Acceptability of the Female Condom by Sub-Saharan African Women: A Literature Review

Anny Peters, Francien van Driel, Willy Jansen

Abstract

Sub-Saharan African women are affected disproportionately highly by AIDS, while experiencing lack of choice for devices which protect them against sexual transmitted diseases, including HIV. One should expect that global policy makers react positive to the female condom, a contraceptive device which offers dual protection. However, those policy makers often argue that the female condom is not acceptable to its users. Our objective is to find out whether this general statement is based on existing empirical data. Through a literature review we analysed empirical studies done between 2003 and 2013 and compared the extent to which female condoms were acceptable among women in sub-Saharan Africa. We found that acceptability was defined in different ways, along the line of two types of studies: intervention and non-intervention studies. The intervention studies defined acceptability as women who agreed to use the female condom several times. The non-intervention studies which were not linked to specific interventions, operationalized acceptability in terms of women who liked the female condom, not necessarily based on practical experience or use. Intervention studies led to a high proportion of women using the technology, rating the experiences as satisfactory, although recommending technical improvements. In contrast, non-intervention studies showed low use due to non-acceptability mixed with reasons of unfamiliarity, unavailability or unaffordability. We concluded that women in sub-Saharan Africa accepted the use of the female condom when potential users were given access to the device, and exposed to interventions which supported the use of a female condom. (Afr J Reprod Health 2014; 18[4]: 34-44).

               

Keywords: acceptability, female condom, sub-Saharan Africa, HIV/AIDS, contraception, policy and practice.

 

Résumé

Les femmes d'Afrique sub-saharienne sont touchées de manière fortement disproportionnée par le sida, tout en manquant la possibilité de faire un choix par rapport aux  dispositifs qui les protègent contre les maladies sexuellement transmissibles, y compris le VIH. L’on devrait s’attendre  à ce que les décideurs mondiaux réagissent de manière positive au préservatif féminin, un dispositif contraceptif qui offre une double protection. Cependant, ces décideurs poussent  souvent l’argument  que le préservatif féminin n’est pas acceptable à ses utilisateurs. Notre objectif est de savoir si cette déclaration générale est fondée sur des données empiriques existantes. Grâce à une étude de la documentation, nous avons analysé des études empiriques effectuées entre 2003 et 2013 et nous avons comparé  jusqu’à quelle mesure les préservatifs féminins étaient acceptables chez les femmes en Afrique subsaharienne. Nous avons constaté que l'acceptabilité a été définie de différentes façons,  en se fondant sur  deux types d'études: études d’intervention et de non-intervention.  Les études d'intervention définissent l’acceptabilité comme des femmes qui ont accepté d'utiliser le préservatif féminin à plusieurs reprises. Les études de non-intervention qui n’étaient pas liées à des interventions spécifiques, ont opérationnalisé  l’acceptabilité dans la perspective des femmes qui ont aimé le préservatif féminin, et dont l’acceptation n’est pas nécessairement basée sur l'expérience pratique ou l'utilisation. Les études d'intervention ont  à une utilisation par une forte proportion de femmes  de la technologie, toute en considérant les expériences comme satisfaisantes, quoi quelles aient recommandé des améliorations techniques. En revanche, les études de la non-intervention ont montré une faible utilisation en raison de la non-acceptabilité y comprenant  des raisons de méconnaissance, d'indisponibilité ou d'inaccessibilité. Nous avons conclu que les femmes en Afrique subsaharienne ont accepté l'utilisation du préservatif féminin lorsque les utilisateurs potentiels ont eu accès au dispositif, et ont été exposés à des interventions qui ont soutenu l'utilisation d'un préservatif féminin. (Afr J Reprod Health 2014; 18[4]: 34-44).

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