Update on Condoms--Products, Protection, Promotion

 An overview of condom use, promotion, and manufacture is presented.  Theoretical effectiveness of condoms is estimated to range from .5-2 pregnancies/100 couple years of use.  Although data are not available on breakage rates during use, estimates of 1/1000 for good quality condoms and 1/100 for poor quality condoms have been offered.  Use-effectiveness rates vary widely; pregnancy rates of .8-22/100 couple years of use have been reported.  Use-effectiveness has been related to age, motivation to space and prevent births, family income, levels of educational attainment, length of marriage, and experience with the method.  Use of spermicides with condoms slighly improves effectiveness.  Continuation rates are lower for condoms than for IUDs or oral contraceptives, and lower in developing than developed countries.  Inconsistent use or unwillingness to use condoms indicates that the method may not be as acceptable as other methods.  The results of several studies indicate that consistent use may reduce the risk of contracting a sexually transmitted disease from an infected partner.  Condom use has also been linked to protection in women against PID, against amniotic fluid infections in late pregnancy and to a preventive or therapeutic effect on cervical cell abnormalities.  Some evidence suggests that condoms may be useful in treating women who become infertile because they produce sperm antibodies.  Surveys of representative population samples estimate that almost 4 million people use condoms.  The highest percentage of users are in developed countries, China accounts for 18% of the users, other Asian countries, 13%; Latin American and Caribbean countries, 3%; and Africa and the Middle East, 1%.  There are 4 ways that condoms reach users:  commercial channels, family planning clinics and physicians, community-based or household distribution programs, and social marketing (government subsidized ) programs, which combine low cost with wider availability.  National and international agencies also supply condoms for developing country programs.  Traditionally promotional activities have been aimed at men.  Recently, women and adolescents have become important targets.  Studies of consumer preferences are guiding the manufacture of different types of condoms and the design of packaging.  Highly visible advertising and promotion does boost condom sales.  Originally condoms were made of animal membranes.  The development of the vulcanization process made the production of rubber condoms possible.  Latex is currently the raw material used for most condoms.  Manufacturing procedures vary slightly and 2/3 are produced in developed countries.  Local packaging in developing countries may be economically feasible and desirable.  Most countries manufacturing condoms have national quality control standards.  Adoption of proposed international standards may eliminate problems associated with multiple import-export testing.  These standards are presented.

Johns Hopkins Bloomberg School of Public Health,Center for Communication Programs,Population Information Program