"Experience and Lessons of Introducing Female Condoms in India   

Global Female Condom Day

12th September 2012

Presented by HLFPPTDr Anasua Bagchi

Head - Technical Services Divn

Some stories..

To set the context..

Munni ….. Nepal se Pune Tak..16 Years she was … a blossoming

mountain flower….. when she crossed the hills and valleys and reached border – searching for food.

She lies in one of the 12 bedded room in a Pune shack ……

green printed curtain swaying

between her and 11 other mountain

flowers……. as 20-22 men enters her inner most soul and body

per day……Munni finally has ensured food on her plate

Champa…. Bengal ke us par se is par..

She stands in one of the most pious

places on Earth…… the temple premises

of KALIGHAT – Kolkata wearing dark

kajals in her dark eyes……. as 18-20 men buys her inner

most beauty and body per day……

At 17, She was a new and naïve bride…..

she crossed rivers and meadows and border….

her dark eyes searching her love and future…..

holding the chit of paper that her pati had given her to meet…

She was all set to start her little peaceful life…

Champa finally has value for her love.

Anna, 28 yrs

Ann, 32 years

Seema, 18 yrs

Pinky, 22 yrs

Sumi, 19 yrs

Mariamma, 30yrs

Madhu 28, yrs

Rasi, 33 yrs

Venda, 34 yrs

Anchal, 40

Madhu, 24 ys

Drug addict

and still going

with life

learnt to stand up again and again

when beaten up by Police and rowdies

…

Widow with three

daughters… never says no

to life

Husband had cut her both

arms… he was angry!!She still

embraces two toddlers with the stumps

Sold by father to earn bread… she

smiles with enchanting fullness

Born in to the oldest profession

in earth, she wants to be like

her mother..

Devdashi .. She is proud of her origin and destiny..

Abandoned by husband and family…takes care of the children and life with

stride

Have been hauled across 32 cities… still dreans of her

small hilly village

While Her smile clears

the truck drivers worries higways.., her one year old

yearns for her milk in the

lonely shack..

HIV positive and still

full of life

more stories to telll..

Arti, Binnu, Titli, Marie, Sarita, Zara, Kashmira, Ammu, Mitu, Roshni , Anju , Vasi, Punyya……. Coming SOON…..

more stories to come…..

What made provision of Female Condom (FC) In

India…

• Increased realization of ‘empowering women to take control of their lives’

• Global research highlighting need for female controlled prevention methods

Vulnerability –“Main ( Condom) lagane ko boli toh woh (husband)

mujhe Jharoo se mara, bola Sali Nakhre karti hai”

When I ask him to use protection he beats me and abuse me saying no… Arti from Kolkata

 • Non-consensual sex• Fear of violence• Economic dependence • Inability to negotiate condom use• Restricted prevention options for women

“ Ghar me chic-chic nahin chahiye, is liye bina condom ke karte hain, malum hai wo kuta to kahin bhi jata hai” –

do not want any kind of uneasiness at home, thus do it without condom, we know that unworthy fellow goes to others-

a respondent of FC study from Orissa..

““humey kahan accha lagta hai jub ganda muh hamare samne ata hai”- we do not like when someone drunk come to us”. – Laxmi from Tamil Nadu

“Hum Pet ke liye karte hain”- we do it for survival”-A Peer Educator from Bilaspur

• An empowerment tool for women

• An additional, alternate option to male condom

• A Tool for protection and safety against STIs, HIV infection

National AIDS Control Organization (NACO) introduced Female Condom as..

Address inconsistent Male Condon usage and Reinforce Risk perception

with regular partner

Female Condom program Journey in India so far..

2003-2004

2006-07

2008-09

2009-10

2010-11

2011-12

Social Acceptability Study in AP, Kerala and MA

Operational Study in WB, Gujarat and MA

Pre Programming Assessment Study- WB, Ma, , AP & TN

Scale Up Program in – WB, Maharashtra, AP & TN

Impact Assessment Study -WB, MA, TN

2005-06

Scale Up phase II , 4 states-

Scale Up in 13 states

HLFPPT had been an active advocate of Female Condom program in India from program initiation days ……..

