Why are condoms used, and how many are needed? Estimates from Orissa, India

Context: In Orissa, one of the most impoverished states in India, reproduct ive health is poor, and the use of condoms and other reversible contracepti ves is uncommon. To promote condom use, it is important to know who is usin g condoms, whether condoms are used for pregnancy or disease prevention and how much potential for use exists in a community. Methods: A cross-sectional population-based survey carried out in 1998 in t he four coastal districts of Orissa among 2,087 men aged 18-35 collected da ta on fertility preferences, sexual behavior and condom use. Levels of use and need for condoms were estimated separately for sexual activity within a nd outside marriage. Aggregate levels of use and need were derived by apply ing individual-level estimates to the male population. Results: Ninety percent of all condoms were used for sex within marriage (4 4% for spacing and 46% for limiting births). Condoms were used during 3% of marital sex acts and 15% of nonmarital sex acts. Two-thirds of the unmet n eed for condoms is for premarital or extramarital sex (53% and 13%, respect ively). Given the current method mix, men in Orissa have an unmet need for 2.3 million condoms annually, but if users of traditional methods were enco uraged to switch to modem methods, that total would reach 4.4 million. Conclusions: Condoms should be promoted differently among different target groups: as an effective way to prevent HIV and other sexually transmitted d iseases among the minority of men who engage in high-risk sexual behavior, as a means of preventing both pregnancy and disease among young unmarried m en and as a spacing method among married couples.