Recommended to read: Chapter 14

Twenty years of the female condom programme in South Africa: past, present, and future

The female condom (FC) was introduced in South Africa in 1998, marking a parallel anniversary to this 20th edition of the South African Health Review. The
FC programme has grown rapidly from a pilot phase to a national programme that is one of the largest government-funded FC programmes worldwide. Twentyseven million FCs were distributed in South Africa in 2015/2016, exceeding the country’s National Strategic Plan (NSP) target of 25 million annually by 2016.

The primary objective of this evaluation, conducted in 2014–2016, was to evaluate the national FC programme and identify determinants of FC uptake and continued use among couples. The study aimed to provide an evidence base for the future direction of South Africa’s FC programme, and to identify health system, provider and client barriers and facilitators to FC uptake and continued use.

The evaluation included four components: a national survey in the public and private sectors consisting of interviews with providers and clients and an anonymous client survey; a cohort of new FC acceptors and their male partners; key informant
interviews with policy and programme managers; and a unit-cost analysis of total programme costs.

Results indicated that nearly 90% of men and women interviewed had heard of the FC, and approximately 20% had used it. Although FCs were available at almost all sites surveyed, only two-thirds of clients knew that FCs were available at their healthcare facility. Female condom distribution has doubled since 2008, but there are marked differences across provinces. Provider interviews indicated that three-quarters of providers had been trained in FC provision, but most sites lacked information, education and communication (IEC) materials and demonstration models. Findings underscore the need to promote awareness of FC availability in South Africa for HIV, sexually transmitted infection (STI) and pregnancy prevention and also to demonstrate the pivotal role of the provider in delivering FCs to potential users.