More gloves for safe love

By Tharuka Dissanaike

Would you buy a condom from a vending machine? Would you prefer a machine to asking for condoms at a pharmacist or grocer?

The United Nations Population Fund (UNFPA) is launching a pilot project to test Sri Lanka's market for condoms from vending machines. The agency's recent call for agents island-wide to manage these vending machines received surprisingly enthusiastic responses- from traders, grocers, government authorities, the military and from places as varied as Jaffna and Ratnapura.

At the pilot stage the machines-imported from the USA- will come as a grant from the UNFPA.

"This is just an interim measure," said Suneetha Mukherjee, Sri Lanka's representative for UNFPA. "Condom vending machines are just a step towards making them more freely available among the populace and to try and cut through the social barriers that prevent people from going into a shop and purchasing the product."

The advantage of the machine is, of course, confidentiality. It is not easy for people to ask for contraceptives, condoms especially, from a vendor.

"You avoid situations where the son would have to ask for condoms from the same shop that his mother buys the bread."

But the vending machine culture is still quite alien to Sri Lanka. "To make the machines more user friendly, some will have Panadols as well as condoms," said Ms. Mukherjee.

Sri Lanka's favourable advance in its demographic indicators- an almost replacement-level birth rate, good literacy and low mortality, has led to a self-satisfied bureaucracy. Now that the country 'has got there' some complacency has crept into the state machinery- especially on future ventures to keep the indicators looking good. This is especially so where family planning and reproductive health is concerned.

In fact behind an apparent increase in contraceptive prevalence rate (the number of people using birth control methods from an eligible population) lie some disturbing patterns. In 1995, contraceptive prevalence was 68.5 percent (the eligible population consists of married women in the reproductive age). A large portion of this -23 percent- uses traditional methods like withdrawal and fertile periods which are most likely to fail. Another 25 percent go in for sterilisation- women much more than men. Less than a third of the population uses modern methods like condoms, pill, IUCD and injectables.

"There is a disturbing gap in contraceptive prevalence. From 1993 to today the number of sterilisations has decreased by almost six percent. But the use of modern methods has not increased substantially to meet the gap," Mukherjee said. "We have been trying to help the government to increase the use of modern contraceptives but the growth has been slow and we have barely gone up three percent in the last few years."

The gap that was created by the drop in sterilisations- mainly due to a cutback in state initiative to promote it- and the low growth in modern methods leaves a dark area in the picture.

"We feel that the high number of abortions happening in the country every day is mainly due to this unmet contraceptive need," Ms. Mukherjee said. Studies have shown that between 500-750 abortions are done daily in the city alone.

"People should have access to contraceptives and should never resort to abortion as a birth control method," she said.

She said that the UNFPA's attempt to promote the use of the condom does not promote promiscuity. It rather, is a good method of protection against unwanted pregnancy as well as any sexually transmitted disease, including HIV/AIDS. "Sri Lanka is categorised as a low prevalence country regarding AIDS. We must strive to keep it that way. "Condoms are also easy to use and have no side effects that most people fear in modern oral pills and injectibles."

Make them aware- FPA

Daya Abeywickrema, Executive Director of the Family Planning Association said that the government must rejuvenate awareness campaigns on family planning.

"A decade ago we had a forceful drive and people were educated on contraceptives on a door-to-door basis. But today the level of awareness is dropping again due to a gap in the education process."

The FPA was first to launch a system of condom vending machines through their dealers, but the project was totally ruined by the high rate of vandalism and is shelved today.

"In my opinion Sri Lanka is not ready for vending machines yet. To avoid vandalism the machines have to be in a semi-public place," he said.

But Abeywickrema agreed that the factors like increase in premarital sex and abortion point to a need for better availability of contraceptives.

According to FPA statistics a total of 11 million condoms are sold every year. The bulk of this-8.5 million is sold through the organisation's dealer network, at an average price of Rs. 15 for a pack of three.

Another 1.5 million is sold by midwives at 50 cents each and another million is distributed through independent traders who import condoms.

Condoms account for as little as four percent of contraceptive use, Abeywickrema said. This is quite low for a country that has been marketing the product for over 25 years.

Growth of sales, especially in the last few years has been slow and this, Abeywickrema said, could be the result of a lack of education and awareness on condom use.

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