Condomania

The Bill and Melinda Gates Foundation has been instrumental in helping to find ways to reduce child mortality and HIV/AIDS (among many other things) in less developed countries, especially in Africa.  In 2012 they expanded the scope of activities to include ways of preventing unwanted births as a means to improving maternal and child health, as I mentioned at the time.  This week's Economist reports on one approach that they are helping to fund--improving the design of the condom so that it will be used more widely. This is a two-fer, since the condom helps to prevent pregnancy at the same time that it slows the spread of sexually transmitted disease, including HIV.

THEY have been made of tortoiseshell and horn. They have been made of the finest silk and the coarsest leather. They have been made of pigs’ bladders and sheep’s intestines. They have been made of rubber (natural and synthetic). They have been made of plastic. But none of these has quite fitted the bill. Condoms, though 15 billion are manufactured each year, and 750m couples use them, are not, when push comes to shove, that popular. In truth, they are awkward passion-killers that have a disturbing tendency to pop off at inconvenient moments.

Build a better condom, then, and maybe the world will beat a path to your door. That, anyway, is what a select band of researchers in laboratories around the world hope will happen. So does Bill Gates, whose foundation is backing some of these efforts with grants of $100,000 apiece as seed money, and the promise of up to $1m more if the initial experimentation comes good.

As the Economist points out, it is not clear how good or popular the various innovations they describe will be. Since the single biggest problem with condoms is that most men would prefer not to use them, any innovation that makes the condom less "intrusive" will likely increase its use, as will a condom that can be used by women, rather than their having to rely on men. The Economist is also a little bit cynical about the potential usefulness of research aimed at innovations in condoms.

That is suggested in particular by the different patterns of condom use seen in different parts of the world. According to the Population Reference Bureau, an American think-tank, 20% of married couples in rich countries use condoms, while 18% prefer the pill—and these two methods are the most popular forms of contraception in such places. In poor countries, intrauterine devices and sterilisation are the most popular methods, and the respective figures for condoms and the pill are 4% and 7%. Moreover, the rapidly falling birth rates in most poor countries suggest that, for family planning purposes, radical change is not needed. So the paradox is that if a better condom does emerge from all this effort, it may be enjoyed more by the rich world’s inhabitants than those of the poor world at whom, at least in Mr Gates’s eyes, it is aimed.

It is not clear where they came up with these numbers from the PRB, but they almost certainly are data only for married women and do not include data from sexually active single women, nor from men. Furthermore, it is a gross overgeneralization to say that we have "rapidly falling birth rates in most poor countries." And in many of the places where it is dropping, we are pretty certain that abortion, whether legal or not, is a key factor. Surely we would prefer that people use condoms.