used; however see studies below. worldwide use sales of female condoms have been low in developed countries, though developing countries are increasingly using them to complement already existing family planning and hiv/aids programming. probable causes for poor sales are that inserting the female condom is a skill that has to be learned and that female condoms can be significantly more expensive than male condoms (upwards of 2 or 3 times the cost). also, reported "rustling" sounds from the original version of the female condom during intercourse turn off some potential users, as does the visibility of the outer ring which remains outside the vagina. regulatory issues have also limited interest in manufacturing female condoms. in the united states, the fda historically categorized female condoms as class iii medical devices, a category with more stringent requirements than class ii, which includes external condoms. following proposals to reclassify female condoms, the fda announced in 2018 that single-use female condoms would now be known as single-use internal condoms, and moved to class ii. in november 2005, the world ywca called on national health ministries and international donors to commit to purchasing 180 million female condoms for global distribution in 2006, stating that "female condoms remain the only tool for hiv prevention that women can initiate and control," but that they remain virtually inaccessible to women in the developing world due to their high cost of 72¢ per piece. if 180 million female condoms were ordered, the price of a single female condom was projected to decline to 22¢. in 2005, 12 million female condoms were distributed to women in the developing world. by comparison, between 6 and 9 billion male condoms were distributed that year. awareness and access recently, a number of initiatives have been undertaken by international and intergovernmental organizations to expand access to the female condom. in 2012, the united nations commission for lifesaving commodities for women and children (uncolsc) endorsed female condoms as one of its 13 life-saving commodities, catalyzing inter-organizational efforts to overcome several commodity-specific barriers currently inhibiting women in the developing world from benefiting from this product. price has been one of the key obstacles in expanding access to female condoms on an international level. female condoms cost, on average, us$2–4, depending on local market factors. at the 2012 family planning summit in london, the female health company pledged to increase access to the fc2 female condom for the world's poorest countries and announced a prospective pricing arrangement based on aggregate purchases and 5 percent free goods based on the prior year's purchases, together with a multiyear agreement to provide $14 million in training and education by fhc over the next six years. the cupid female condoms have been sold in kyrgyz republic through unfpa for their public distribution system. the woman's condom has been sold to the public sector in china. globally, it is acknowledged that further price reductions are necessary to achieve universal access to female condoms. based on market analysis it is expected that sustainable price reductions are feasible. campaigns prevention now! the center for health and gender equity's prevention now! campaign promotes the use of male and female condoms as a means of preventing the spread of hiv/aids; reducing instances of unintended pregnancy, unsafe abortion, and other unsafe outcomes of unprotected sexual intercourse; promote the sexual and reproductive health and rights of all persons; and expand choices for those living with hiv/aids. put a ring on it! the chicago female condom campaign is a coalition of hiv/aids, reproductive justice, women's health, and gay men's health organizations dedicated to increasing access, affordability, availability, awareness, and utilization of female condoms. lead partners include the aids foundation of chicago, chicago women's aids project, illinois caucus for adolescent health, pediatric aids chicago prevention initiative, mujeres latinas en accion, and planned parenthood of illinois.