The Danger of Giving Out Condoms (and no, this is not religious)
The conversation of handouts is one what we often hear when doing aid work. The common sentiment seems to stand that when you give a handout it is less likely that the person or community that you give the hand out to will continue to have stake in the project after you leave and that when you require them to either contribute money or labor and time into the project, the more likely they will be invested in its continuation and upkeep after you leave.
This philosophy and spurred many organizations to require some sort of literal community buy-in. For example, when building water wells, many organizations have the community contribute some amount of funding and if that is not possible, expect that the community help in building the well. Obviously many times you cannot expect that a community will be able to fund half, but many organizations require that the community give something, because they believe it makes them more invested in the longevity of the well, that they will keep up the maintenance and that it will be something important to them.
I believe that this is a valid belief, and that when people need to work for something they are more invested in seeing that thing completed and continue to succeed. I believe then, that the same idea should be held true for condoms, a controversial topic, I’m sure, but something to think about.
Aid organizations and governments give out millions upon millions of condoms for free every year. For example, Malawi has just implemented a new policy in which each time a person comes to a clinic, they should be offered/given 30 condoms at each visit. The use of condoms is incredibly important, for obvious reasons like the prevention of STIs and HIV as well as family planning. However, my fear is that giving out free condoms may not actually help in getting people to use them.
Doing research on the use of condoms is one of the frustrating things that you can do. Obviously you cannot stand over every person who you’ve given a condom to and make sure that they put it on when they have sex, nor can you ask them to bring back their used condom to prove that they have used it, so you need to rely on surveys. The problem with surveys is that most people will tell you that they use condoms much more than they actually do. They do this for obvious reasons, but namely, because they know that the person doing the survey probably wants them to be using condoms and they don’t want to look bad or irresponsible and so they will probably tell you they use them even when they’re not.
Because asking people their sexual habits is the best we can do, it’s near impossible to gauge whether or not the condoms we are distributing are actually being used. While I was working at Kala refugee camp in Zambia, the UNHCR distributed thousands of condoms on a weekly basis. The statistic I was told is that people were receiving 2 per person per day, and there were approximately 18,000 people in the camp. I am not sure that this number is entirely accurate, but I do know that there were a lot of condoms in distribution. Upon leaving the camp, I had a clever idea for a book which I would never write, which is “1,001 ways to use a condom” based on the amazing and inventive ways people used the condoms that were distributed to them. I am sure that some were used during intercourse, however, I saw an amazing soccer ball that some children made completely out of condoms (they are quite bouncy!), people used the condoms to fix the tires on their bike, I saw a clothesline made of condoms tied together, and I can go on…
When I was in high school, there was always a big basket full of free condoms in the nurse’s office. My friends and I used to go by and scoop up handfuls of these condoms and put them in our pockets. I’m sure I collected over 50, which accumulated in a secret drawer in my room so my parents would never find them. I had no need for condoms at the time, I wasn’t even sexually active, it was just an exciting novelty item and it was free. I never did end up using them.
People love collecting free stuff. I am willing to bet that each and every one of you has a collection of free stuff you’ve acquired over the years in a pile somewhere, things you’ve never used, but just picked up because it was free.
So this is my concern, how do we measure the impact that the free distribution of condoms is actually having? I say, we attach a nominal fee, as little as a penny. That ONE penny (and I haven’t tested this, so I cannot say for sure) will probably stop a lot of people from just taking advantage of the free handout and instead, people who actually intend on using the condoms will be the ones coming to collect. Once you attach a price on it, just like with making a community contribute to a project in their town, the value of the thing changes. When you need to spend money on it, the likelihood of you using it goes up. I bet that once that happens, the amount of condoms we give out will decrease, and I think we will also have a better understanding of how many people are actually using the condoms.
I know that there is a danger to this, which is maybe people who would have come and picked up free condoms that they actually intended to use, might not. And we are so concerned about the spread of STIs and HIV that we would be too afraid to start charging people for them. But really, the indicators don’t make much sense, as of right now, organizations say “we’ve distributed 100,000 condoms!” but really, what does that mean? I don’t think that it means much.