Condom Availability

Condom Availability Programs

A sizeable minority of adolescents experience unintended pregnancies and sexually transmitted diseases (STDs). Unintended pregnancy rates are highest among individuals younger than 20 years of age. STD rates among adolescents are particularly concerning because national estimates show that youth between the ages of 15 and 24 experience the highest rates of chlamydia and gonorrhea and these STDs increase susceptibility to HIV. To reduce rates of unintended pregnancies and STDs among adolescents, a variety of sexual health intervention programs have been implemented in school systems. One school-based intervention approach is to make condoms available in school settings, since the male latex condom affords both pregnancy and STD prevention. Condom availability programs are typically implemented as a component of a comprehensive sexual health education program in the schools.

A number of studies point to low rates of consistent condom use among sexually active adolescents. Limited access to condoms, the costs associated with condoms, and embarrassment of purchasing condoms may serve as important barriers to adolescents' use of condoms. School-based condom availability programs offer the opportunity to overcome these barriers by providing free access to condoms in a setting where adolescents spend much of their time. In support of condom availability programs, the Institute of Medicine, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Medical Association have all issued policy statements supporting the provision of condoms in schools. Despite the promise of condom availability programs, such programs have been surrounded by political controversy attributable, in part, to increased emphasis on abstinence-only sexual health programs. Indeed, only a small number of middle schools and high schools in the United States make free or reduced-cost condoms available to students. Additionally, condom availability programs across schools have different requirements before adolescents can acquire condoms including active (i.e., written permission) or passive (i.e., written refusal) consent from parents.

[Page 118]There is a growing body of literature indicating that condom availability programming is acceptable as part of comprehensive, school-based sexual education and results in increased rates of adolescent condom use. For example, one recent study with parents of youths enrolled in public schools found support for providing information about condoms and conducting condom use demonstrations as part of sexual health instruction. The majority of parents also agreed that condoms should be available in schools; however, there were differences in the acceptability of condom availability programs based on some characteristics of respondents (political views, religious affiliation).

A second study examined whether sexual behaviors and condom use behaviors differed between adolescents based on whether or not their school had a condom availability program. There were no differences in sexual activity initiation between schools that did and did not have condom availability programs. However, students in the condom availability schools were twice as likely to report condom use during their most recent sexual encounter. In contrast, adolescents in schools without condom availability programs were more likely to endorse use of other contraceptive methods. Thus, this cross-sectional study suggests an association between the presence of condom availability and increased condom use among adolescents.

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