Understanding Female Condom Use and Negotiation among Young Women in Cape Town, South Africa

By Martin, Julia; Lora, Patsy de et al. | International Perspectives on Sexual and Reproductive Health, March 2016 | Go to article overview

Understanding Female Condom Use and Negotiation among Young Women in Cape Town, South Africa


Martin, Julia, Lora, Patsy de, Rochat, Roger, Andes, Karen L., International Perspectives on Sexual and Reproductive Health


CONTEXT: In most countries, female condoms are not widely available and uptake has been slow. More information is needed on how women and men successfully negotiate female condom use.

METHODS: In-depth interviews were conducted at two sites in Cape Town, South Africa, with 14 women and 13 men who had used female condoms. A structured interview guide was used to elicit information on how women negotiate female condom use, and how male partners negotiate or respond to negotiations of female condom use. Thematic analysis was used to identify key patterns in the data.

RESULTS: Participants reported that female condoms are easier for women to negotiate than male condoms, largely because the method is understood to be under a woman's control. The main barrier to use was lack of familiarity with the method; strong negative reactions from partners were not a major barrier. Personal comfort and tensions with partners usually improved after first use. Some male respondents preferred the method because it shifts responsibility for condom use from men to women.

CONCLUSIONS: Findings suggest that female condoms empower women to initiate barrier method use, and that programs designed to educate potential users about female condoms and familiarize them with the method may be useful. That some men preferred female condoms because they wanted women to take responsibility for condom use is cause for concern, and suggests that counseling efforts should be directed toward men as well as women, and should include a discussion of gender dynamics and responsibility that emphasizes condom use as a choice that couples make together.

The female condom is a female-initiated barrier method that offers potential for reducing the incidence of HIV, other STIs and unintended pregnancy. In many countries, female condoms are not widely available and use rates have remained low. Brazil and South Africa stand out as exceptions, as women in both countries have greater knowledge of the female condom and higher levels of use than do their counterparts in other countries, largely because of promotion and distribution campaigns. (1) South Africa was deemed an appropriate site for this study because of its low levels of male condom use (2,3) and its strong female condom program.

Female condoms are the only alternative barrier method to male condoms for HIV prevention and, like male condoms, are highly effective for preventing other STIs. Use of female condoms is likely to reduce the prevalence of negative health outcomes, such as STIs and unintended pregnancy, and to reduce the rates of unplanned childbearing and morbidity and mortality due to unsafe abortion.

Understanding barriers to female condom use in long-term relationships is essential to improving reproductive health outcomes. The barriers specific to use in South Africa have not been adequately explored and include taboos about the female body and reproductive anatomy, gender-based violence and gender disparities in power. (4-7) In particular, it is essential to examine the feasibility of women's using the female condom to gain control of sexual encounters. In a 2012 study, Beksinska et al. noted concerns that abuse and violence could increase if women attempted to initiate use of the female condom; however, no evidence supporting or refuting this claim exists. (8)

HIV in South Africa

The prevalence of HIV in the general population of South Africa is 18%--the fourth-highest prevalence in the world (9)--which indicates a hyperepidemic. (8) Around 6.1 million South Africans are living with HIV, and 240,000 die yearly from AIDS-related illnesses. As in other countries, large disparities exist by province and demographic characteristics. (10) For example, HIV prevalence is around 40% in KwaZulu-Natal, compared with 18% in both the Northern and Western Cape provinces. Women are disproportionally affected, and on average are infected earlier in life than men: Female prevalence peaks at 33% between ages 25 and 29, whereas for men the peak is at 26% between ages 30 and 34. …

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