What a Come Down

R.I.P. The female condom

In a crumbling South Mumbai building, a thin man is cracking dirty jokes, egged on by two companions. “Meet our devis and devtaas (gods and goddesses),” says Praveen Bansal, executive director of Cupid Ltd, as he empties two large drawers onto a glass-top table. Sachets and packets of condoms with images of men and women embracing and kissing each other tumble and bounce about, leaving a small mound on the table. He digs into this heap of condoms with names like Stud, Bull and Black Cobra to extract what looks like a pack of lavatory freshener. “And this,” he says, holding the pink packet aloft, “is our rani.”

Called Cupid, this ‘queen’ is a brand of female condoms. Marketed by Cupid Ltd, it is among a few recent innovations being looked up to with a giddy sense of expectation. It’s the great equaliser, hope its advocates, one that might touch off a contraceptive revolution that will place women’s condoms at par with men’s.

According to Cupid Ltd’s founder Om Garg, the company has already started showing signs of success in its two years of existence. Last year, it produced and sold 2 million female condoms in various markets across the world. This year, given his bulging order book, he says he will have to escalate production to at least 10 million units. In 2010, while the product was still undergoing trials, Cupid fulfilled an order of half a million condoms from South Africa, where pharmacies needed to stock up for the FIFA World Cup. In India, however, sales have been extremely slow so far. Of the 2 million units sold last year, only 2,000 were bought in this country.

People are unfamiliar with Cupid. This is something Bansal is keen to change. When a tea delivery boy turns up in his office, he tears open a sachet of Cupid for the fellow’s benefit.

What emerges from the packet is something that looks like a cross between a male condom and some strange species of aquatic life. It is a large oily latex tube, thicker in girth than any male condom and at least seven inches in length, a rubber ring dangling on one end and a sponge on the other.

Bansal holds the condom aloft and squeezes the sponge.

“Do you know what this is, boy?” he asks the tea vendor.

Puzzled and embarrassed by turn, the boy hurriedly leaves the room.

The original female condom, a lubricated polyurethane tube designed to line the vagina, had a ring at either end: a closed inner ring for insertion (to guard the cervix) and an open outer one for penetration. Back in 1993, when it was invented and introduced by a US-based firm called Female Health Company (FHC), it was hailed as the greatest contraceptive invention since the Pill. It was portrayed as something that empowered women, granting them easy control over pregnancy and infection risks.

As it turned out, though, this first female condom—FC1 for short—was a miserable failure. Made of polyurethane, which is less pliable than latex, it was expensive, baggy and cumbersome. It was awkward in other ways too, with reports of it slipping out if not inserted properly, and worse, of an irritating noise—a crinkly rustle—during the act. It soon became an object of ridicule and was called all sorts of names: ‘garbage bag’, ‘water balloon’ and whatnot. There were, however, some practical things that worked in its favour. As a prophylactic, it was found to be as effective as the male condom. Also, it could be inserted up to eight hours before a sexual encounter, so it did not necessarily have to be worn in the partner’s presence.

A few years later, FHC launched an upgraded version of that condom, FC2. This condom was made of nitrile instead, and while it addressed the noise issue and was priced lower, it never recovered from the bad reputation of the polyurethane original. The nitrile FC2 has found some success in several emerging markets, particularly in Africa. In India, it was launched in 2007 under the brand Velvet by Hindustan Latex Ltd (now called HLL Lifecare Ltd), which had a tie-up with FHC, but failed to find takers despite all the buzz around its efficacy and ease of use.

Velvet had a dual target audience; it was aimed at independent urban women at one level and sex workers at another. Over the chemist’s counter, it was priced at Rs 100 per packet. For sex workers, it was subsidised and made available at just Rs 5. In 2012, it sold 38,000 units in the open market, and the National Aids Control Organisation (NACO) procured some 280,000 pieces for sex workers. Last year, however, was a washout. According to Dr KRS Krishnan, director, technical and operations, HLL Lifecare Ltd, over- the-counter sales numbered “just a few thousand”, and red-light districts got no further supplies because NACO did not buy any of these condoms. The State-run organisation was awaiting a go-ahead for the fourth phase of its National Aids Control Programme, which finally happened only last week.

HLL Lifecare Ltd has not given up hope, though. The company recently started making FC2 on its own at a plant in Kochi, Kerala. The bulk of the production would presumably be for sex workers, since independent urban women remain largely unimpressed by female condoms. The marketers of Cupid, which sells for Rs 25 a piece, complain that it is difficult convincing pharmacies to stock even a few female condoms. “It is not an easy product to sell,” admits Dr Krishnan. “We have to overcome our biases against women assuming control over their sexuality. And we have to get over its ‘unusualness’. We have so far failed, but we always knew this would take many years to find acceptance here.”

Even among sex workers, it’s a tough sell. In 2003, Dr Rekha Davar, head of JJ Hospital’s gynaecology department in Mumbai, oversaw a NACO-WHO-funded feasibility study on the adoption of female condoms by the city’s sex professionals. “Even then, I could see that this would not work out in the long run,” she says. “The women found it difficult to use. They complained of unease, although perhaps this was more psychological than anything. And once they got the hang of it after a few attempts, their clients were shocked at its appearance. Some of them began to fear that the women suffered from some contagious illness. Moreover, here in India where women do not even touch themselves [down there], asking them to insert something—even though a contraceptive— would have few takers.” According to Dr Davar, despite the subsidy, many sex workers also found the product too expensive. They could not afford it.

