by Ellen Cole

In 1977, Seattle-based PATH proposed a new way of looking at health technologies for poor countries. In the shag-carpeted apartment that served as their first office, the nonprofit’s founders plotted ways to bring health care solutions to the developing world that lasted longer, worked better, and cost less. PATH was built on creating sustainable fixes, designed to fit the countries where they were needed most.

At PATH, "sustainable" isn’t just about being easy on the environment or economically sound. It’s about the user, and what it takes to make an innovation part of the fabric of daily life. A sustainable technology reaches the hands that need it, to be used and used again. PATH designs are notable for their seamless style. They try to solve health problems without creating new ones.

When it comes to the female condom, "sustainable" means imperceptible. The best condom, male or female, is the condom that seems not to be there. But that’s just the problem with condoms: being there is a prerequisite to stopping unwanted pregnancies and HIV. And it’s a big problem for women in developing countries, who often don’t have the negotiating power to get their partners to use a condom. A solution they can use every day needs to be cost-effective, easy, and, ultimately, unnoticeable.

The current design for a female condom looks like a large, loose male condom with two rigid rings, one that fits inside the vagina and one that remains outside, to stabilize the condom. It’s a little noisy. A little awkward. A little difficult to keep in place. And for some couples, even a little uncomfortable.

These women have lots to smile about, thanks to PATH.
In the developing world, all of these challenges are heightened. Plus, cost is a greater issue, sexual negotiations are more difficult, and there are fewer options, so the available products need to hit the target dead on. To make sure its designers knew what the target was, PATH reached out to couples in four nations—the United States, Mexico, Thailand, and South Africa—and asked them what they liked and disliked about the female condom.

Over the course of six years, PATH produced more than 50 designs for an improved female condom. The best of those went through cycle after cycle of user testing and refinement. To reduce the condom’s less-than-sexy crinkling sound and to improve sensitivity, PATH’s team of engineers and health professionals worked to find a material that was thin and flexible but still an effective barrier. The hard, unforgiving inner ring was replaced by a few small circles of an adhesive that’s also used to close surgical incisions—enough to reliably keep the condom in place during sex, but not enough to be felt. A soft tip of soluble material holds the end of the condom tight, making insertion easy and quick.

The final design for PATH’s Woman’s Condom scored high marks for stability, comfort, ease of use, and sensation among the final user-testing group. As one South African participant said, “It was my first time to have sex with a female condom. I thought I won’t enjoy sex—but [PATH’s Woman’s Condom] proved me wrong.? A female condom that defeats preconceptions about condom use gives women throughout the developing world more power over their own lives and reproductive health.

PATH's work has made for lots of happy couples like these.
Other technologies developed by PATH include a syringe that automatically disables after use, so that it can’t be reused and spread infection; a one-size-fits-most diaphragm that doesn’t require fitting by a doctor and can be distributed to women who are far from professional health services; and a nutritional supplement that fortifies a simple bowl of rice. Since its inception, PATH has constantly worked to meet the health needs of countries as geographically and culturally far from Seattle as you can get.

In the past three decades, the organization has outgrown the make-do apartment and moved into an industrial-hip building with a state-of-the-art product development shop. PATH now has a worldwide staff of nearly 500, in 19 offices in 13 countries. PATH’s work has expanded to strengthening health systems and encouraging behaviors that lead to good health -- but the dedication to good design remains.



Ellen Cole is Senior Marketing and Communications Officer at PATH.