Academic journal article International Perspectives on Sexual and Reproductive Health

Empowering Women or Pleasing Men? Analyzing Male Views on Female Condom Use in Zimbabwe, Nigeria and Cameroon

Academic journal article International Perspectives on Sexual and Reproductive Health

Empowering Women or Pleasing Men? Analyzing Male Views on Female Condom Use in Zimbabwe, Nigeria and Cameroon

Article excerpt

The female condom is the only available female-initiated contraceptive method that offers dual protection against pregnancy and STIs, including HIV. It is as effective as the male condom, (1,2) and possesses unique features that make it a potentially valuable addition to the array of modern protection methods. The female condom can be inserted several hours before sexual intercourse, (3) its use does not require an erect penis (4) and users report greater pleasure than with the male condom. (5) Moreover, because the female condom is worn by women instead of men, its use may increase women's control over their reproductive health. (6) Nevertheless, use of female condoms remains low all over the world, including Sub-Saharan Africa. The promotion of the female condom as a female-initiated method without including male-sensitive messages may in fact contribute to the low rates of use.

Low usage has been explained by the female condom's limited availability and high price, (7) its unattractive appearance, and the considerable practice required for easy and confident use. (6,8,9) An additional reason for low usage mentioned in the female condom literature is the lack of male acceptance. (6,10) Male authority in sexual and reproductive decision making prevents women from introducing condoms (male or female) into their relationship. (11,12) The literature therefore stresses the importance of male involvement in female condom programming. (6,10) However, men have been neglected as subjects in female condom studies and are rarely targeted by female condom programs. (13)

Our study focuses exclusively on men. To our knowledge, this is the first study that explores perceptions of and experiences with the second-generation female condom in a relatively large sample of male users. Three other female condom studies in the Sub-Saharan region have included men. Pool et al. conducted 50 in-depth interviews and seven focus group discussions in Uganda. (14) None of their study participants had used a female condom; the study mainly explored male attitudes toward the potential use of female-controlled methods. Masvawure et al. conducted indepth interviews in South Africa with 38 men whose partners were enrolled in a female condom intervention trial. (13) Twenty-one participants had used the first-generation female condom and 17 had not. These studies showed that men want to protect their partner, but worry about losing control over the method and sexual encounters. Unfamiliarity with the product, limited awareness of the benefits for men (13,14) and user-related problems (13) were mentioned as the main barriers to use. These barriers were also found by Mantell et al., who conducted focus group discussions in South Africa with 74 male tertiary school students. (15) Although the majority of these young men (95%) had heard about the female condom, only eight had ever used them; unfortunately, the study does not elaborate on their experiences with the female condom. In comparison with the other two studies, the male respondents in the Mantell study seemed more accepting of women's initiation of female condoms. Four other studies on first-generation female condoms were conducted with men in the United States and are therefore less relevant to gaining an understanding of the low usage rates in Sub-Saharan Africa. (16-19)

The objective of our study is to explore male perceptions of and experiences with use of female condoms and to provide recommendations to female condom programs on how to involve men. The analysis distinguishes explicitly among men's different types of sexual partners, thereby contributing to the limited number of studies on female condom use by partner type, which have yielded varying results. For example, two studies among U.S. women suggest that female condoms are used mainly within stable relationships, (20,21) whereas a study among Zimbabwean sex workers finds that they were less likely to use female condoms with their stable partners than with their clients. …

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