1. FC prevents the transmission of STIs, including HIV/AIDS.

FC provides significant protection from STIs. In vitro studies confirm that FC provides an effective barrier to organisms even smaller than those known to cause STIs. A clinical study in the US showed FC to be at least equivalent to the male condom in preventing gonorrhoea, trichomoniasis and chlamydia. Another clinical study has demonstrated that FC prevents re-infection with Trichomoniasis. Calculations, based on correct and consistent use, estimate 97.1% reduction in the risk of HIV infection for each act of intercourse.

A controlled study of STI transmission amongst sex workers in Thailand found that when both FC female condom and male condoms were available, the rate of STI transmission was reduced by one-third of the rate in a similar group with access solely to the male condom.

A more recent study in 2003 in the US found that women counseled on and provided with female condoms fared no worse than those with access to male condoms alone, and actually experienced a reduction (Statistically non-significant) in STIs, as compared to male condom users.

2. FC prevents unintended pregnancies.

a) Summary of US Study:

In 1994, a study was carried out to determine the contraceptive efficacy of the female condom. 328 participants, all in mutually monogamous relationships and using the female condom as their sole method of contraception, took part in the study at six US and three Latin American sites. During correct and consistent use of FC female condom, the 6 month accidental pregnancy rate was 2.6% in the US population and 9.5% among the Latin American population.

Conclusions drawn from the study are that the FC female condom provides contraceptive efficacy in the same range as other barrier methods and has the added advantage of providing protection against sexually transmitted diseases.

b) Summary of Japanese Study:

The U.S. study was replicated in Japan. A clinical trial took place in ten centres throughout the country to assess the contraceptive efficacy and acceptability of FC female condom. The six-month life table probability of becoming pregnant was 3.2% during typical use and 0.8% during correct and consistent use of the condom.

3. Expanding choices increases protection.

FC female condom is not a replacement for the male condom as a means of contraception or disease protection; rather it is an addition to barrier method options. As a female-initiated method, it is an important tool for women who cannot negotiate male condom use due to personal or cultural constraints. Its addition to sexual and reproductive health programmes world wide has resulted in an increased number of protected sexual acts without a reported effect on male condom substitution.

Country Programme Experiences:

Findings from a study amongst Zambian couples with STIs confirm the above. The addition of FC female condom to the contraceptive method mix increased protected sex acts amongst couples at high risk of HIV infection. In addition, the proportion of acts protected by male condoms also increased during the study period.

Similarly, a controlled study amongst sex workers in Thailand found that when both the female and male condom were available, there was a 17% reduction in unprotected sex acts compared to when there was access to the male condom alone.

In Philadelphia, a study amongst STI patients compared three groups who were counseled on male, female or a hierarchy message. (The hierarchy message promoted male and female condoms, the diaphragm, cervical cap and spermicides in descending order of effectiveness against STIs.) The results indicated that offering a choice of male and female condoms resulted in an increased number of protected sexual acts, over counseling on the use of the male condom only. Protected sex acts were 30% at baseline and 70% at six months.

Findings from an FC acceptability study in Brazil amongst 2000 users of public health services found that when FC female condom was offered along with the male condom, this increased the proportion of protected sex from 31% at the beginning of the study to 65% at the end.

FC female condom is now providing additional protection from HIV/ STDs in Zimbabwe. Findings from a Population Council Study after one year of social marketing of the FC female condom in Zimbabwe reported that 16% of all women and 28% of married women using the female condom had never used male condoms prior to using the female condom. In addition, 20% of consistent female condom users had not been consistent male condom users in the past, indicating that for them, the female condom provided additional protection. Thus, female condom use has not replaced male condom use but brought about an incremental increase in protection.

A study of FC female condom use in three states in India in 2003 confirms the above findings. Use of male as well as female condoms was consistently high over the three-month period, moving to 96% at the end of the study. Strikingly, male condom use rose dramatically for men who have sex with men (MSM), with more than a three-fold drop in unsafe sex over the three month period. This is reflective of condom programming that increases overall condom use, both male and female at the same time, through intensive education and support.