With training and Communication Material in 10 Languages

Reaching out to –

• > 3LAKH FSWs• Approx 300 TIs• 13 States

Program Strategies

• Capacity Building • BCC & Demand

Generation • Social Marketing

• Monitoring & Evaluation

The thrust of entire capacity building process need to be on increasing ownership of TI partners and

stakeholders in sustaining- increased use of FC by target group

Learning -

No NGOs team Trained

PE Trained Counselors NGO staffs trained

FC SMP CB Fact Sheet – 2009 -12

0

1000

2000

3000

4000

5000

6000

7000

295

5886

3349

2357Series1

Capacity Building

IPC with FSW

• Peer Educators• ORWs• Counselors -TI• ANM/MO of TI clinic• Counselors- STI Clinic,

ICTC

Direct Communication with FSWs -

• SWAYAM events• DIC meetings• TI community events

Mid-Media

• Branded Kiosk• Banners• Branded Boards for

TIs & STI clinics

Advocacy workshops at

State/district/community level for creating enabling

environment

Behavior Change Communication (BCC) Strategy and Demand Generation

Behavior Change Communication (BCC) Strategy and Demand Generation

Swayam Community events

6000 7000 13000 5000

176558

43850 46050

114250

195730

292300

73650

614906

12000

376500

Impact of SwayamPrimary salesJuly 2010 – Aug 2011

Nov – Aug 98% of pro-gramme Achievement in terms of primary Sale .

36786 3563029462

44696

9692384940

62362

151862

51832

125487

163650154195

125957

189782

Swayam Events

Introduced

Impact of SWAYAM ON Secondary SalesJuly 2010 –Aug 2011

Learning

Successful model for Demand Generation

and Direct Communication

IPC with > 85,000 FSWs

1280 Hot spots and Male inclusion events conducted in 8 states

Social Marketing

NACO

•Procures condoms from the manufacturer

SMO

•Procures condoms from NACO @Re. 1.00/ piece

NGO/

CBO

•Procures condoms from SMO @ Rs. 2.00/ piece

PE

•Procures condoms from NGO/CBO @ Rs. 2.50/ piece

FSW

•Procures condoms from PE @ Rs. 3.50/ piece

Focus is on demand generation and acceptance of the product

Step 1 – Enhancing knowledge about FC among communities and TI NGOs

Step – 2 – Placing the product to the target population.

Step – 3 - communication strategies to continue demand generation

 

 

No of

states

Coverage of FSWs

Off take of Female Condom from SMO to

NGOs ( 2009-12)

13 3, 25,44

Approx 4 million

Form B

•Peer Educator fill the form on weekly basis capturing

•1.- IPC : actual number of KP's reached

•2. Female condom sales to each FSW

• Form B compiled on weekly basis ORWs

Form C

•Form- C - compilation of form - B capturing the information on Monthly basis by ORW

Compilation M & E

•M & E officer share report of IPC and sales to SACS and PO TSU Monthly Basis

Reporting flow at TI NGO

• Integrated M&E (Simplified reporting system ) in CMIS• Regular feedback mechanism. • Systematic tracking of sales data from field.

FSW 2 FSW 3FSW 1

Peer Educator

ORW

M & E / Accountant

SACS

Guidance by FE

TSU PO

NACONACOTSG TSG

FC TEAM FC TEAM

M&E

Close Monitoring , Mentorship , and

process facilitation by TSG

Program monitoring,

Technical guidance, support by NACO -

Key Learning's• Continued Interaction between user and service

provider is critical for acceptance– Interpersonal communication backed up with

regular demonstration and counseling

• Communication strategy need to be tailor made as per the socio – demographic and Professional profile of the women

• FC has established itself has a empowerment tool to women

• FC is perceived as a tool for protection and maintenance of health to partners

• > 80% of users re purchase the product establishing the fact that FC demand has been degenered

“I cannot trust my partner, he may be sleeping with other women also…..with Female Condom I can be rest assured about my safety.”-

25 yrs, FSW from Baluguda, Damanjodi

“I hear about so many new diseases and infections today and a poor women like me who have limited means of income and resources depend on Female condom for my protection. It empowers me.” FSW, 40 yrs from Silchar

Global Positioning of FC….

Condoms in spotlight after 19 years of neglect…..

NINETEEN years after female condoms were approved by the US FDA in 1993, they are not yet available as widely as one would have wished.

FC are a cost-effective and lifesaving tools, yet

they represent only 1% of all condoms distributed

worldwide

What could have delayed their optimal utilisation to meet the unmet prevention needs:-

·was it because female condoms were not rolled out under a robust enough and well-resourced comprehensive programme and strategy,

or

· Potential users didn’t prefer using them?

Zawadi

Sookjay

Aurora

Juan

Universal Access to Female Condoms (UAFC) -) Paper Dolls Campaign

How we can built on the learning?

• Investing time and efforts on FSWs preparedness of FC• Work on enhancing use among regular partners• Strong advocacy at all levels to develop conducive environment• Reinforce ownership among the NGOs/CBOs• Mainstream FC in existing health services (Counseling and

testing centers /STIs clinics), Monitoring system, Training structure and IECs

Lets make FC reachable to them..

There are large arenas untouched by FC – which are waiting for it with open hands and hope….

thanks