By Carly James.
South Africa has been ransacked by HIV for decades, consistently ranking as the country bearing the highest prevalence of HIV among adults in the world. Records indicate that roughly 5.6 million South Africans face the disease every day. Furthermore, statistics reveal that HIV rates among pregnant women in South Africa are significantly higher than among adults. With such a staggering rate of HIV, the southernmost country of continental Africa has been pin-pointed as a key distribution site for various forms of contraception, awareness campaigns, and other efforts.
Despite the multitude of government and civil society organizations working against the virus, stigmas surrounding HIV remain a steep obstacle. Accompanying such stigmas is the rather strict taboo of female contraception, and more specifically, the female condom. Sometimes referred to as a “femidom,” the internally-worn female condom protects women against unplanned pregnancies and sexually transmitted diseases (STDs). They are reportedly able to reduce the risk of HIV transmission by 90 percent.
The demand for femidoms has never been consistent or widespread in South Africa. Assorted reasons exist for why women decline to use femidoms. Among them, women claim that there is a distracting and unpleasant noise associated with use of the condom and it is considered to be very uncomfortable. Moreover, anecdotal evidence has revealed that male partners have very negative perceptions of femidoms and do not generally prefer them to be used during intercourse. Additionally, femidoms can be more expensive than other forms of contraception. Coordinated action among national governments, bilateral aid agencies, and international donor contributions would theoretically be enough to drive prices down, however, just like many other treatment or prevention methods.
Some of the negative perception surrounding female condoms relates to the gender inequality inherent to South African social structure. Though the femidom (used with the male condom) offers dual protection against unplanned pregnancies and STDs, South African social norms simply may prevent the country from being the right environment for this particular form of contraception. South African society is generally considered to be androcentric, which naturally influences the way in which South Africans approach sexual relations. As the male condom places responsibility on the male, the femidom similarly places a perceptible responsibility on the female. Therefore, it may be that anything which aims to equalize the power dynamic between sexual partners, as the femidom does, directly opposes South African tradition and thus creates a taboo.
Nevertheless, many organizations are trying to broach a frank national conversation on the topic of femidom use, and more precisely, female responsibility toward contraception. Decisions for Life is a network which promotes the rights of women all over the world through training programs, advocacy campaigns, and other initiatives. Decisions for Life in South Africa has recently launched “Rights to Choose a Femidom,” a campaign to encourage condom use among women. The campaign has chipped away at the taboo of femidom use in South Africa, while also making very gradual steps toward normalizing female contraceptive responsibility.
Jeanette Hunter, CEO of Health Systems Trust, has admitted the need for hard data detailing women’s specific concerns with the femidom. “I think to just go out on a drive that ignores what may be bona fide complaints against the female condom would not be wise,” says Hunter. Simply put, more evidence is needed in order to proceed most effectively with creating a more marketable femidom product. Health Systems Trust is a not-for-profit organization established in 1992 to support the transformation of the health system in a democratic South Africa.
Still, it is worth acknowledging that the stigmatization against female condoms in South Africa is not as exotic as the term ‘taboo’ might suggest. When approved by the United States Food and Drug Administration in 1993, the idea of an internally-worn female contraceptive was not immediately accepted. The United States and South Africa are assuredly different contexts in many respects, but it is worth noting the population’s similar aversion to femidoms when they were initially released. All contextual differences aside, it remains to be seen whether or not the femidom will be fully embraced by women around the world anytime soon.