Executive Summary

The female condom (FC) is the only woman-initiated contraceptive that offers triple protection against unintended pregnancy, HIV, and other sexually transmitted infections (STIs). Historically, the female condom has been underfunded and underused, falling victim to a cycle of limited promotion and demand generation, low availability, and higher manufacturing costs compared to other methods. The past several decades have seen major shifts in funding for HIV prevention and male condom programs, yet little has been done to harness the potential of female condoms. Moderate financial investments and one-off initiatives have drawn attention to the importance of this method, yet there has been little effort to develop robust female condom markets.

Under the United States Agency for International Development (USAID)-funded Expanding Effective Contraceptive Options (EECO) project, WCG Cares (WCG) conducted a Total Market Approach (TMA) assessment in Zambia and Malawi from June to August 2018 to identify potential strategies for fostering sustainable female condom markets. The assessment included a desk review of relevant literature, as well as in-depth interviews with key stakeholders using structured questionnaires to identify key market failures in the female condom ecosystem and opportunities for strengthening support for this method.

Several key themes arose in both countries:

• The concept of a total market approach for female condoms is in a nascent stage in both Malawi and Zambia. While national strategy documents commit to applying a TMA lens to condom programming, there is still room for enhancing technical capacity for implementing and monitoring TMA strategies.
• Both Malawi and Zambia are reliant on donor funding for female condom programs. However, donor funding for female condoms has declined and is volatile, resulting in decreased access and availability.
• Collection and dissemination of female condom program information is a challenge. There is a lack of data on the relationship between use and need for end users. While procurement figures are usually available for understanding supply, there is inaccurate or missing data from the various distribution points on the way to the end user.
• Demand generation is a critical component of building markets for female condoms. However, raising awareness and acceptability of female condoms must be a long-term and sustained effort, rather than a one-off initiative.

This report presents the results of the TMA assessment, including an overview of the key challenges and opportunities for female condom programs in each country. The report concludes with overarching recommendations for creating more equitable and sustainable female condom programs.