Conversely, price increases reduce condom sales, as occurred in Zimbabwe following a government attempt at cost recovery (90). In Bangladesh, when the prices of five brands of contraceptives sold by the social marketing program were raised by an average of 60%, condom sales fell by 46% over the next 12 months before recovering (103). In Pakistan an increase in the price of a socially marketed condom resulted in a steep decline in use by low-income users (132).

Some public providers of condoms have begun charging most clients, while providing fee exemptions and sliding fee scales to help ensure that the poorest clients are not denied services (548). If people who can afford to pay for services are encouraged to do so, the needy may be better provided for (535). The resources previously allocated to providing services and commodities for middle-income families could be redeployed to provide more for poorer families (418).

In some countries the private sector is providing more reproductive health services (78, 535). In Uganda, for example, where demand for condoms has risen sharply, 70% of imported condoms are purchased through the private sector (376). Commercial condom prices vary greatly—from country to country and within countries. A 1993 survey found that prices ranged around the world from only one or two US cents to more than US$1.00 per condom (461).

In developing countries commercial condom prices can be too high for most consumers. Imported condoms often are subject to import duties, taxes, and licensing fees that can substantially raise their prices (128, 295, 461). Also, international shipping adds somewhat to costs (229, 447), as do the price margins of distributors, wholesalers, and retailers (489).

Free distribution? If lower prices boost condom sales, then providing condoms free of charge, as many government programs and nongovernmental organizations do, should increase their use even more. In some situations offering condoms free has increased use, while discontinuing free supply has reduced it. For example, when free distribution to refugees in northern Uganda was ended, and sales were substituted, distribution fell to less than 10% of previous levels (252).

Condoms obtained free may not be used as much as condoms that are purchased, however (350). In Cameroon, for example, a study found that half of people who obtained free condoms never used them compared with only 10% of people who bought them (351). Paying for a condom demonstrates an intention to use it, while receiving it free may not (564). In addition, people may think that free condoms are of lower quality (230, 351, 422). Free distribution may not improve access if free supplies are limited or if the condoms are available only at widely scattered health clinics (425).

Logistics management. Most programs can increase access by becoming more efficient at condom delivery (125). Local and even national shortages can often be avoided or reduced through better condom programming (199, 562, 563)—that is, ensuring that demand is accurately estimated and matched with available supply and support (591). Good logistics management and forecasting can make condoms more available, avoiding the problem of having a large stock of condoms in warehouses without an effective distribution system.