This research study aims to assess the effectiveness of three female condoms [Cupid, Cupid 2 and Female Condom 2(FC2)] for the prevention of pregnancy among women choosing the female condom (FC) as their method of fertility regulation. Participants will be followed-up monthly for up to seven months. A daily diary will be used to record menstrual pattern, acts of intercourse and details of condom usage.

This research study aims to assess the effectiveness of three female condoms (Cupid, Cupid 2 and FC2) for the prevention of pregnancy among women choosing the female condom (FC) as their method of fertility regulation.

The study is a randomized comparative prospective follow-up study. Participants will be followed-up monthly for up to seven months. A daily diary will be used to record menstrual pattern, acts of intercourse and details of condom usage. The primary endpoint will be the occurrence of pregnancy or use of emergency contraception, and the diary information will allow pregnancy rates to be characterized by patterns of condom use and failures (contraceptive efficacy and effectiveness rates).

The target population will be 780 urban and peri urban, sexually active women who are experienced users of FCs. Recruitment will be from a family planning clinic associated with the MatCH Research Unit (MRU), University of the Witwatersrand, Durban, South Africa and the surrounding community. The woman rather than the couple will be the unit of observation since the major outcome to be measured is pregnancy. There will be monthly follow-ups of participants from enrollment until after the 6th menstrual cycle (month 1,2,3,4,5 and 6). All visits will be conducted at the research site. The diary, to be completed on a daily basis by the participants, will indicate whether the coital frequency differs significantly between subgroups (students, urban, peri-urban).

Female clients of the Commercial City Clinic and other women presenting at the site will be informed about the study. If a potential participant expresses interest in participating, she will be given the study information sheet to read, which will describe the study requirements and her potential role in the study. If she agrees to take part in the research, she will be asked to provide written informed consent. The participant will be administered the screening form to determine whether she meets study inclusion criteria.

Eligible women who agree to participate will undergo a baseline interview. Information collected during the enrollment interview will include demographic data and information on the participant's general and reproductive health. The data collected on reproductive health variables will include the date of last menstrual period (LMP), history of pregnancies, births and miscarriages, a contraceptive history as well as a sexual history. After completion of the interview, the participant will be randomized to the use on one FC type.

Male partners will not be asked to sign an Informed Consent as they will not be required to participate in the research, but female participants will be given an additional information sheet if they desire to give to the male partner to tell them about the study.

If a potential participant does not wish to be enrolled, she will be provided with referral (should she wish) for any reproductive health services according to normal clinical practice at the study site. Her reasons will be recorded on the log of refusals. This information will be used to compile statistics on the participation rates and reasons for nonparticipation.

Although all study participants are required to have ever used a FC, some may have not used the FC they have been randomized to and have experience with other FC types. All participants will be retrained regardless of previous FC use using a pelvic model. The study staff will demonstrate FC insertion and train the participants in the proper use of the randomized FC type. Further, they will provide instruction on how to complete the condom use log and the study diary. She will also receive instructions on use in her preferred language (English or Zulu).

The participants will be given their first study packet which will contain either Cupid, Cupid 2 or FC2 with a diary for the first month of the study. Research staff will discuss with the participant how many condoms they require for the month. The participants will be instructed how to complete the diary card. The first follow-up visit should occur approximately one month after enrollment and should be pre-scheduled. The date of the first follow-up visit should be written in an appointment card and on the designated location on the Condom diary card. Participants who finish using their condoms prior to their scheduled follow-up visit, will be encouraged to contact MRU for a resupply.

There will be six follow-up visits in person at 1, 2, 3, 4, 5, and 6 months. Telephonic follow-up will be conducted between 7-14 days post enrollment to confirm any queries or problems in use of condoms or diaries.

Participants will be administered a follow-up survey about their experiences using their randomized FC, whether there has been a delay in expected onset of menses, the date of last menstrual period, and information on the use of other contraceptives since the last visit. The daily diary will also be reviewed at each visit for completeness and accuracy. A pregnancy test will be carried out at every on-site visit. Any reported or confirmed pregnancies will include counseling and referral to an antenatal or other healthcare facility. The final follow up visit will be scheduled after 6th menstrual cycle.

