20 Essential Resources: Condoms and Family Planning

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WHO, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins CCP, USAID (2018)

CONDOMS & FAMILY PLANNING

20 Essential Resources

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Training Resource Package for Family Planning

As recent-day family planning and reproductive health efforts place greater emphasis on innovation, it is important to remember the value of evidence-based family planning tools that have been effective for decades. Since the physical properties of condoms have not undergone substantial change, many people may forget the power of condoms as a family planning tool. This collection was created as a reminder to all of us that some methods continue to work even as innovations arise in FP/RH. Condoms also play an important role as the only method in existence that offers triple protection from unintended pregnancy, sexually transmitted infections, and HIV infection. Among adolescents and youth populations, condoms may be the only affordable method of protection and data show that they continue to be of value to youth. In many regions around the world, youth are the largest proportion of the population, so it is important to invest in methods used by young people. Furthermore, humanitarian crises, such as the COVID-19 pandemic, continue to impact supply and distribution of FP/RH commodities and information. The promotion of updated and relevant information on condoms is necessary now more than ever.

Publication

Webpage

Map

USAID, WHO, and UNFPA (2021)

Family Planning: A Global Handbook for Providers

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Adaptable Communication Strategy for Demand Generation

Health Communication Capacity Collaborative (2014)

Details

Using Total Market Approaches in Condom Programs

USAID, PEPFAR, and SHOPS (2015)

Curated by

KNOWLEDGE SUCCESS & FHI 360

How to use this collection

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The resources are organized by focus area. Introductory Evidence & Impact Program Examples Training

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Introductory

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How and Why Social Norms Matter for Sustainable Development

Learning Collaborative to Advance Normative Change (2019)

Contributors Design: Elizabeth Tully Writers: Kirsten Krueger, Reana Thomas, Hannah Webster (FHI 360) Technical input and review: Alison Bodenheimer (FHI 360); Irina Yacobson (FHI 360); Steve Hamel (FHI 360); Christine Bixiones (FHI 360); Markus Steiner (FHI 360); Aurelie Brunie (Research for Scalable Solutions); Tamara Fasnacht (FHI 360); Bidia Deperthes (UNFPA); Heather Vahdat (Male Contraceptive Initiative); Jen Pope (PSI); Alison Malmqvist (PSI) About Knowledge SUCCESS Knowledge SUCCESS (Strengthening Use, Capacity, Collaboration, Exchange, Synthesis, and Sharing) is a five-year (2019-2024) global project led by a consortium of partners and funded by USAID’s Office of Population and Reproductive Health to support learning, and create opportunities for collaboration and knowledge exchange, within the family planning and reproductive health community. We use an intentional and systematic approach, called knowledge management, to help programs and organizations working in family planning and reproductive health collect knowledge and information, organize it, connect others to it, and make it easier for people to use. About FHI 360 FHI 360 is an international nonprofit working to improve the health and well-being of people in the United States and around the world. FHI 360’s deep technical knowledge, specifically in family planning, maternal and child health, HIV, gender, and youth will be leveraged to ensure Knowledge SUCCESS is at the forefront of family planning knowledge exchange at global and regional levels. This collection was curated and published in October 2021. Resource links were active at the date of publication. Images courtesy of Images of Empowerment, World Bank Flickr, UNFPA Uganda Flickr, UNFPA WCARO Flickr, IWHC Flickr, MSCP Flickr, Diana Kotikova, Michael Musombe, Nora Miller, and Jessica Scranton.

Acknowledgements

This collection is made possible is made possible by the support of the American People through the United States Agency for International Development (USAID) under the Knowledge SUCCESS (Strengthening Use, Capacity, Collaboration, Exchange, Synthesis, and Sharing) Project. Knowledge SUCCESS is supported by USAID’s Bureau for Global Health, Office of Population and Reproductive Health and led by the Johns Hopkins Center for Communication Programs (CCP) in partnership with Amref Health Africa, The Busara Center for Behavioral Economics (Busara), and FHI 360. The contents of this webpage are the sole responsibility of CCP. The information provided on this webpage does not necessarily reflect the views of USAID, the United States Government, or the Johns Hopkins University. Contributors Design: Elizabeth Tully Writers: Kirsten Krueger, Reana Thomas, Hannah Webster (FHI 360) Technical input and review: Alison Bodenheimer (FHI 360); Irina Yacobson (FHI 360); Steve Hamel (FHI 360); Christine Bixiones (FHI 360); Markus Steiner (FHI 360); Aurelie Brunie (Research for Scalable Solutions); Tamara Fasnacht (FHI 360); Bidia Deperthes (UNFPA); Heather Vahdat (Male Contraceptive Initiative); Jen Pope (PSI); Alison Malmqvist (PSI) About Knowledge SUCCESS Knowledge SUCCESS (Strengthening Use, Capacity, Collaboration, Exchange, Synthesis, and Sharing) is a five-year (2019-2024) global project led by a consortium of partners and funded by USAID’s Office of Population and Reproductive Health to support learning, and create opportunities for collaboration and knowledge exchange, within the family planning and reproductive health community. We use an intentional and systematic approach, called knowledge management, to help programs and organizations working in family planning and reproductive health collect knowledge and information, organize it, connect others to it, and make it easier for people to use. About FHI 360 FHI 360 is an international nonprofit working to improve the health and well-being of people in the United States and around the world. FHI 360’s deep technical knowledge, specifically in family planning, maternal and child health, HIV, gender, and youth will be leveraged to ensure Knowledge SUCCESS is at the forefront of family planning knowledge exchange at global and regional levels. This collection was curated and published in October 2021. Resource links were active at the date of publication. Images courtesy of Images of Empowerment, World Bank Flickr, UNFPA Uganda Flickr, UNFPA WCARO Flickr, IWHC Flickr, MSCP Flickr, Diana Kotikova, Michael Musombe, Nora Miller, and Jessica Scranton.

