in abundance.

“In the family setup and village context, a woman found to have worn condoms is perceived [as] unfaithful, “Chamvula is quoted as saying.

Thus, at best, female condoms remain a minefield in Malawi’s largely conservative society, tilting the SRH scales against women. Yet, the National Strategic Plan [2011-16] indicates that Malawi has a gender equality index of 0.374, an indication of the despairing inequalities between men and women.

Irony

The Mulanje and Lilongwe women may, however, be neglecting what could be regarded as a precious resource in other countries. Reports indicate that some women have been re-using the female condom, in part due to its scarcity and in part because of the high cost of such condoms.

According to a World Health Organisation (WHO) report titled ‘The Safety and Feasibility of Female Condom Reuse: Report of a WHO Consultation’, women in other parts of the world struggle to access condoms.

The report, which was published in 2002 after a meeting convened in Geneva, Switzerland, between January 28 and 29, reads in part: “Many women face difficulties in negotiating the use of male condoms.  The female condom may, therefore, be an important option to assist women in protecting themselves and their partners from both unwanted pregnancy and sexually transmitted infections.

“Some women have reported using the same female condom for multiple sex acts, a behaviour said to be motivated by the high cost or limited availability of the device as well as by its perceived strength.  Such practices may expose women or their partners to pathogens during washing or subsequent reuse of the female condom, especially for populations living in areas of high STI [Sexually Transmitted Infections]/HIV prevalence.”

Thus, in response to requests for advice on the practice of reuse of the female condom, WHO and UNAIDS convened an experts’ consultation in June 2000 on the safety and feasibility of multiple uses of a single female condom.  

The consultation concluded with the recognition of the need for risk-reduction strategies for women with limited resources who may be at risk of unplanned pregnancy or sexually transmitted infections including HIV.  

“The consultation determined that currently available evidence regarding the safety of reuse was not conclusive and that re-use of a single female condom could not be recommended.  However, the panel also recognised the urgent need to provide guidance to women who may currently be reusing the female condom.  It was agreed that used female condoms should be disinfected before being washed and handled in order to reduce the risk of exposure to HIV and other pathogens,” reads part of the report.

Following the meeting, a draft protocol for safe preparation of used female condoms for additional use, based on theoretical considerations regarding disinfection, washing, drying, storage and re-lubrication, was formulated.  

Forsaken

By July 2009, only 3 out of 100 women were using female condoms in Malawi, according to the United Nations Population Fund. This sharply contradicted the percentage of men who were using condoms at the time [45 percent].

“There is need to direct more energy towards scaling up FCs distribution in rural areas,” Sandra Mapemba, UNFPA female condoms programmes coordinator for Malawi, is quoted as saying at the time [2009].

However, this state of affairs has implications which, according to the Ministry of Health in conjunction with Ipas, a reproductive rights organisation headquartered in the US, include abortion.

A study conducted by the Ministry of Health and Ipas indicates that 70,000 women had an illegal abortion in 2009 alone. It adds that 17 percent of maternal deaths in Malawi are the result of unsafe abortions.

‘Dancing for demand’

On Wednesday this week, Malawi joined the world in commemorating the 2015 Global Female Condom Day under the theme ‘Dance4Demand in Support of Female Condoms’.

This was the fourth time since 2012 that the Hunger Project Malawi in conjunction with the Reproductive Health Directorate of the Ministry of Health and other female condom stakeholders led Malawians in commemorating the day at Kasungu Community Ground.

The Hunger Project Malawi Country Director, Rowlands Kaotcha, set the tune for this year’s celebrations by calling for increased investments towards female condom education, procurement as well as supply-chain management to effectively meet the local need and demand.

“The need for female condoms in Malawi cannot be overemphasised. Malawi is still recording 48, 000 new HIV infections annually and the unmet need for contraceptives is at around 26 percent. Studies have demonstrated that bringing in female condoms to the mix of available prevention methods leads to increased rates of protected sex acts,” observed Kaotcha.

He added: “Further, studies show that, for HIV prevention, where both male and female condoms are available, total number of protected sex acts increases as compared to situations where only male condoms are available. As such, positioning female condoms within the method mix improves method choice and coverage, resulting in fewer STI [Sexually Transmitted Infections]/HIV infections and fewer unintended pregnancies.”

Otherwise, without embracing these interventions, women may continue to dance to the tune of men.