Interaction of condom design and user techniques and condom acceptability

Area of Science:

• Public Health
• Reproductive Health
• Materials Science

Background:

• Public sector condom supply in an African nation shifted from USAID to WHO in 1991.
• Complaints arose regarding the quality and performance of WHO-supplied condoms compared to USAID ones.

Purpose of the Study:

• To compare laboratory quality of USAID and WHO condoms.
• To investigate the reasons behind reported condom failures and user dissatisfaction.
• To inform design modifications for improved condom usability.

Main Methods:

• Laboratory analysis of condom physical properties and lubricant levels.
• Field interviews with end-users, particularly sex workers, and program educators.
• Correlation of laboratory findings with user-reported issues.

Main Results:

• Laboratory tests confirmed WHO condoms were of adequate quality but showed differences in lubricant quantity, width, and thickness compared to USAID condoms.
• User dissatisfaction was concentrated among a specific group receiving instructions from educators, suggesting user error.
• Lower lubricant levels and slight dimensional differences were noted but within commercial market ranges.

Conclusions:

• Reported condom failures were primarily linked to incorrect application, exacerbated by specific usage instructions, rather than inherent condom defects.
• WHO condom design modifications were implemented to reduce the likelihood of incorrect use.
• Effective user education is crucial for optimal condom performance and safety.