Icons demonstrate the resource format.

Introductory

Details

WHO, UNFPA, FHI 360 (2012)

Use and Procurement of Additional Lubricants for Condoms

Introductory

Details

The Keystone Design Framework

PSI (2018)

Introductory

Details

Systematic Global Review of Condom Availability in High Schools

Journal of Adolescent Health (2019)

Evidence & Impact

Details

Systematic Review of Peer-Reviewed Literature on Global Condom Promotion

International Journal of Environmental Research and Public Health (2020)

Evidence & Impact

Details

USAID, PEPFAR, EECO, and WCG (2018)

Assessing the Total Market for Female Condoms in Malawi and Zambia

Introductory

Details

Guideline on Self-Care Interventions for Health and Well-Being

WHO (2021)

Introductory

Details

Condom Needs and Resource Requirement Estimation Tool

UNFPA and UNAIDS (2019)

Introductory

Details

Male Latex Condom Procurement Specification

UNFPA (2013)

Introductory

Details

BMC (2021)

Beliefs and Misconceptions about Condom Use Among Adolescents

Program Examples

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Condoms and Lubricants in the Time of COVID-19

UNFPA, Global HIV Prevention Coalition, and UNAIDS (2020)

Program Examples

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Family Planning 101 - Condoms Section

Global Health eLearning Center (2019)

Training

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FC2 Female Condom Masterclass Episodes

FC2 (2020)

Training

Details

UNFPA and UNAIDS (2020)

Developing Effective Condom Programmes

Evidence & Impact

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Strategic Donor Investments for Strengthening Condom Markets

PSI (2019)

Evidence & Impact

Details

Consistent Condom Use and Dual Protection Among Female Sex Workers

Sauti Project (2019)

Program Examples

Details

Condom Use and Incident STI After Initiation of LARCs

American Journal of Obstetrics and Gynecology (2017)

Program Examples

Details

Video

The global handbook offers clear, up-to-date information and advice to help providers meet clients’ needs and inform their choice and use of contraception. The handbook is also an excellent resource for training and can help to reinforce supervision. It was created in partnership between the World Health Organization (WHO) and the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs with support from the United States Agency for International Development. WHO family planning guidance documents are seminal resources used by many national governments as reference tools to develop or revise national service delivery guidelines for contraception. About World Health Organization The World Health Organization (WHO) is the United Nations agency that connects nations, partners, and people to promote health, keep the world safe and serve the vulnerable—so everyone, everywhere can attain the highest level of health. About Johns Hopkins Bloomberg School of Public Health The Bloomberg School works to keep millions around the world safe from illness and injury by pioneering new research, deploying knowledge in the field, and educating tomorrow’s public health leaders. About Johns Hopkins Center for Communication Programs Johns Hopkins Center for Communication Programs is a public health communications entity that works with governments and NGOs, providers and clients, community health workers and religious leaders, and men and women who simply want healthier lives for those they love. About United States Agency for International Development The United States Agency for International Development (USAID) is the world's premier international development agency and a catalytic actor driving development results. USAID works to help lift lives, build communities, and advance democracy. USAID's work advances U.S. national security and economic prosperity, demonstrates American generosity, and promotes a path to recipient self-reliance and resilience.

Chapter 15 (Internal/Female)

This toolkit includes a chapter specific to external/male condoms and a chapter specific to internal/female condoms. Each chapter includes practical and relevant information on use, behavior, user support, using condoms with other methods, and common misconceptions. Program managers and technical advisers can adapt and use these resources for training sessions with health workers and community health workers.

