Using female condoms as a birth control method

It is a cold Thursday morning when I meet Clare Namakula, a single mother of one. She is all thrilled to share her experience of using a female condom as a birth control measure for the last three years. Despite limiting her to only the missionary sex position where the female lies on her back during intercourse, Namakula commends the female condom for enabling her to have safe sex.

“It helps where some male partners do not want to use condoms. They would find me set because I can even move with it freely before sexual intercourse,” Namakula, who is also a peer educator at Reproductive Health Uganda (RHU) a non-governmental organisation, says.
Although most men are ignorant and reluctant about female condoms, Namakula says there are those who ask her to use them so they can have a feel of having sex with a female condom.
“There are men who appreciate it and even ask that I use it for them to experience,” she adds.
However, Namakula says it sometimes makes sex uncomfortable and boring to hold the condom ring to prevent it from slipping into the vagina.
“Some men use a lot of force and end up displacing it because they use much energy,” she says.

Namakula advises the manufacturers to modify the condoms and make them smaller and in form of panties as opposed to holding it.
She says: “It would make them easier and more attractive to use. I prefer the female condom to male condom because the latter used to disturb me whenever I tried to put it on my partner,” she says.
She concludes that the whole aspect of female condoms give women especially sex workers, more bargaining power to have protected sex with some reckless men who do not want to use them.
“Even if I am to make love with a man who does not want to wear a condom, he finds when I have already put on mine,” Namakula says she often has sex with different men.
But because of the strict measures involved in using the female condoms compared to the male condoms which involve putting on only once and put off after the intercourse, some women have rejected them completely.

Majority of the women, mostly sex workers with whom Namakula was trained at RHU in 2007 as peer educators, have rejected them saying the condoms had too much work.
Another female Rose Nakanyike (not real name) from Rakai District says a female condom is difficult to insert (in the vagina), which makes it very difficult to do for a woman to touch herself in sensitive parts so that it can fit.
“…at least for the male condom you can see what you are doing and can even put it on without much trouble.
They should make for us another version of the female condom which does not require us to keep holding its ring when having sex because how can you enjoy when you have to keep holding it?”
Nakanyike also suggests that maybe if the manufacturer brought one which you wear like knickers then people can start using “but this one has many problems.”

Sad reality
Dr Peter Waiswa, a lecturer at Makerere University School of Public Health is in agreement with Nakanyike, saying the introduction of the female condom could have been an elitist view and people on ground were not consulted.
“We need to go back to the design stage and do this with women and men and produce a product that is acceptable to them and society,” Dr Waiswa advises.
Collins Oteba, a male student at Makerere University, says the female condom is as effective as the male condom, saying there are higher chances of sinking, which requires a lot of physical training. “They (female condoms) have existed for years but most women don’t like them,” Oteba says.

About female condoms

Although female condoms had been a reserve for men, about 24 years ago, a female Condom 1 (FC1) was introduced on the global market and later in Uganda.
The female condom also known as the internal condom has been recommended as an alternative family planning tool for safer sex ever since its introduction in Uganda in 1993.
During intercourse, the pouch is used to prevent pregnancy and reduce the risk of sexually transmitted diseases. Before vaginal intercourse, it is inserted deep into the vagina.
The condom has flexible rings at each end, and the ring at the closed end holds the pouch in the vagina.
Fred Ssemakula, a volunteer at RHU, who trains mostly sex workers in the slums of Bwaise, in Kawempe division a Kampala suburb, says female condoms are mostly demanded by sex workers.

How it is inserted
Ssemakula explains that prior to sexual intercourse, a woman folds the upper ring part of the condom into figure eight. She then pushes the condom into the vagina and uses a finger to fix it.
It is very important for the woman to keep holding it so it does not alter during intercourse, he adds.
“It is easy for the man to penetrate aside and the whole condom enters. So the ring has to remain outside,” Ssemakula, who trains sex workers from the slums of Bwaise, says.
After intercourse, Ssemakula further explains that the same condom has to be folded at the upper ring so that the semen does not pour out before it is removed.

In 2016 alone, RHU distributed a total of 444,611 free female condoms but a total of 10,120,786 condoms were distributed the same year at their branches across the country and through other community outreach programmes.
The trends of female condoms distributed by RHU have, however, increased over the years from 172,011 in 2013, 257,343 in 2014, 427,193 in 2015 and 444,611 in 2016.
A 2009 situational analysis on female condom use in Uganda by the Ministry of Health revealed that the available female condoms were mostly being taken up by commercial sex workers.
The price of the condom, which currently stands at Shs1,500, the study identified it as a hindrance to the uptake and use of the female condom.

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