THE STRUGGLE TO BRING FEMALE CONDOMS TO THE MASSES ISN'T JUST ABOUT DESIGN INNOVATION

As a trip to an impoverished Brazilian community shows, women can learn to love the female condom and it can save lives. But more than anything else, education is what is needed.

The female condom is more difficult to use than the male condom, it's expensive, women often complain that it feels uncomfortable at first, and perhaps most frustratingly, it's often put on the backburner in favor of male condoms by organizations that promote safe sex. Despite a lot of talk about new innovation, the fact remains that the contraceptives remain in the shadow of male condoms.

Not that you'd ever know any of these things from talking to Camila, a gregarious hairdresser and female condom advocate living in the impoverished Coelhos community in Recife, Brazil.

To get to Camila's small two-story house, I walk down a series of worn cobblestone streets and past a large Afro-Brazilian center of worship, which sits next to a smaller Christian church. The neighborhood smells of sewage, and still water lines the streets. I'm accompanied by a pair of community health workers, who check up the health of local citizens about once a month, and three women from Gestos, a local nonprofit that advocates for the rights of people dealing with HIV/AIDS and STDs.

Camila is 30, with two children and a boyfriend. At one point, she used an injectable contraceptive, but ultimately stopped because of weight gain. Before being approached by the Gestos women, she had only seen a female condom at a school science fair.

Camila had heard they were expensive--and at 12 to 15 reais, or about $6 to $8 dollars, they are. But the Brazilian government gives them away for free (Brazil and South Africa are the only countries to do this), and she never knew they were available at no cost from her local health clinic until Gestos showed up.

"There are no downsides [to the female condom]," she says. "It's quite the contrary. I prefer the female condom. It's practical, and I can put it on eight hours before intercourse." Plus, Camila adds, it's more well-lubricated than the male condom.

Brazil is a culture of machismo, where men often call the shots in relationships. The female condom empowered Camila; her boyfriend used to be opposed to condom use in general, but once she gained the ability to decide whether to use a condom, the conversation changed. When Camila's boyfriend first saw the female condom, she told him he would either like it or not have any sex. So he decided to like it, or at least to tolerate it.

Now, Camila is a female condom proselytizer, telling all her clients to give them a try when they stop by her living room hair salon. Many of them had never heard of the female condom before. And she is clearly enthusiastic about spreading the word, giving me and the other journalists in my group a detailed demonstration on female condom use.

Down the street from Camila, in a much smaller cement home, a 38-year-old woman named Rosa lives with her husband and four children. Rosa says she has grown to love the female condom. "The first time, I didn't use it properly or like it," she says. "But it's better for me. I think it is safer, and won't pop as easily."

Her husband, a professional driver, is still not a fan. He tells her that it's too tight, that it squeezes him. Rosa smirks as she explains what she tells him: "Yes condom equals pants up, no condom equals pants down." She agrees with Camila that the female condom is more well-lubricated. Rosa also believes that's more sensitive.

But the big reason that she likes to use female condoms is that they make her feel like she's in control. "Women have to take care of ourselves. Men have to know we have our own form of protection now," says Rosa, who spends most of her time as a homemaker and sells baskets and dolls to others in the community on the side.

While the Gestos women are often hanging around the community ("The volunteers are always here pestering us," Rosa jokes), not every woman in Coelhos knows how the female condom works. Even in this one community--a small slice of Recife, and an even smaller slice of Brazil--it will take years to fully educate every woman.

Even when they are educated, some women just aren't interested. Teenagers in Coelhos often neglect to use condoms because they think having kids will elevate their social status, Camila explains. They're oblivious to the dangers of STDs.

Coelhos was once considered a favela (a slum), but the quality of life has improved just enough that the term no longer quite applies. Some residents make more than the minimum wage of $289 per month, while others subsist on support from Bolsa Família, a stipend offered by the government to poor families. Many residents have electricity, televisions, and decently large homes; others--mainly women--live on stilt houses that are sometimes submerged by the nearby Capibaribe River.

Gestos representatives have been visiting the women of Coehlos regularly for seven months, trying to convince them to at least give female condoms a try. Out of 445 women interested in learning more about the condoms, 262 tried them out, and 143 have actually started using them regularly.

The NGO gets all of its female condoms for free, but funding for every other aspect of the program comes from the MAC AIDS Fund. That funding is guaranteed for at least another year, and Gestos will soon bring its female condom campaign to another poor neighborhood in Recife.

Gestos has made real headway in Coelhos, and new innovations in the female condom space (see this Co.Design article detailing the next generation of female condoms), such as PATH's tampon-like Women's Condom, are promising. But convincing women to try female condoms will remain a struggle for the foreseeable future--and not just in Brazil. In developed and developing nations alike, women have preconceived negative thoughts.

That means better design can only take the female condom so far. Education is key. Because even in a country like Brazil, where women can get female condoms for free, plenty of people don't even know the contraceptives are available (or what they are). One of the community health workers tells me a story of a nearby hospital that had stockpiled 15,000 female condoms--and until Gestos launched an educational campaign, no one knew they were there.

Design innovation will make it possible to have simpler, cheaper female condoms. But innovation means nothing if women aren't receptive to female condoms in the first place.

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