Despite being available in Asia as early as 1995, the female condom remains surprisingly underused in the region. While this can be said of global north countries as well, failed attempts to promote higher usages in countries like Vietnam, Thailand and Indonesia are a reflection of narrowly-perceived target groups, high costs and lack of political will. 

Available in Europe since 1992 and approved by the US Food and Drug Administration in 1993, the female condom is currently used in public health programs in 108 countries and is commercially marketed directly to consumers in ten countries. Yet, for the Asia-Pacific region, in ten years since its introduction, less than 1 million female condoms had been distributed amongst a population of close to 1 billion women of reproductive age. At the 7th International Congress on AIDS in Asia and the Pacific, held in Japan in 2005, it was recognized that both demand and political will needs to be built. As is a pertinent problem around the globe, this demand must be met by access.

So the question remains: Are low rates of usage a problem of access, demand or both? Demand may be affected by problems with the condom itself. Some women cite difficulties in insertion, the size of the condom and its visual appearance as well as challenges in negotiating with male partners as reasons to explain its lack of acceptability. On the other hand, while there has been a range of promotional programs to increase support and use for the female condom in such countries as South Africa, Ghana, and Brazil, with support from UNAIDS and Governments, this uptake has not been matched in the Asia region.

Rather, in countries like Thailand and Vietnam the focus has largely been on female sex workers, this approach already creating stigma around the female condom's use. In a trial conducted in Vietnam in 2000, under a joint UNAIDS and World Health Organization initiative, 481 women in districts around Hanoi were invited to use the female condom. Among the 428 women who actually ended up using the condom, more than half affirmed that female condoms were acceptable and 230 said they would continue to use them if they were provided free of charge, or if they could buy them at a suitable price. Unfortunately, one of the study's recommendations was giving priority to sex workers and women with STIs in order to help them prevent the spread of STIs and HIV/AIDS, ignoring the interests of all women who might choose to use the female condom if it was more readily available. In Vietnam, where sexual violence including marital rape remains a pressing issue, the value of the female condom for women's ability to protect themselves against unwanted pregnancy should not be understated.

Similarly in other countries, distribution and cost are blamed for low female condom use. In Indonesia, which Family Health International ranks the lowest in terms of condom usage in Asia, the strong patriarchal culture and sporadic approach to promoting condoms are blamed for the low usage. In an attempt to address rising rates of HIV in Indonesia, the government ran a trial of female condoms in selected areas of Papua in August 2006. In response to the initial success, the government launched a national female condom program in February 2007. Yet, six months later, local groups in the Papuan provincial capital, Jayapura, criticized the poor distribution and high cost of the female condoms at 15,000 rupiahs, or US$1.60 for a pack of two.

Narrow-mindedly, some activists in Indonesia have criticized the female condom, arguing that it is "once again, putting the burden on women." Rather than seeing it as a tool for empowerment, these activists fear women will be blamed when HIV infections remain uncontrolled in ten years time. They also insist that campaigns continue to call on men not to have unsafe sex with sex workers rather sending the message that men should not have sex with their wives without using condoms.  

Of course, the higher price of the female condom over the male condom remains an obstacle. Though the newer FDA approved version of the female condom is 30 percent less expensive than its predecessor, prices still ranging from US$1.40 to US$2.10 for consumers, considerably higher than the male condom and out of the price range for many women. However, economies of scale suggest that the price will decrease as demand increases, which will allowing the female condom to be a tool for empowerment that it was initially seen to be. Further research must also be undertaken. In 2004, the Guttmacher Institute, calling for a renewed commitment to research on the acceptability and implementation of female condom programs, highlighted the short-term nature of many studies on female condom use, with only a few studies tracking use beyond six months. 

The female condom gives women more options and empowers them to have control over their own lives. Interestingly, some studies have revealed that female condom has opened the door for women to discuss sex with their partners. With global efforts, including advocacy, program scale-up, public and private sector investment, to overcome some of the negative perceptions and the very real barriers to accessing the female condom, such as costs, women in Asia can join others around the world who currently benefit from its use.