Inter Press Service, September 3, 2004
At Three Cents a Unit, Condoms
Often Rare as Hens Teeth
'Countdown 2015: Sexual and Reproductive Health
and Rights for All', a conference that wrapped
up in London Thursday, was awash with statistics
on a range of matters.
One statistic had particular resonance, however
- namely that men in sub-Saharan Africa only
have access to an average of three condoms
This figure encapsulates one of the most frustrating
realities faced by health workers today the
fact that there simply aren't enough contraceptives
to go around. This is despite the fact that
condoms cost, on average, about three cents
While progress has been made since the International
Conference on Population and Development (ICPD),
about 123 million couples in the world's poorer
countries still lack access to contraception.
The ICPD, held in the Egyptian capital, Cairo,
in 1994, was a landmark event that aimed to
make sexual and reproductive health services
available to all by 2015.
In the case of condoms, which also play a major
role in preventing the spread of HIV, almost
10 billion units were required in 2002 in the
developing world and Eastern Europe. However,
donors provided just 2.5 billion, according
to the Washington-based lobby group Population
Action International (PAI).
Granted, this marked an increase from the 950
million condoms supplied in 2000. But, the
increase has been ascribed to what PAI calls
"one-time contributions" by governments
in Britain, the Netherlands and Canada not
funding that had been committed for several
years to come.
In addition, these contributions must be seen
in the context of a general decline in support
for provision of contraceptives. In spite of
the donations made by Britain and other funders,
the United Nations Population Fund (UNFPA)
says overall funding for contraceptive programmes
fell in 2002 to almost 198 million dollars.
(By 2015, 1.8 billion dollars will be needed
to fund comprehensive contraception initiatives,
says the UNFPA.)
Although the condom and contraceptive shortfall
received top billing at 'Countdown 2015', it
seems odd that it has not featured more prominently
in the public arena since the Cairo meeting
when contraceptive shortages were also the
order of the day. ('Countdown 2015', a three-day
gathering, was held to discuss the status of
efforts to implement a plan of action that
emerged from Cairo.)
"There are many of us who have known, for
a very long time, that there are problems of
not enough contraceptives," PAI President
Amy Coen told IPS. "But remember, when
HIV/AIDS first came out, it took a full decade
for people to even know there was this horrific
pandemic happening It's like every other dawn
on a terrible problem: the sun comes up slowly."
As far as condoms are concerned, there may also
be a deeper and more subtle interplay of issues
behind the fact that they are not more readily
In a booklet entitled 'Condoms Count', PAI notes
"What needs to be done to improve condom
distribution - and how - is clear."
"What is lacking is firm, unambiguous acceptance
of the indispensable role of condom promotion
in prevention and commitment to action principally
on the part of governments and some key donors
" the booklet adds.
It's a trend that Frances Kissling, president
of Catholics for a Free Choice, a non-governmental
organisation (NGO) based in Washington, has
"I think there are two aspects to it. One
aspect is a genuine, medical concern in the
sense that condoms are not fool-proof And,
while the failure rate is small, the price
of failure is tragic," she said in an
interview with IPS, adding "There is an
uneasiness One doesn't want to over-endorse
a condom if there is the risk."
According to various sources, the male condom
is about 98 percent effective in preventing
pregnancy if used correctly. Studies cited
on the Reproductive Health Outlook website,
run by the Seattle-based Programme for Appropriate
Technology in Health, indicate that condoms
prevent the transmission of HIV amongst about
80 percent of users, and upwards.
The second aspect to ambiguity about condoms,
says Kissling, relates to questions about the
ethics of sexual relationships where there
is a risk of a deadly disease being spread.
"I think that one of the problems that has
existed, particularly over the last five years,
is that there is an increasing negativity towards
sexual activity in general and sexual activity
by people at risk," she noted. "I
think there are many people in NGOs as well
as in government agencies who really believe
that people who are at risk of transmitting
HIV simply should not have sex."
Many delegates to 'Countdown 2015' appeared to
believe that this moral queasiness had found
its clearest expression in the policies of
U.S. President George W. Bush.
While officials in the United States have endorsed
the 'ABC campaign' ('Abstinence', 'Being faithful'
or 'using a Condom') - something used to great
effect in Uganda - it is abstinence rather
than condom use which appears most attractive
A 15-billion-dollar AIDS package, the President's
Emergency Plan for AIDS Relief (PEPFAR) that
came into effect in 2003, requires a third
of U.S. funding for AIDS prevention to be spent
on programmes that encourage abstinence before
Coen believes this has a "chilling effect"
on initiatives which deal with other areas
of sexual and reproductive health.
In a speech to delegates given Aug. 31, UN Foundation
President Timothy Wirth also claimed the United
States was supplanting "comprehensive
family planning and reproductive health strategies
by well-meaning, but far less effective and
largely unproven abstinence efforts."
A conference held in the Turkish city of Istanbul
in 2001 highlighted the growing urgency of
the need to close the so-called "condom
gap", and various NGOs have since joined
forces over the matter. Four such groups formed
the Supply Initiative, for example: a project
that, amongst other things, uses the internet
to help streamline the funding and procurement
Kissling also believes that dogged persistence
in the face of shortages is key.
"There is no magic in terms of how you create
social change or political will. You simply
hammer away at the facts, and you keep on advocating
for what you think needs to happen," she
says. "You just push, and push, and push,
and push - that's how every social change has
As was noted at 'Countdown 2015', countries that
are recipients of contraceptive aid also need
to demonstrate a clearer commitment towards
universal contraception - even though their
lack of infrastructure may pose considerable
challenges to ensuring timely distribution
of condoms, or monitoring their use.
For Kevin Osborne, a senior advisor on HIV/AIDS
to the London-based International Planned Parenthood
Federation, the corporate sector holds valuable
lessons in this regard.
"I'm going to use the analogy of Coca-Cola.
No matter where you go, you can find Coca-Cola
and if we can get Coca-Cola to the most remote
villages, then the question of infrastructure
- we look at it in a different light,"
he told IPS.
<< Inter Press Service -- 9/3/04 >>
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