Female Condoms


Potential Lives Saved/Year: If unmet need for modern methods were fully satisfied, an estimated 53 million unintended pregnancies would be avoided, ~ 90,000 women’s lives would be saved and ~590,000 newborn deaths would be averted¹

>>>Read the full case study (PDF)

Problem and Proposed Intervention

(Centre) community health worker Medias Kyalikunba chats with 11-year-old Govere during an outreach visit to the family’s homestead, in Kicuzi sub-county in Ibanda District, Uganda, in 2013. Govere’s mother, Sylvia Katuseimme, sits nearby.

Sexually-active women of reproductive age in developing countries experience high rates of unintended pregnancy. According to the Guttmacher Institute, nearly 90 percent of the estimated 208 million pregnancies in 2008 occurred in the developing world. Globally, 86 million pregnancies were unintended; of these, 41 million ended in abortions, 33 million in unplanned birth, and 11 million in miscarriage. When women and couples can access a wide range of contraceptive methods, they are more likely to find a method they like and can use over a period of time, to switch methods when life circumstances change, and to meet their contraceptive intentions. Among investments in public health, those made to ensure access to contraceptive supplies and services are proven to result in significant improvements in the health of women and children. The 603 million women who currently use modern contraception in developing countries, combined with the 215 million women with an unmet need for modern contraception, attest to the need and desire for contraceptive services and related commodities overall. Three main reproductive health products have long been classified by the Coalition’s Caucus on New Underutilized Methods as being “underutilized:” emergency contraception, female condoms and contraceptive implants. As a group, the three serve as a bellwether for identifying opportunities for improving access, use and effectiveness of family planning and for meeting Millennium Development Goal 5b—universal access to reproductive health.

Several studies show that providing the female condom, as part of a comprehensive prevention strategy, results in increased levels of protection.2 The product, however, has not yet achieved its full potential due to inadequate promotional activities, insufficient supply and comparatively higher cost than male condoms. Attention is needed to increase access and use of the only barrier contraception that gives women and adolescent girls greater control over protecting themselves from HIV, other STIs and unintended pregnancy: the female condom. – See more at: http://www.everywomaneverychild.org/resources/un-commission-on-life-saving-commodities/life-saving-commodities/female-condoms#sthash.BvEc7nkD.fWHlkaXL.dpuf

Female condom (FC) product characteristics:

Drug/Product: Female Condom
Proposed Indication: Dual protection contraception against HIV transmission and unintended pregnancy
Avg. Cost: average of $0.57

Initial Findings from Product Case Study Working Paper

* Note: The strengths and challenges outlined below are initial findings from a longer working paper developed to analyze the current global situation of each product. The findings are presented below to catalyze further thinking and discussion in order to finalize a list of issues and recommendations. The full working paper texts are forthcoming.

Strengths Challenges
Policy and Regulation
  1. In the 2011 WHO EML [1], condoms are listed as barrier methods.  The challenge is that the EML does not specify male or female condoms.3


[1] WHO EML = World Health Organization Model List of Essential Medicines

  1. Male and female condoms are not listed separately in the WHO EML, making it especially difficult for countries to enter female condoms in their national essential list of commodities.
  2. Limited funding of special studies to assess the impact of the female condom on STI/HIV prevention, cost-effectiveness studies or efficacy/effectiveness studies.
  3. It is a relatively expensive method.
National, Regional
  1. Female condoms do not require a prescription or clinician involvement.
  2. The product has no side effects.
  3. Effective female condom interventions can decrease STI prevalence.
  4. No cold chain storage is needed.
  5. Studies provide important evidence that the female condom is complementary to the male condom and contributes to increased use of both.
  1. The vast majority of low- and middle-income countries do not have a budget line for male and female condom acquisition.
  2.  Governments often do not include the female condom in prevention programs.
Product specification & characteristics
  1. Female condoms do not require a prescription or clinician involvement.
  2. The product has no side effects.
  3. Effective female condom interventions can decrease STI prevalence.
  4.   No cold chain storage is needed.
  5. Studies provide important evidence that the female condom is complementary to the male condom and contributes to increased use of both.
  1. Efficacy depends on correct and consistent use by the end-user.  Proper insertion training must accompany product availability.
  2.   Proper storage conditions can be a challenge in low-resource, developing country settings
Financing, Procurement & Supply
  1. A relatively small number of countries use domestic funds to buy female condoms. They include Botswana, Brazil, India and South Africa.
  2.   A number of new female condom products are available in limited distribution in some countries or are in the development process. The Cupid Female Condom, made in India has a limited global distribution.
  3. Available female condom products are currently under review by the WHO/RHR Female Condom Technical Review Committee to determine their suitability for public-sector purchase.
  4. FC2 is the only female condom to have completed the technical review process by the WHO, which found it acceptable for bulk procurement by all United Nations agencies in 2007, followed by USFDA approval in 2009.
  5. Innovation: The Origami Female Condom made of silicone is still being developed and plans to test the device for its reusability potential will form part of future testing of the device.
  6. Female condom experts expect a drop in the procurement price to at least $0.35 per unit.
  1. Female condoms are relatively expensive to procure.  Average price is $0.57 for a female condom vs. $0.03 for a male condom.
  2.   There is currently no private sector involvement in the sale of female condoms at the country level, with the exception of small enterprises distributing through social marketing.  Private sector market is almost non-existent in Sub-Saharan Africa.
  3.   Little variety in product choice.
  4. Global public sector distribution of female condoms was only about 35 million in 2010 (50 million in 2009) for all sexually active women at risk of HIV and unintended pregnancy and whose partner is reluctant to use a male condom. That translates to 1 female condom available for 13 women in sub-Saharan Africa.   
  5. “With the exception of Zimbabwe, less than 1 female condom/woman/year was available.”4
  6. Poor distribution systems significantly restrict male and female condom accessibility.
Service Provision (Rational Use) Female condom programming requires at least four to five times the product cost to ensure that service providers are adequately trained and that educational materials including demonstration models are made available to women and couples.
  1. Women may be able to negotiate use of the female condom more easily than the male condom, giving them potentially more power to protect themselves in a sexual relationship.
  2.  Studies conducted in more than 40 countries in Africa, Asia, Europe, Latin America and North America have found good initial acceptability.
  1. Female condom use is based on user-awareness of the method and its benefit.  Awareness is often low and therefore a potential barrier.
  2. Currently the choice to use a female condom is rarely an option.
  3. Without proper and adequate training and demonstration, men and women who want to use the female condom for the first time can experience difficulties inserting the tool correctly and may feel intimidated or discouraged.
  • Guttmacher Institute, International Planned Parenthood Federation, Facts on Satisfying the Need for Contraception in Developing Countries, November 2010. Original source: World Health Organization (WHO) et al., Trends in Maternal Mortality: 1990 to 2008, Geneva: WHO, 2010.
  • Vijakumar G, Mabude Z, Smit J, Beskinska M, Lurie M. A review of female condom effectiveness; patterns of use and impact on protected sex acts and STI incidence, Int J STD AIDS 2006.
  • WHO. WHO Model List of Essential Medicines (March 2011), 17th edition. Available at: http://whqlibdoc.who.int/hq/2011/a95053_eng.pdf. Accessed March 26,2011
  • Is there a condom gap in 2010? A Review of Condom Availability, Accessibility, and Acceptability in Sub-Saharan Africa. USAID. 2010