4. FC is acceptable to a wide range of women and men.

A wide range of research in different social and economic settings in more than 40 countries in Africa, Asia, Europe, and Latin and North America has shown a good acceptance of FC female condom amongst women and men. These studies indicate that, on average, 50% to 70% of male and female participants find FC to be acceptable. A study amongst street-based CSWs in Colombo, Sri Lanka indicated that over 90% of participants like FC female condom, with 70% preferring FC female condom to the male condom.

In Togo, 82% of the CSWs said they were willing to use FC with all their partners – occasional and regular clients, their boyfriends or their husbands. Research conducted in Brazil in 1999 amongst 2,000 female users of public health services found an acceptability rate for FC of 97%. Additionally, 56% of their partners reported positively on FC use—comparing it favorably with the male condom in that it didn’t interrupt sexual activity, and it felt more similar to unprotected sex than a male condom. This finding is consistent with other studies. More recently, evaluation from an FC promotion in pharmacies in France found that women feel FC female condom is empowering and is a positive additional choice in the available contraceptive method mix.

5. FC is safe.

Because of the polyurethane used to make it, FC is strong and durable. No special storage arrangements are needed because polyurethane is not affected by changes in temperature and dampness. The expiry date is 5 years from the date of manufacture. Research confirms that FC has no serious side effects, does not alter the vaginal flora, nor cause significant skin irritation, allergic reactions or vaginal trauma. Polyurethane does not produce irritation or allergic reactions in people sensitive to latex, from which most male condoms are made.

6. Practice makes FC use easier.

A consistent finding in FC programmes is that FC female condom becomes easier to use with practice. In India, the percentage of CSWs who said FC insertion was difficult dropped from 36% at the beginning of the study to nil after eight weeks of usage. Most programmes now suggest that women try FC up to three times before deciding whether they like it or not. The occasional complaints about FC – it seems too long, it is difficult to insert the first time, it is noisy, etc. – are mostly reduced or solved by consistent use. This is particularly true where FC users have access to on-going support and information on FC female condom.

7. FC provides additional emotional comfort, sense of security and control.

In many places, women have little or no say in sexual matters and are in no position to ask their partner to abstain from sex with others or to use a male condom. FC is the only method providing dual protection over which women themselves exercise some control. FC, therefore, can contribute to women’s sense of personal control and empowerment, increase women’s knowledge about their bodies and STIs, and improve communication between men and women, as well as act as a catalyst to strengthen women's decision marking. A recent comment from an eligible couple in Kerala, India following an FC training and counseling session highlights this point: "Probably after this, we started talking; that way it is more useful." Additionally, women feel a sense of safety and security that is sometimes lacking with the male condom. FC users in Ghana, India, Togo and Zimbabwe all reported that they felt more "in control" with FC female condom and that it slipped and broke less than its male counterpart. In several studies, women who feared that they were at risk of STI infection were more inclined to accept FC, and said they felt reassured with FC because they knew that polyurethane is stronger than latex and were more confident there would be no breakage.

8. FC can be a cost-effective addition in prevention programmes.

One important research finding is that providing people with FC can be cost-effective. The findings from various activities indicate that FC not only is cost-effective, but also is a cost-saving addition to prevention programmes, particularly when specifically targeted to people who practice high-risk behaviours. Family Health International, FHC, Health Strategies International (HSI), the Institute of Health Policy Studies at the University of California, the London School of Hygiene and Tropical Medicine, Population Services International (PSI) and UNAIDS have all been engaged in research to measure the cost-effectiveness of introducing FC into reproductive health programmes. A cost-effectiveness workbook has been created by HSI to collect and analyze data from within a country in order to determine whether allocating funds to FC programmes is a reasonable option.

Moreover, given the percentage of women who are infected with HIV/AIDS worldwide and the fact that women are increasingly shouldering the burden of the epidemic, it is important that HIV/STI prevention methods are available for women to negotiate and control. Even in situations where the frequency of FC use is low, the cost to a national programme may be justified in instances where unprotected sex and exposure to HIV/STIs is averted.