Relaunch: An AI-Powered Multilingual SRHR Companion for Women and Girls
For more than two decades, the female and inner condom has been recognised as one of the few HIV prevention technologies that simultaneously prevents HIV, other sexually transmitted infections and unintended pregnancy while giving the receptive partner greater control over protection. Despite this, the product has remained largely absent from public health conversations, national prevention campaigns and routine service delivery across much of Africa.
When discussions about the FC2 do occur, they often arrive at the same conclusion: demand is low. Yet remarkably little evidence exists to explain why. Is the product genuinely unwanted? Or have health systems failed to create the conditions that allow women and other users to choose it?
To answer these questions, the African Alliance undertook a multi-country assessment across Zimbabwe, Kenya, Zambia, the Democratic Republic of the Congo. Rather than focusing only on individual knowledge or behaviour, the research examined the wider ecosystem that determines whether the FC2 is available, promoted and supported. We explored procurement systems, financing, policy implementation, provider training, community engagement, supply chains, social norms and the role of civil society in shaping access to the product.
Our objective was not simply to measure awareness or document distribution figures. It was to understand why countries with policies supporting the FC2 continue to experience limited uptake, and to identify the structural barriers and opportunities that influence demand creation.
The findings challenge many long-held assumptions. Across the countries studied, stakeholders consistently pointed away from women themselves and towards the systems surrounding them. The evidence suggests that low uptake is less a reflection of individual choice than of inconsistent procurement, declining provider confidence, fragmented coordination, insufficient investment in community-led demand creation, and the gradual erosion of political and programmatic priority.
Understanding these systemic barriers is essential. Expanding access to the FC2 will require more than communication campaigns or commodity procurement alone. It requires health systems that consistently make the product visible, available, affordable, trusted and easy to access. This research was undertaken to provide governments, civil society, donors and implementing partners with the evidence needed to build those systems.
Key Findings Across Africa
Supply shapes demand
Supply shapes demand
Supply shapes demand
Supply shapes demand
Supply shapes demand
Supply shapes demand
Regional Report
Rather than asking why women are not choosing the FC2, we asked a different question:
What within our health systems makes choice possible, or impossible?
Our research explored procurement, financing, provider training, community engagement, gender norms and policy to identify the structural barriers preventing women from accessing the FC2.
Supply shapes demand
Across every country, stakeholders challenged the idea that FC2 uptake is limited by women’s interest. The stronger explanation is that inconsistent procurement, weak distribution and declining visibility suppress demand before women ever have the opportunity to choose.
Procurement determines visibility
Products that disappear from procurement rapidly disappear from clinics, training programmes and public awareness.
Demonstration changes behaviour
The FC2 is a skills-based prevention technology. Providers who can confidently demonstrate correct use generate substantially higher uptake than those relying on verbal counselling alone.
Data remains weak
Most countries cannot accurately report FC2 distribution or uptake, limiting accountability and evidence-based planning.
Community organisations are the system
Civil society organisations consistently carry responsibility for education, demand generation and last-mile distribution, particularly among communities underserved by routine health services.
Domestic ownership matters
Heavy reliance on donor procurement has exposed FC2 programmes to funding shocks. Long-term sustainability requires predictable domestic financing and stronger national ownership.
Partners
Kenya
- Ministry of Health’s Family Planning Programme and the National Syndemic Diseases Control Council (NSDCC).
- Hostess Empowerment & Support Programme (BHESP),
- Coast Sex Workers Alliance (COSWA), Cheer Up Program,
- Divas of Changamwe,
- International Centre for Reproductive Health (ICRH),
- Kiambu Sex Workers Alliance (KIASWA), Kisumu
- Sex Workers Association (KISWA),
- Link Empowerment Initiative,
- Sex Workers Outreach Program (SWOP).
DRC
- Fondation Marie Claire
- Association D’encadrement Des Personnes Vulnerables
- International Youth Alliance For Family Planning (IYAFP)
- Trois Fois Saint (TROFOS)
- Forum Sida (FOSI)
- UCOP+
- Pyramide
- Jeunes Eclaires Contre Le Sida (JECS)
- Action pour le Dévelopement des Milieux Défavorisés (ADMD)
- Fondation Femmes Plus
Zambia
- Ministry of Health (MoH), the National AIDS Council (NAC),
- Zambia Medicines and Medical Supplies Agency (ZAMMSA)
- Network of Zambian People Living with HIV (NZP+),
- Zambia Network of Young People Living with HIV (ZNYP+),
- Edutainment Health Foundation (EHF),
- Treatment Advocacy & Literacy Campaign (TALC),
- Common Grounds, Dignitate Zambia Limited,
- Decisive Minds,
- Key Populations Alliance of Zambia
Zimbabwe
- CeSHHAR facilities in Harare, Mutare, and Bulawayo
- Pangaea Zimbabwe AIDS Trust (PZAT)
- City Health Departments in Masvingo and Bulawayo
- Forbes Clinic