A review of female-condom effectiveness: patterns of use and impact on protected sex acts and STI incidence

Abstract

We conducted a systematic review of 137 articles and abstracts related to various aspects of the female condom, as well as a closer analysis of five randomized controlled trials on effectiveness. These five studies indicated strongly the benefits of female-condom use in increasing protected sex acts, and two studies found promising decreases in sexually transmitted infection (STI) incidence with the introduction of the female condom. Ten studies provided detailed information on patterns of long-term use, many suggesting that the female condom reaches women less likely to use other dual protection methods. There exists limited but convincing evidence that the female condom is effective in increasing protected sex and decreasing STI incidence among women. Future research on the female condom must move away from assessing acceptability and focus on assessing effectiveness and improving impact in diverse settings.

The female condom: the international denial of a strong potential

“…Studies, reviews, reports, policy documents, commentaries, editorials, written opinions and position papers were reviewed and categorised according to acceptability, availability and affordability issues covered. Three earlier reviews were also studied: a review of eight years (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003) of female condom promotion in South Africa and the USA; 24 the systematic review of 137 articles from 1996-2004 by the HIV Research Unit, University of the Witwatersrand, South Africa; 8 and an in-depth study of the introduction of the female condom in 2008, guided by the Harvard School of Public Health. 25 Secondly, we analysed the Lancet edition on the "state of the art of HIV prevention", presented at the International AIDS Conference in Mexico in 2008, written by key international HIV prevention experts.…”

“…8,12,23,39 From the first international meeting on female condoms in 1993 to the sixth in 2007, global public policymakers such as UNFPA and USAID have considered the price a major barrier to access. 18,57 Users in developing countries have been unable to purchase female condoms on the private market, because they cost US$2-3 each (FC1).…”

“…7 A review of 137 articles on the female condom concluded that it is effective in increasing protected sex and lowering STI incidence. 8 A significant number of studies have also demonstrated that a wide range of choice of contraceptive methods and STI/HIV prevention devices is the primary factor in achieving safer sex practices. [9][10][11] As early as 1990, the South African women's health researcher and activist Zena Stein made a plea for HIV prevention methods that women can initiate or control.…”

“…I found it very cool." 29 Kaler, 24 Vijayakumar et al, 8 and Frost and Reich 25 , describing the lessons learned from the introduction of the female condom, all concluded that acceptability and acceptance by users were not barriers for the introduction of the female condom.…”

“…10,20,29 People's initial lack of interest can be reversed, negative rumours dispelled, fears alleviated, and awareness that one can have pleasurable sex while being protected can be raised. 2,6,[8][9][10][11]13,19,20,24,25,[28][29][30] Yet, these findings have not been taken seriously by stakeholders at higher levels. The myth that women do not accept and like the female condom persists and continues to be influential.…”