Lessons from the evaluation of the South African National Female Condom Programme

Abstract

Background Understanding of the facilitators and challenges to female condom (FC) uptake has been limited due to lack of evaluation of national FC programmes. Setting The FC has been an integral component of South Africa's (SA) HIV prevention programme for 20 years and is the largest government-funded FC programme worldwide. Methods The national FC evaluation used a mixed-methods approach and consisted of key informant interviews and a telephone survey in a national sample of public and non-public sites. A sub-sample of sites participated in client and provider interviews, and a self-administered client survey. A review of distribution statistics from South Africa's District Health Information System was also conducted. Results All 256 public-sector and 28 non-public-sector facilities reported having ever distributed FCs. Less than 5% of these facilities reported stock-outs and less than 3% reported they had a supply of expired female condoms. Systems for male condom (MC) and FC distribution were complementary, with similar ordering, delivery and reporting processes. FC promotion by providers (n = 278) varied with regard to FC training, whether attitudes about FCs influenced providers offer of FCs, and how they counselled clients about FCs. Of the 4442 self-administered client surveys in 133 facilities, similar proportions of women (15.4%) and men (15.2%) had ever used FCs. Although FCs were available at almost all sites surveyed, only two-thirds of clients were aware of their availability.

Perceived male partner attitudes toward the female condom predict female university students’ use of the female condom

“…The FC has been shown to be as effective as the male condom, 13 acceptable 14 and cost-effective. 15–17 Several new FC brands have been approved by WHO/UNFPA and are now available.…”

The Social, Behavioral, and Ethical Modalities of COVID-19 on HIV Care in South Africa: A Systematic Review

“…Promoting condom use was an existing issue in South Africa that was further challenged during the pandemic. For over 20 years, both male and female condoms have been used in the South African HIV prevention program, which employs condom distribution targets at public sector facilities [ 40 , 41 ]. One study revealed that many of these public sector sites had skewed distributions of condoms, increasing the unmet need for contraceptives in South Africa [ 26 ].…”

Offering choice in female condoms: The South African experience

“…The National South African Female Condom programme evaluation was conducted in all nine provinces between 2014 and 2017. 8 The sampling frame for the study was the existing SA national STI sentinel surveillance sample. 9 Fieldwork for the National study was underway when the condom programme introduced new FC brands.…”

“…South Africa (SA) has one of the largest and best established, public-sector male and female condom programmes worldwide. 8 The FC2 was the only FC brand procured by the South African Department of Health (DoH) until 2014, when a further two FCs were added to the programme (Cupid and Pleasure More). Some training of health care providers was conducted and the new FCs were gradually introduced over approximately a year, becoming available to the public and non-public sectors (non-governmental organisations [NGOs,] private sector and tertiary education) as sites ordered new FC stock.…”