Consider the observations of Sreenivasan Purvi, a team leader at the Maharashtra AIDS Control Society, which distributes female condoms with the help of NGOs. “Once a sex worker told us how her client used to tease her about it,” says Purvi, “When asked what he would say, she was too embarrassed to discuss it. Apparently when he’d see her opening a packet, he used to say, ‘Sabzi lene jaa rahi hai kya?’ (Are you going out to shop for vegetables?).”

To its credit, FC2 comes in handy with obstinate sex clients who refuse to wear condoms themselves. Dr Anasua Bagchi, head of technical services at Hindustan Latex Family Planning Promotion Trust, which runs the company’s own female condom programme among sex workers, highlights the product’s role in ‘condom negotiation’. “A sex worker has around 15 to 20 sexual encounters in a day,” says Dr Bagchi. “Many clients refuse to wear condoms. In such a scenario, where the woman needs the client’s money, the female condom probably saves her life. We used to ask the woman to wear a female condom in advance, and the men are often too drunk to even notice it.” It’s meant mainly as a fallback safety device, she adds. “We never intended it to replace the male condom anyway, just to promote it along with the male condom, so that anytime they’re unable to wear a male condom for whatever reason, they could use this one [for safety].”

According to sexual health experts, one reason why the female condom finds so few takers among women in general is its association with sex workers. “It communicates to people the sense that it is not for everybody, that somehow it is just for high-risk groups like sex workers, when in fact it can act as a replacement for the male condom,” says Beatrijs Janssen, a Netherlands-based communications advisor with Universal Access to Female Condoms (UAFC), a female condom advocacy group. In some countries, like Nigeria, Cameroon and Mozambique, UAFC has sought to get around that stigma by promoting female condoms through hairdressers. “Hair salons are an ideal spot,” she says, “[Hairdressers] know all the gossip of the town, they chit-chat and banter. Their female patrons open up to them. And we get the hairdressers to talk to them about the female condom.” Instead of pharmacies, it is well-trained hairdressers who offer usage advice and sell female condoms— in lieu of a small commission— in those markets.

Both FC1 and FC2, which have long dominated the market of female condoms, have a double-ring design. For these products to gain popularity, however, they need the adrenaline of market competition—newer designs, lower prices, sales rivalry and everything else that goes with it. Thankfully, a number of new types of female condoms are currently under development. Some are already being tested. These include a Colombian female condom called The Panty Condom, which is tethered to a pair of underpants and thus does not require an outer ring, and an American condom of moulded silicone called Origami that is transparent and oval- shaped; the outer ring of this condom doesn’t dangle on being worn, but instead sits flat against the labia.

A recent article in the journal Lancet Global Health discusses the emergence and effectiveness of three new kinds of female condoms. A Chinese invention by a global healthcare organisation, Program for Appropriate Technology in Health, called the Woman’s Condom, still to be approved by the WHO, is a thin film polyurethane pouch that is partially enclosed in a soft capsule to aid insertion. The capsule dissolves after it is inserted into the vagina, allowing the pouch to expand. Dots of foam then appear, helping the pouch cling to the vaginal walls during sex. Two others, Cupid, which has been approved by the WHO, and VA Wow, contain a sponge to help users insert and anchor the condom inside the vagina. The study found the three as effective and safe as FC2. “This year could be the year for the female condom,” says Janssen, pointing out how all this innovation could energise the market.

Back in Cupid Ltd’s office, Bansal is optimistic about making a success of his product in India. Squeezing the sponge of a Cupid condom with his thumb and forefinger, he says, “Women say female condoms are uncomfortable. They ask, ‘How do you insert a ring into a vagina?’ I say, ‘Try Cupid’.” According to him, what sets his brand apart from others is its sponge. “It can easily be inserted without discomfort. It’s like… it’s not there. It’s like skin on skin.”

Cupid is available in plain, vanilla and chocolate flavours, and in two different sizes, but its Nashik factory is trying to come up with other variants as well. These include ribbed, dotted, multi-textured and what he calls ‘five-finger’ condoms. “There will be tiny latex fingers at the enclosed end which during penetration will increase sensation for the woman,” he explains, admitting though that he needs a better name for it. “We will make our female condoms as diverse as the male ones, maybe even better. If only we can improve our sales here.”

Since the NACO programme mentions the promotion of female condoms as part of its fourth phase, both Cupid and HLL Lifecare Ltd are in negotiations with the organisation to supply female condoms to sex workers. “Globally, there’s a lot happening with female condoms,” says Garg, “It’s bound to gain some traction sooner or later. Along with that, if we are able to secure NACO’s order for sex workers, we can then push to popularise it among other women in India.”

Cupid Ltd’s marketing campaign may be modest in its reach, but the company believes it is making headway. It sponsors theatre events, for example, and then uses the venue to hand out female condoms free. Since last year, it has been giving the 500-odd men employed at its Nashik factory five such condoms each along with their salaries every month. “When we started this practice, they would complain and ask why we don’t give them raises instead,” says Bansal, “But nowadays no one complains. They quietly accept and pocket it… I suppose some people at least have realised its worth.”

cupidfemale condomsex