WHO, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins CCP, USAID (2018)

Family Planning: A Global Handbook for Providers—Chapter 14 (External/Male) and Chapter 15 (Internal/Female)

Why is it essential?

Female Condoms Module

Why is it essential?

These training modules on male and female condoms are designed specifically for providers who most often provide family planning services in low-resource settings, making them essential for those working in that context. Providers do need basic literacy skills. The training modules are comprehensive and include slides, role-plays, case studies, practice sessions, and competency-based skill assessments.

Developed by a consortium led by USAID, WHO, and UNFPA, the Training Resource Package for Family Planning (TRP) is a comprehensive set of materials designed to support up-to-date training on family planning and reproductive health design, implementation, and evaluation. It includes the learning objectives necessary to effectively describe the condom characteristics, counsel clients on best practices, and demonstrate the ability to conduct routine follow-up for clients. Developed using evidence-based technical information, the TRP was designed to actively involve the trainees in the learning process. About United States Agency for International Development The United States Agency for International Development (USAID) is the world's premier international development agency and a catalytic actor driving development results. USAID works to help lift lives, build communities, and advance democracy. USAID's work advances U.S. national security and economic prosperity, demonstrates American generosity, and promotes a path to recipient self-reliance and resilience. About World Health Organization The World Health Organization (WHO) is the United Nations agency that connects nations, partners, and people to promote health, keep the world safe and serve the vulnerable—so everyone, everywhere can attain the highest level of health. About United Nations Family Planning Agency United Nations Family Planning Agency (UNFPA) is the United Nations sexual and reproductive health agency with a mission to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled.

USAID, WHO, and UNFPA (2021)

Training Resource Package for Family Planning: Male Condoms module and Female Condoms module

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Why is it essential?

As an underutilized family planning method, female condoms have been identified as a valuable contraceptive option because of the potential female self-care and autonomy provided. Demand generation programs, when well-designed and implemented, can help countries reach the goal of increased utilization of contraception. The six-step communication strategy is adaptable and includes a compendium of ready-to-use messaging as well as an extensive list of linked references.

This strategy document from the Health Communication Capacity Collaborative, led by UNICEF and USAID, outlines essential step-by-step guidance, specific strategies, and illustrative content for a communication strategy that is essential to generate demand for female condoms. The guide presents program managers and technical advisers with key questions to consider for female condoms when working on audience and communication analyses, potential linkages to other interventions, and considerations for monitoring and evaluating the communication activities. The strategy is useful for multiple audiences, including staff from ministries of health, non-governmental organizations, and community-based organizations. About Health Communication Capacity Collaborative From 2012 to 2017, the Health Communication Capacity Collaborative (HC3) was USAID’s flagship social and behavior change communication (SBCC) project. The five-year global project strengthened developing country capacity to implement state-of-the-art SBCC programs.

Health Communication Capacity Collaborative (2014)

An Adaptable Communication Strategy for Demand Generation—Female Condoms

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Why is it essential?

The Total Market Approach (TMA) is an essential concept as condom subsidies are shifted to a more diverse market that includes commercial players. The tool provides technical information and guidance to increase the size of the total market while increasing sustainability, reduce subsidies through more effective targeting, increase access for some underserved consumer segments and reduce the burden on the public sector by increasing the commercial sector’s share of the produce or service provision. This resource includes elements of a national condom strategy based on TMA as well as practical guidance for developing and adopting the strategy.

This framework, developed by SHOPS for funders, program managers, and policymakers, presents key strategies and indicators for each stage of condom market development within the public, nonprofit, and commercial sectors. Over 46 pages, the resource outlines how to strengthen sustainable condom markets in countries by moving away from donor-funded demand-creation programs and transition to commercial suppliers. Charts, questions to consider, and case examples throughout the resource make the strategies tangible and easier to understand. About United States Agency for International Development The United States Agency for International Development (USAID) is the world's premier international development agency and a catalytic actor driving development results. USAID works to help lift lives, build communities, and advance democracy. USAID's work advances U.S. national security and economic prosperity, demonstrates American generosity, and promotes a path to recipient self-reliance and resilience. About U.S. President's Emergency Plan for AIDS Relief U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is the largest commitment by any nation to address a single disease in history, enabled by strong bipartisan support across nine U.S. congresses and three presidential administrations, and through the American people's generosity. About SHOPS The Strengthening Health Outcomes through the Private Sector (SHOPS) project is USAID’s flagship initiative in private sector health. SHOPS focuses on increasing availability, improving quality, and expanding coverage of essential health products and services in family planning and reproductive health, maternal and child health, HIV and AIDS, and other health areas through the private sector.

USAID, PEPFAR, and SHOPS (2015)

Using Total Market Approaches in Condom Programs—USAID SHOPS project primer/framework

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Why is it essential?

