Estimating condom use is difficult. Surveys of AIDS-related behavior provide different data about condom use than do family planning surveys. The estimate of 6 to 9 billion condoms used worldwide each year is based partly on surveys of actual use and also assumes that, of the 8 to 10 billion condoms produced each year, 10% to 20% are never used.

Use within marriage. An estimated 44 million married couples use condoms for family planning (see Table 1). These 44 million make up about 4% of all couples in which the wife is of reproductive age, and about 7% of married couples who are using some method of family planning. This estimate is based largely on surveys of women of reproductive age.

Worldwide, condoms rank near the bottom among contraceptive methods used by married couples. About as many couples rely on vasectomy. Only female barrier methods, spermicides, and injectables are used by fewer married couples (544). Japan is home to almost one-fifth of all married condom users worldwide. In Japan 46% of all couples, or 78% of all family planning users, rely on condoms (544).

In developing countries the prevalence of condom use among married women of reproductive age is between 2% and 6% in about half of countries surveyed and below 2% in the other half. In some countries where overall use of contraception is at low levels, condoms account for a substantial proportion of all methods used. In Cameroon, Ghana, and Zambia, for example, fewer than 4% of couples use condoms, but condoms account for more than 10% of all contraceptive use (544).

Globally, the percentage of married couples using condoms for family planning appears to have declined slightly during the past decade. In India the prevalence of condom use fell from about 5% in 1988 to about 2% in 1994 (541). In some countries, however, condom use has increased somewhat. In Bangladesh and Vietnam, for example, the proportion of couples using condoms for family planning rose about three percentage points between the late 1980s and mid-1990s (541). Levels of condom use within marriage increased a few percentage points in Brazil, Colombia, Costa Rica, and Peru and rose in Jamaica from 9% to 17%.

Low levels of condom use within marriage do not necessarily imply high risk of HIV/AIDS or other STIs. If both members of a married couple are free of infection and the couple remains monogamous, their risk of contracting an STI is virtually nil, and other modern contraceptives are available for family planning.

Ghana Social Marketing Foundation

Be happy in the game of love—use condoms, this Ghanaian poster suggests. Closing the condom gap is a public health challenge.

Use outside marriage. Worldwide, as many as 60% of all condoms are used outside marriage, Population Reports estimates. This includes both use in extramarital sex and use among the unmarried. Data from Demographic and Health Surveys (DHS) and US Centers for Disease Control Family Health Surveys (FHS) show that in developing countries levels of condom use among unmarried people vary widely but are generally higher than among married people. More men report using condoms than women.

In sub-Saharan African countries surveyed, 2% to 17% of sexually active unmarried women and 7% to 50% of sexually active unmarried men report using condoms. In Latin America condom use reported by unmarried women ranges from 1% or less to 36%; reported use by unmarried men is higher (see Table 2). Few data are available from Asia.

Use with multiple partners. The number of people, whether unmarried or married, having sex with "nonregular" partners—that is, sex partners other than their regular partner—appears to be substantial. In Burkina Faso in 1992, for example, about three-fifths of men and one-third of women ages 15 to 24 reported having nonregular partners. In Papua New Guinea in 1994 about 15% of men and 12% of women ages 15 to 49 reported having nonregular partners. In the Czech Republic one-third of men ages 15 and over reported having nonregular partners (266).

In some countries recent surveys among people with nonregular partners show high levels of condom use. In Uganda, for example, of the 25% of men and 13% of women ages 15 to 49 having nonregular partners, almost two-thirds of the men and half of the women used a condom with their most recent partner. In Cuba, of the 21% of men and 13% of women having nonregular partners, more than half of the men and more than one-third of the women reported using a condom with their most recent partner. In Latvia, where such use was most widely reported, of the 20% of men and 10% of women ages 15 to 49 having sex with nonregular partners, over two-thirds used condoms (271).