Where are the Female Condoms

Where are the Female Condoms- Summary of Policy Analysis

INTRODUCTION:

The female condom is capable of protecting both women and men from sexually transmitted infec­tions, HIV/AIDS and unplanned pregnancies. Aside from that, it reduces the risk of being exposed to Human Papilloma Virus (HPV) which, when contracted, can lead to cancer of the uterus. With the ability to protect from all these, the female condom, as would be expected, will be one of the most important and most demanded reproductive health commodity.

In Nigeria, the female condom hasn’t garnered much attention from policy & law makers, unlike its counterpart, the male condom. As a result of this, the demand and usage of the commodity is almost insignificant. The National Demo­graphic Health Survey reported in 2008 that only 14.7% of women in Nigeria know what a female con­dom is, and only about 0.2% have used one.

The Female Condom Advocacy Project seeks to increase focus and attention by Sexual and Re­productive Health (SRH) and HIV/ AIDS policy makers, program planners and implementers in Nigeria on the female condom. While some efforts have been made to increase awareness, ac­cess and availability of female condoms, when compared to male condoms the female are seen to receive less attention.

Where are the Female Condoms- Summary of Policy Analysis

METHODOLOGY:

Qualitative methodology was used in the policy review and analysis. A total of six SRH and HIV/AIDS policies were reviewed.

 These include: National Reproduc­tive Health Policy Strategy (2001, & 2010), Reproductive Health Commodity Security (2011), Na­tional HIV/AIDS Prevention Plan (2010-2012), National Condom Strategy (2007-2012), National Policy on HIV/AIDS (2009). The purpose of the policy analysis is to understand the scope and con­text to which Female Condoms were discussed/programmed for in Nigerian HIV and Reproduc­tive health policies and plans. Analysis featured a simple word search and comparison between references to male and female condoms in each document. The findings from the policy analysis will be used to generate key rec­ommendations to influence the context of these policies during possible upcoming reviews.

Where are the Female Condoms- Summary of Policy Analysis

SUMMARY OF KEY FINDINGS

1. Insufficient inclusion of Fe­male Condoms in RH and HIV pre­vention documents: In review of reproductive health and HIV/AIDS policy documents, it appears that most of the documents have insuf­ficient inclusion of the female con­doms. When analysed in the con­text of HIV/AIDS prevention, and family planning it becomes obvious that many of these policies only make reference to female condoms passively. For example the 2001 Na­tional Reproductive Health Policy, condoms was referenced only once in the entire document, in the con­text of HIV/AIDS prevention and no reference to its use as a form of con­traception. Also, the National Policy on HIV/AIDS and the National HIV/ AIDS Prevention Plan both showed inclusion of female condom, how­ever insufficient, as both document made reference to FCs once. The only reference to female condoms in the National Policy on HIV/AIDS was “in view of the low awareness of female condom, communication activities shall be undertaken to promote knowledge of female con­dom among health workers males and females of reproductive age group, and MARP, and to increase its adoption by all sexually active people…” There were no parts of the document detailing how the female condom would be promoted.

2. Male condoms are promot­ed more than female condoms: In policies where female condoms are included, when compared to male condoms, male condoms are pro­moted more than the female con­doms. When compared to female condoms, outlined plans for male condom programming activities are more detailed. Although the Repro­ductive Health Commodity Security policy, referenced challenges in the low uptake of female condoms but there was no mention of specific strategies to address the challenge. It specifically included a target on how to in­crease use of male condoms only – “increase the proportion of sexually active adolescents using male condom from 11 percent for fe­males and 36 percent for males to 67 percent for both sexes in 2015.” The document laid out no such plans for female condoms. In­terestingly, the 2010 National Reproductive Health Policy specifies the same target with­out mentioning female condoms. In other documents like the National HIV/AIDS Pre­vention Plan, the plans and strategies for the promotion of both condoms are lumped.

3. None of the policies or plans identify specific strategies for increasing availability/ access to FC (lumped approach): The Repro­ductive Health Commodity Security policy spells out strategic ways through which it plans to increase the access and availabili­ty of male condoms. Even though the doc­ument highlights the need for increased awareness around female condoms, it does not identify strategies through which that can be achieved. The National HIV/AIDS Prevention Plan also acknowledges the chal­lenge of poor access to female condoms without listing strategies either. Where strategies were listed out addressing female condom uptake, they are lumped together with male condom. For instance the Nation­al HIV/AIDS Prevention Plan states: “pro­vide adequate supplies of male and female condoms and promote their consistent and correct use.” The National Condom Strategy, which makes the most reference to female condoms, also applied a lumped approach. An excerpt reads “Increase knowledge about dual protection benefits and promote appro­priate use of male, and female condoms as well as lubricants among the general popula­tion especially Key Target Populations.

4. Reference to female condoms in con­text of Most at Risk Population: The Nation­al Policy on HIV/AIDS does not only overlook female condoms but mentions them only in the context of most at risk population, spe­cifically female sex workers. Making refer­ence to female condoms in the context of certain target groups leaves an undesired effect on the uptake of the product. None of the documents layout specific plans for capacity building for female condom promotion with the exception of the Na­tional Condom Strategy and Nigeria Reproductive Health Commodity Security (RHCS) Strategic Plan. The 2010 HIV/AIDS National Prevention Plan vague­ly stated capacity building as part of its intervention for preventing sexual transmission. The preceding document made reference to capacity building only for the purposes of media promotion, condom ne­gotiation, and logistics management. In its 3rd ob­jective, the Reproductive Health Commodity Secu­rity Plan lays out a capacity building plan that does not include capacity building for health service pro­viders on female condoms.

Conclusion

Where are the Female Condoms- Summary of Policy Analysis

In terms of policies and guidelines, highlighting the need for female condoms is not enough. There needs to be concrete plans on how to make female condoms available, and plans on how to sustain de­mand. Also the impression that is created when fe­male condoms are addressed in the context of cer­tain target groups pulls the focus away from initial target, which is all women of reproductive age. As a strategy for demand generation, female condoms need to be marketed not to certain target groups but to all women of reproductive age. Furthermore, when gender issues are addressed in the context of HIV, the inclusion of female condoms is important because the commodity is a female controlled bar­rier method that not only protects from HIV/AIDS and unwanted pregnancy, but also reduces the risk of being exposed to HPV which can cause cervical cancer.