Female condoms are underutilized and included in programs; however, moderate investments and initiatives have drawn attention to the importance of this method and developing robust female condom markets. This resource can be used by those working in countries in an early or nascent stage in the market development of female condoms to better understand challenges and barriers to developing the market further based on experiences in Malawi and Zambia.

This Total Market Approach (TMA) outlines essential strategies that increase access to priority health products and services for female condoms, which have been identified as an underutilized family planning tool with significant potential and self-care opportunity. The TMA approach for female condoms is in the early stages in both Malawi and Zambia, but national strategies have committed to applying TMA to condom programming. There is still great opportunity for enhancing technical capacity for implementing and monitoring these strategies. Under the United States Agency for International Development-funded Expanding Effective Contraception Options (EECO) project, WCG Cares conducted a TMA assessment from June to August 2018 in each country through a desk review of relevant literature and interviews with key stakeholders to identify market failures in the female condom ecosystem and opportunities for growth. The report also outlines a brief history of the female condom, the state of the female condom market, and complete findings of the TMA and potential capacity of each country. Using the knowledge and capacity of both countries, the team generated five general solutions in the Zambia and Malawi contexts combined: 1. Assign a female condom champion. 2. Do not assume that all female condom users are the same. 3. Invest in demand generation, monitoring, and evaluation. 4. Leverage existing platforms for family planning and HIV prevention. 5. Do not assume that male and female condoms are the same in terms of market and supply. About United States Agency for International Development The United States Agency for International Development (USAID) is the world's premier international development agency and a catalytic actor driving development results. USAID works to help lift lives, build communities, and advance democracy. USAID's work advances U.S. national security and economic prosperity, demonstrates American generosity, and promotes a path to recipient self-reliance and resilience. About U.S. President's Emergency Plan for AIDS Relief U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is the largest commitment by any nation to address a single disease in history, enabled by strong bipartisan support across nine U.S. congresses and three presidential administrations, and through the American people's generosity. About Expanding Effective Contraception Options Expanding Effective Contraception Options (EECO) is designed to support the introduction of five new contraceptive methods that will address method-related reasons for non-use and better meet the reproductive health needs of women and girls. About WCG As a woman-led organization, WCG is dedicated to ensuring that women around the world, regardless of location or socio-economic status, have access to reproductive health solutions.

USAID, PEPFAR, EECO, and WCG (2018)

Assessing the Total Market for Female Condoms in Malawi and Zambia

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Why is it essential?

As a global normative agency, WHO is known worldwide for its leadership, research, and standard-setting. The WHO’s level of credibility is valuable for decision-makers' ability to trust new evidence and take action. This WHO self-care guideline specifically highlights the correct and consistent use of condoms as a recommended self-care mechanism, especially among key populations. Program managers and technical advisors can identify through these guidelines how recommendations for condoms fit into existing guidelines on self-care in family planning, intimate partner violence, sexual violence, sexual health, training of health care workers, and considerations during humanitarian crises.

The 2021 version of WHO’s guideline on self-care interventions for health is an update of the original guideline launched in 2019 that consolidates both new and existing recommendations. Evidence-based self-care interventions included in the guidelines can help advance health equity worldwide—supported by high-quality programs and services. As a self-administered family planning method, condoms are considered a self-care intervention for health. This guideline highlights people-centered primary health care, with emphasis on sexual and reproductive health, and noncommunicable diseases. The new recommendations are accompanied by a series of good-practice statements on key programmatic, operational, and service-delivery issues that must be addressed to promote and increase safe and equitable access, uptake, and use of self-care interventions; and key considerations on specific topics to guide future research and guidelines processes. While condoms are noted throughout the guideline as one of the most effective methods of protection against STIs, it also makes two recommendations specific to condom use: 1. encouraging consistent condom use as a method to protect against HIV, STIs, and unintended pregnancy; and 2. using condom-compatible lubricant. About World Health Organization The World Health Organization (WHO) is the United Nations agency that connects nations, partners, and people to promote health, keep the world safe and serve the vulnerable – so everyone, everywhere can attain the highest level of health.

World Health Organization (2021)

WHO consolidated Guideline on Self-Care Interventions for Health and Well-Being

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Why is it essential?

It is important for decision-makers, bulk procurement agencies, social marketing programs, and national regulatory authorities to know how to apply the essential elements of condom quality assurance to guarantee that a quality product is purchased, promoted, and distributed to the end-user. Poor-quality condoms adversely affect promotion, programs, budgetary resources, and the credibility of the device.

