Agency widens access to use of female condoms
The woman in your next examination room tells you she has a long-term partner who has multiple sexual contacts. While she says she is concerned about protection against HIV, she admits she cannot convince her partner to use a male condom. What is your next move?
The female condom (Reality or FC1 condom, Female Health Co.) represents an effective form of female-controlled protection against HIV and other sexually transmitted diseases (STDs), and provides nonhormonal birth control as well.1-7 However, its use has lagged in the United States since its 1993 approval by the Food and Drug Administration (FDA).
One agency is set to change that statistic: The New York City Department of Health and Mental Hygiene has approved a $2 million contract to purchase 2 million female condoms that will be made freely available in health clinics and organizations across the city. The department is moving allocations from various areas to fund the purchase because it has made HIV prevention a priority, says Monica Sweeney, MD, MPH, assistant commissioner of the department's Bureau of HIV/AIDS Prevention & Control. "We applaud Mayor Michael Bloomberg and the City of New York for recognizing the HIV/AIDS risk to women and providing the much-needed education and protection," said O.B. Parrish, chairman and CEO of the Female Health Co., in the company's announcement of the condom purchase.
The city first began offering free female condoms about 10 years ago, but has noted an uptick in their use in the last year. In 2007, the city distributed 659,000 female condoms, 200,000 more than in the previous year.8
The department made a bold move in 2007 in introducing its private label male condom, NYC Condom, since that time the health department has distributed more than 36 million male condoms. This uptick in growth is twice the number given out annually before the city launched its own brand, and seven times the number given out annually just a few years ago. Some 900 local businesses, clinics, and nonprofit organizations now distribute the male condoms free of charge.9
Price can be a factor when it comes to condoms. Male condoms usually cost a dollar or more when purchased on an individual basis, with packs of three costing from about $2 to $6.10 Nationwide and online, a single female condom costs about $3.60.11 For many women, when faced with spending their own money to buy a female condom vs. using it for other necessities, the condom purchase may be sacrificed, says Sweeney. "We don't want anyone to end up with a sexually transmitted disease, or an unplanned/unwanted pregnancy, for lack of a barrier method," she states.
As a contraceptive, female condoms are slightly less effective than male condoms, but are slightly more effective than other barrier methods.1 Six-month failure rates for the female condom range from 0.8% to 9.5%.2,3 It is estimated 21% of women will experience an unintended pregnancy during the first year of typical use; with perfect use, that rate falls to 5%.4
Need is great
A distribution emphasis for the female condom is through the city's district public health offices, explains Sweeney. These offices are located in communities that have been the hardest hit by the HIV/AIDS epidemic. While they represent one-eighth of the population of New York City, they also represent almost 50% of the AIDS deaths in the city, states Sweeney.
"We know where we need to be, and we want to make sure that they are available in these areas," she says.
The agency is requiring all organizations who participate in distributing female condoms to receive education and training on sexual risk reduction, with specific information on how to use the female condom, says Sweeney. "We provide training for a day here at the New York City Department of Health so people can both be educated about it and advocates for using the female condom," she states.
Some 26 million female condoms were distributed worldwide in 2007, compared to 11 billion male condoms. Female condoms account for just 0.2% of total global condom supply.12
This fact may be set to change with the introduction of the second generation of the female condom, known as the FC2. The Female Health Co. moved forward in 2005 with the FC2, with large-scale distribution in 2007. Made of nitrile, the FC2 looks and performs in a statistically similar manner to the original FC Female Condom,13 yet is less expensive to manufacture. Due to the manufacturing process involved in making the FC1, its price (about 72 cents per unit) was not affected by bulk purchasing. Since the FC2 carries a less expensive manufacturing cost, it can be made available for as little as 22 cents per unit.14
The Female Health Co. now is seeking FDA approval of the FC2. It filed its premarket application in February 2008.
References
- Hoffman S, Mantell J, Exner T, et al. The future of the female condom. Perspect Sex Reprod Health 2004; 36:120-126.
- Trussell J. Contraceptive efficacy of the Reality female condom. Contraception 1998; 58:147-148.
- Farr G, Gabelnick H, Sturgen K, et al. Contraceptive efficacy and acceptability of the female condom. Am J Public Health 1994, 84:1,960-1,964.
- Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology: 18th revised edition. New York City: Ardent Media; 2004.
- French PP, Latka M, Gollub EM, et al. Use-effectiveness of the female vs. male condom in preventing sexually transmitted disease in women. Sex Transm Dis 2003; 30:433-439.
- Fontanet AL, Saba J, Chandelying V, et al. Protection against sexually transmitted diseases by granting sex workers in Thailand the choice of using the male or female condom: Results from a randomized controlled trial. AIDS 1998; 12:1,851-1,859.
- Feldblum PJ, Kuyoh MA, Bwayo JJ, et al., Female condom introduction and sexually transmitted infection prevalence: Results of a community intervention trial in Kenya. AIDS 2001; 15:1,037-1,044.
- Lucadamo K. New York's free condom craze is stretching to women. New York Daily News, June 15, 2008. Accessed at www.nydailynews.com/ny_local.
- New York City Department of Health and Mental Hygiene. Health Department Releases New NYC Condom Wrapper. Feb. 13, 2008. Press release. Accessed at www.nyc.gov/html.
- Planned Parenthood Federation of America. Condom. Accessed at www.plannedparenthood.org.
- Planned Parenthood Federation of America. Female Condom. Accessed at: www.plannedparenthood.org.
- Center for Health and Gender Equity. Saving Lives Now: Female Condoms and the Role of U.S. Foreign Aid. Takoma Park, MD; 2008.
- Beksinska M, Smit J, Mabude Z, et al. Performance of the Reality polyurethane female condom and a synthetic latex prototype: A randomized crossover trial among South African women. Contraception 2006; 73:386-393.
- Female Health Company. Female Health Company Announces International Availability of Second-Generation Female Condom at Significantly Lower Price. Press release. Sept. 29, 2005. Accessed at www.femalehealth.com/Investor.
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