Women will be discontinued from the study at any stage during follow-up for: pregnancy, unwillingness to continue use of FCs or change to a non-study contraceptive method as her main contraceptive method, or refusal to be followed up.

Block randomization will be used. A statistician (not otherwise involved in this study) will develop the random allocation sequence using a validated statistical program in Stata (StataCorp LP, College Station, Texas, USA). Use-order assignments will be generated via the RedCap electronic program. The statistician will be blinded until all data have been captured and the primary analysis programs have been verified. Due to dissimilarities of the study products, it will not be possible to blind participants and clinic staff associated with the project.

Inclusion Criteria:

1. Healthy sexually active women who have ever used an FC and using condoms (male or female) as their current method of contraception.

2. Be 18 to 40 years at enrolment (inclusive).

3. Have a negative urine pregnancy test at enrolment visit.

4. Is HIV negative

5. Have a history of regular cyclic menses (usual length of 21 to 35 days) when not using hormonal contraception.

6. Have at least one spontaneous menstrual cycle (two menses) following a pregnancy that ended at 14 or more weeks gestation.

7. Have at least one cycle (two menses) after an abortion at less than 14 weeks gestation.

8. Be willing to accept a risk of pregnancy.

9. Reporting to have at least four acts of heterosexual vaginal intercourse per month for a period of 6 months.

10. Be willing to only use the study product (Cupid or FC2 female condom) as the primary method of contraception over the course of the study.

11. Be capable of using the study product properly and agree to observe all study directions and requirements.

12. Be willing to keep a daily diary to record menstrual pattern, acts of intercourse, and details of condom use and any condom failures.

13. Be willing to state that, to her best knowledge, her sexual partner:

    • Has not had a vasectomy or been previously diagnosed as infertile.
    • Is HIV negative
    • Has no known history of allergy or sensitivity to natural rubber latex, water-based or silicone lubricants
    • Does not want her to become pregnant in the next 7 months

14. Agree to have fingerprint identity check

15. Be willing to give written informed consent to participate in the trial.

16. Intend to stay in the area for the next 6-7 months

17. Be willing to be randomized

Exclusion Criteria:

1. Have a history of allergy or sensitivity to rubber latex or water-based /silicone lubricants
2. Have evidence of sexually transmitted infections on syndromic assessment and / or vaginal examination
3. Be pregnant, have a suspected pregnancy or desire to become pregnant during the course of the study.
4. Have a history of infertility or pelvic inflammatory disease without a subsequent spontaneous intrauterine pregnancy.
5. Have been diagnosed with pelvic inflammatory disease (PID) without a subsequent intrauterine pregnancy.
6. Be in a monogamous relationship of less than 4 months with their partner.
7. Have any contraindications to pregnancy (medical condition) or regularly use medications that are unsafe to use in pregnancy
8. Have shared injection drug needles in the past unless has a negative HIV test at least 6 weeks since last use.
9. HIV positive.
10. Have been diagnosed with genital herpes simplex virus (HSV), with the first occurrence (initial episode) within 3 months prior to screening or have clinical evidence of HSV on exam.
11. Be lactating or breastfeeding.
12. Have any clinically significant abnormal vaginal bleeding or spotting within the month prior to screening.
13. Have had vaginal or cervical biopsy or vaginal surgery within 3 months prior to screening.
14. Have used vaginal or systemic antibiotics or antifungal agents within 14 days prior to screening or enrollment.
15. Have received a Depo-Provera® injection in the 6 months prior to enrolment or Nur-Isterate in the last 4 months prior to enrolment
16. Have a past (within 12 months) or current history of alcohol or drug [recreational, prescription or over-the-counter (OTC)] abuse.
17. Have taken an investigational drug or used an investigational device within the past 30 days.
18. Have issues or concerns (in the judgment of the investigator) that may compromise the safety of the subject or confound the reliability of compliance and information acquired in this study.

Participants must be female as female condoms inserted vaginally are being evaluated

The three condoms in the trial are distinctly different and so condom specific training is required and so cannot be blinded. The statistician analysing the data will be blinded to female condom type.