While condom manufacturing has not changed in decades, the quality of the product has been significantly improved by better processes and standards of production. This document outlines UNFPA’s technical requirements, specifications, and guidelines for the procurement of male/external latex condoms. It gives submitters the necessary information to understand UNFPA’s technical requirements based on the current standards and regulations. Requirements are presented in multiple, clearly organized tables throughout the document. The document is primarily meant for decision-makers, managers, or procurement officers versed in procuring natural latex male condoms, but the resource can also be reviewed by others working in reproductive health programs. About United Nations Family Planning Agency United Nations Family Planning Agency (UNFPA) is the United Nations sexual and reproductive health agency with a mission to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled.

UNFPA (2013)

Male Latex Condom Procurement Specification

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Why is it essential?

The tool estimates female and specialty condoms and extra lubricant needs and costs, which is a crucial need for program implementers around the world. It also promotes an interactive and facilitated approach for strategic dialogue on condom programming, which addresses the known need for multi-stakeholder partnerships to drive the scale-up of condoms globally and at the country level.

This unique Excel tool, developed jointly by UNFPA and UNAIDS, provides essential support to countries to develop and implement robust, comprehensive, and people-centered condom programs by estimating country and community total condom needs and commodity costs for a period of 3-5 years up to 2023. In addition, it estimates male, female, and special condoms and extra lubricant needs and costs. The tool provides a standardized methodology to estimate program costs based on UNFPA's Comprehensive Condom Program (CCP) framework (leadership and coordination, demand creation, commodity security, support). It also allows the mapping of available funds against the estimated total program costs, creating an estimate of the financial gap. About United Nations Family Planning Agency United Nations Family Planning Agency (UNFPA) is the United Nations sexual and reproductive health agency with a mission to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled. About Joint United Nations Programme on HIV/AIDS Joint United Nations Programme on HIV/AIDS (UNAIDS) is leading the global effort to end AIDS as a public health threat by 2030 as part of the Sustainable Development Goals.

UNFPA and UNAIDS (2019)

Condom Needs and Resource Requirement Estimation Tool

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Why is it essential?

While this resource is not specific to condoms, it is a tool that guides program designers and implementers through a framework of ‘consumer-powered healthcare’. The resource draws on behavioral theory, market principles and practices, health expertise, user-centered design, and consumer insights. Program managers and technical advisors following this guide will learn how to create and promote sustainable healthcare markets and influence consumer behavior for condom use.

The Keystone Design Framework is a tool PSI developed for implementers or government representatives when analyzing reproductive health need and designing a response. The framework works well for market-based approaches, such as expanding condom use. The tool goes through diagnosing gaps using public health data and human-centered design processes to determine what strategies might be most successful, design with user input, and deliver interventions. About Population Services International Population Services International (PSI) is a non-profit organization working in international development to tackle health challenges facing people around the world. The organization’s practice areas include sexual and reproductive health, water, sanitation, and hygiene, malaria, HIV/TB, and non-communicable diseases. PSI’s mission is to make it easier for all people to lead healthier lives and plan the families they desire.

PSI (2018)

The Keystone Design Framework

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Why is it essential?

Because of the positive impact of lubricants on reducing incidents of condom failure and its frequent use by key populations, lubricants play an important role, and they mustn't be forgotten in condom procurement and promotion. This advisory note, produced by the WHO, UNFPA, and FHI 360, covers the use and procurement of additional lubricants for male and female condoms.

Additional lubricants, supplied separately and applied to the condom or body at the time of intercourse, are sometimes used to improve comfort during intercourse. There is a significant demand for additional lubricants to be used with condoms, particularly for MSM, female sex workers, and women in menopause. This advisory note covers the impact of lubricants on condom failure rates, what types of lubricants should be procured, condom compatibility, safety issues, and technical recommendations for lubricant and condom use. About World Health Organization The World Health Organization (WHO) is the United Nations agency that connects nations, partners, and people to promote health, keep the world safe and serve the vulnerable—so everyone, everywhere can attain the highest level of health. About United Nations Family Planning Agency United Nations Family Planning Agency (UNFPA) is the United Nations sexual and reproductive health agency with a mission to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled. About FHI 360 FHI 360 is a nonprofit human development organization dedicated to improving lives in lasting ways by advancing integrated, locally driven solutions.

WHO, UNFPA, FHI 360 (2012)

Use and Procurement of Additional Lubricants for Male and Female Condoms

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Why is it essential?

Facing the high levels of HIV, STIs, and pregnancy among adolescents, decision-makers continue to explore interventions that increase access to condoms. Once a CAP is in place, students utilize it, and condom use increases, which translates to improved sexual health outcomes. The evidence is essential in promoting the availability and supply of condoms as a valuable contraceptive tool among adolescents. It can also be used to correct pervasive misconceptions about condom availability leading to promiscuity.

This global literature review of condom availability programs (CAPs) at the high school level investigates the arguments of the opponents of CAPs. CAPs, when implemented with best practices noted in the review, show promise in reducing barriers adolescents face when obtaining condoms in spaces outside of schools. This is the first review to evaluate CAPs at a global level. There are other CAPs reviews at community and country levels. The review looks at the impact of CAPs on condom uptake/acquisition, impact on student’s sexual behavior, students’ and parents’ attitudes toward CAPs, and impact on other health outcomes (STIs, HIV, and pregnancy rates). This review confirms that CAPs do not increase sexual activity nor lead to a greater number of sexual partners and disproves fears or incorrect assumptions that condom availability promotes promiscuity. About Journal of Adolescent Health The Journal of Adolescent Health is a multidisciplinary scientific journal dedicated to improving the health and well-being of adolescents and young adults. The journal publishes new research findings in the field of Adolescent and Young Adult Health and Medicine ranging from the basic biological and behavioral sciences to public health and policy.

Journal of Adolescent Health (2019)

A Systematic Global Review of Condom Availability Programs in High Schools

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Why is it essential?

This brief is necessary for decision-makers and technical advisors in countries preparing funding requests to launch or expand comprehensive condom programs. It provides several best practices and considerations from programmatic experience with a variety of populations to model after and incorporate into requests and program plans.

The UNFPA and UNAIDS report, published in 2020 by the Global Condom Working Group, provides guidance and best practices for the design and implementation of condom programs in countries with a moderate-to-high burden of HIV, which indicates a need for strong condom programs as part of the national HIV prevention strategy and to prevent sexually transmitted infections (STIs) and unintended pregnancies. The guidance in this document can be used to support the development of national condom programs and decisions on allocating resources for condom programming as contraception and the prevention of HIV and other STIs. About United Nations Family Planning Agency United Nations Family Planning Agency (UNFPA) is the United Nations sexual and reproductive health agency with a mission to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled. About Joint United Nations Programme on HIV/AIDS Joint United Nations Programme on HIV/AIDS (UNAIDS) is leading the global effort to end AIDS as a public health threat by 2030 as part of the Sustainable Development Goals.

UNFPA and UNAIDS (2020)

Developing Effective Condom Programmes Technical Brief

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Why is it essential?

In light of tremendous demographic shifts, support for condom programs is essential. The review emphasizes the opportunity of condoms as an evidence-based contraception option, especially among adolescent and young populations, as well as the need for adequate funding of condom programs. Technical advisors and program managers can use this resource to understand the landscape of marketing techniques, marketing theories, and condom promotion studies. New intervention strategies using digital media, the channel most widely used among priority populations, are also presented.

This systematic review, sponsored by the United Nations Family Planning Agency (UNFPA), identified and analyzed 99 articles published between 2000 and 2019 on condom promotion programs, with a focus on promotion in low- and lower-middle-income countries and with adolescent and young populations. It confirms condoms as inexpensive, cost-effective products to reduce HIV/STI incidence, morbidity, mortality, and unintended pregnancies, and resulting in health care cost savings. A few articles of interest include “impact of a social franchise intervention program on the adoption of long- and short-acting family planning methods in hard to reach communities in Myanmar” by Aung et al (2019); “POWER for reproductive health: Results from a social marketing campaign promoting female and male condoms” by Bull et al (2008); and “Stakeholder perceptions of a total market approach to family planning in Vietnam” by Drake et al (2010). About International Journal of Environmental Research and Public International Journal of Environmental Research and Public Health is an interdisciplinary, peer-reviewed, open access journal published semimonthly online by MDPI. It covers Environmental Sciences and Engineering, Public Health, Environmental Health, Occupational Hygiene, Health Economic and Global Health Research, etc.

International Journal of Environmental Research and Public Health (2020)

Systematic Review of Peer-Reviewed Literature on Global Condom Promotion Programs

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Why is it essential?

The resource is important for decision-makers advocating for and making investments to strengthen condom markets. Program managers, technical advisors, and conveners can also use the findings of this study to recommend certain investments in consumer research and distribution system improvements, demand generation, and market facilitation for condoms.

This study in Zimbabwe conducted by Population Services International focuses on the results of a social marketing intervention with a price increase in a socially marketed condom and a public sector condom. The study found no significant difference in sales between experimental and control districts, no significant differences in brand preference among traders, and a significant increase in emotional attachment and beliefs about condoms efficacy amongst consumers in experimental districts. About Population Services International Population Services International (PSI) is a non-profit organization working in international development to tackle health challenges facing people around the world. The organization’s practice areas include sexual and reproductive health, water, sanitation, and hygiene, malaria, HIV/TB, and non-communicable diseases. PSI’s mission is to make it easier for all people to lead healthier lives and plan the families they desire.

PSI (2019)

Strategic Donor Investments for Strengthening Condom Markets: The Case of Zimbabwe

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Why is it essential?

The resource highlights the triple protection (STIs, HIV, and unintended pregnancy) nature of condoms and the importance among many key populations. The needs raised by this study call for program managers, technical advisors, and conveners to consider pointed integration activities and increasing awareness and agency of female sex workers when strengthening integrated HIV and family planning service delivery.

The 2019 study using programmatic surveillance, conducted by Jhpiego, analyzed protection against sexually transmitted infections/HIV and unintended pregnancy (dual method use of contraceptives as well as condoms) among the key population of female sex workers; a key population identified as at a higher risk of HIV, STIs, and unintended pregnancy related to many factors, including discrimination and lack of access to needs. The study found that dual method use was quite low in a routine service provision setting when compared to other research findings conducted in the region. About the Sauti Project Sauti ("Voices") Project is a five-year, USAID-funded effort to help Tanzania’s Ministry of Health and the Tanzania Commission for AIDS operationalize the new National Guidelines for Comprehensive Package of HIV Interventions for Key Populations, which will direct the provision of health and HIV services among vulnerable demographics.

Sauti Project (2019)

Consistent Condom Use and Dual Protection Among Female Sex Workers: Surveillance Findings from a Large-Scale, Community-Based Combination HIV Prevention Program in Tanzania—AIDS and Behavior 24, 802-811

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Why is it essential?

As the only contraceptive option that offers triple protection from HIV, STIs, and unintended pregnancy, condoms serve as a unique and powerful SRH tool. This case study concludes that long-acting reversible contraceptive users in the study reported less consistent condom use and were more likely to acquire a sexually transmitted infection in the 12 months following LARC initiation.

This study compared changes in condom use and incidence of sexually transmitted infection acquisition among new initiators of long-acting reversible contraceptives to those initiating non-long-acting reversible contraceptive methods. Data from the Contraceptive CHOICE project was analyzed for two sample populations of contraceptive users that either self-reported condom use continuously for 12 months or reported sexually transmitted infection status for 12 months. Results show that few participants in either group reported consistent condom use across the 12 months with all partners. About the American Journal of Obstetrics and Gynecology The American Journal of Obstetrics and Gynecology, “The Gray Journal,” covers the full spectrum of obstetrics and gynecology. The journal aims to publish original research (clinical and translational), reviews, opinions, video clips, podcasts, and interviews that will have an impact on the understanding of health and disease and that has the potential to change the practice of women's health care. An important focus is the diagnosis, treatment, prediction, and prevention of obstetrical and gynecological disorders. The journal also publishes work on the biology of reproduction, and content that provides insight into the physiology and mechanisms of obstetrical and gynecological diseases.

American Journal of Obstetrics and Gynecology (2017)

Condom Use and Incident Sexually Transmitted Infection After Initiation of Long-Acting Reversible Contraception

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Why is it essential?

The study highlights the vital need to debunk inaccurate knowledge and misconceptions and to properly educate adolescents on safe sex practices, including the use of condoms. Technical advisors and program managers will benefit from acknowledging persistent beliefs and misconceptions when designing and assessing condom use in programs with adolescents and young people.

This 2021 qualitative study explored potentially dangerous misconceptions about condoms and other methods of preventing pregnancy among urban and rural and in-school and out-of-school unmarried Nigerian adolescents between the ages of 8 and 13. The study used focus group discussions to assess adolescent’s correct understanding of various types of contraceptives and how they are used. The adolescents named many incorrect emergency contraceptive methods and misunderstandings about emergency pills, male condoms, and varied notions of sexual pleasure with contraception. About BMC BMC Public Health is an open-access, peer-reviewed journal that considers articles on the epidemiology of disease and the understanding of all aspects of public health. The journal has a special focus on the social determinants of health; the environmental; behavioral and occupational correlates of health and disease; and the impact of health policies, practices, and interventions on the community. BMC Public Health does not publish clinical research: this should be submitted to the relevant BMC Series medical journal.

BMC (2021)

Beliefs and Misconceptions about Contraception and Condom Use Among Adolescents in Southeast Nigeria

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Why is it essential?

While this brief aims to ensure that the COVID-19 pandemic does not disrupt the supply of and demand generation for condoms, lessons learned from this 2020 UNFPA brief can be applied to emergencies and crisis situations going forward. Sexual behaviors are transformed in emergency contexts, but family planning and SRH services are always necessary.

This three-page brief, published by the UNFPA, Global HIV Prevention Coalition, and UNAIDS in the early days of the global coronavirus pandemic, is intended for country condom program managers and experts. The three main sections of the brief provide a summary of relevant actions to sustain supplies and demand generation of male condoms, female condoms and lubricants, and how to adjust approaches for condom promotion during the time of COVID-19. The brief was produced to mitigate any disruptions to the supply of and demand for condoms during the COVID-19 pandemic. About United Nations Family Planning Agency United Nations Family Planning Agency (UNFPA) is the United Nations sexual and reproductive health agency with a mission to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled. About Global HIV Prevention Coalition The Global HIV Prevention Coalition was established in October 2017 to galvanize greater commitment to and investment in HIV prevention, and to agree on a road map to achieve the 2020 targets. About UNAIDS UNAIDS is leading the global effort to end AIDS as a public health threat by 2030 as part of the Sustainable Development Goals.

UNFPA, Global HIV Prevention Coalition, and UNAIDS (2020)

Condoms and Lubricants in the Time of COVID-19

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Why is it essential?

Identified as an underutilized product with enormous potential impact, demand must be generated, sustained, and met globally for the female condom as a contraceptive option. Program managers, technical advisors, and conveners may use the information presented in the videos for training programs with providers or advocacy with government entities.

The FC2 Female Condom Masterclass Episodes provides free, online training sessions through a series of nine episodes on the FC2 female condom. The episodes range from six to 35 minutes and cover the development of the female condom, sexual and reproductive health, setting up for program success, gender considerations, values-based communication, behavior change, pleasure, and negotiation skills. The series of videos provide helpful, informal yet informative language and tips for advocacy to increase utilization and demand for female condoms by women and men. About FC2 FC2 is the brand name of the female condom created by Veru Pharma, a biopharmaceutical company that’s dedicated to the development and commercialization of drug candidates to address unmet medical needs.

FC2 (2020)

FC2 Female Condom Masterclass Episodes

The Impact of Population, Health, and Environment Project

The Evidence Project (2015)

Details

Introductory

Healthy People, Healthy Ecosystems Projects

World Wildlife Fund (2008)

Details

Introductory

Family Planning HIPs Can Improve PHE Program Outcomes

Population Reference Bureau (2018)

Details

Introductory

The Impact of Population, Health, and Environment Project

The Evidence Project (2015)

Details

Introductory

Healthy People, Healthy Ecosystems Projects

World Wildlife Fund (2008)

Details

Introductory

Family Planning HIPs Can Improve PHE Program Outcomes

Population Reference Bureau (2018)

Details

Introductory

PHE as a Biodiversity Conservation Strategic Approach

ICF, Environmental Incentives (2018)

Details

Introductory

PHE eLearning course

Global Health eLearning Center (2016)

Details

Introductory

Removing Barriers to FP: Background Paper and Call to Action

Margaret Pyke Trust (2019)

Details

Introductory

PHE Integration Programming Manual

PHE Ethiopia Consortium (2018)

Details

Evidence & Impact

PHE Partnerships Guide

PHE Network Madagascar, Blue Ventures (2017)

Details

Evidence & Impact

PHE Approaches Enhance Youth Leadership and Development

PACE (2018)

Details

Evidence & Impact

New Research Links FP and MCH to Boosting Resilience

PACE (2018)

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Evidence & Impact

A Guide for Monitoring and Evaluation PHE Programs

MEASURE Evaluation (2018)

Details

Program Examples

Linking FP to Resilience in the Sahel

Evidence to Action Project (2019)

Details

Program Examples

HoPE-LVB Interactive Toolkit

Pathfinder International (2017)

Details

Program Examples

Community of Hope: A Look at HoPE-LVB Project

PACE (2018)

Details

Program Examples

Institutionalizing Integration through PHE Advocacy in East Africa

Pathfinder International (2018)

Details

Training

Working Together: PHE in Madagascar

John Snow Inc (2019)

Details

Training

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Why is it essential?

Currently, there are limited free, e-training courses on family planning that are open and accessible globally. The course material features essential information specific to condoms as a family planning mechanism and a condom use toolkit. Program managers and technical advisors can use elements of the course to orient new staff to the benefits and best practices of condoms as a family planning method.

This course provides a comprehensive overview of the basic information relevant to family programs and services. The eight parts of this overview include the rationale for voluntary FP, contraceptive method considerations, contraceptive options, contraceptive security, needs for certain populations, quality and access, service delivery, and provider training. Information on condoms generally and on the acceptability of condoms can be found in the section on short-acting contraceptive methods. The end of each session has a short knowledge recap quiz leading up to a user-friendly final exam at the end to pass the course comprising mostly multiple-choice and true/false questions. About Global Health eLearning Center The Global Health eLearning Center is a USAID-funded platform that provides a variety of courses for the public working in health. A majority of the learners come from outside of USAID staff and partners.

Global Health eLearning Center (2019)

Family Planning 101—Condoms Section

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Why is it essential?

Global Health eLearning Center (2019)

Family Planning 101— Condoms Section

Chapter 14 (External/Male)

Chapter 15 (Internal/Female

Female Condoms Module

How to use this collection

Full Handbook

Chapter 14 (External/Male)

Male Condoms Module