Impacts on Affected Countries

Dominican Republic

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USAID is the primary supplier of condoms but neglects the needs of Dominican youth

From the mid-1990s to 2003, the demand for condoms in the Dominican Republic was met in large part by contraband condoms from Population Services International (PSI) Haiti’s program, funded by USAID. These condoms were supplied at highly subsidized prices to Haitians, and thus prices undercut the market of condom sales in the Dominican Republic. In the early 1990s, USAID also funded Profamilia’s condoms. In an attempt to encourage sustainability by Profamilia and the Dominican government, USAID stopped funding these condoms altogether. Seeking to encourage the Dominican government to absorb responsibility for reproductive health supplies and for control of the contraband condoms, USAID stopped funding condoms in the Dominican Republic approximately five years ago. Following this decision, there was a period of three to four years during which the country had almost no condoms. No research seems to have been conducted on the behavioral impacts of condoms’ unavailability during this time.

USAID resumed supplying condoms to the Dominican Republic in 2003 through a targeted condom social marketing project, providing 4.7 million condoms (valued at approximately $288,000). USAID condom shipments to the Dominican Republic increased to 10.8 million in 2004 and then to 15 million condoms (about $439,000) in 2005. The condoms are supplied to PSI through the CONECTA project run by FHI. PSI then partners with six local NGOs, including Profamilia, who distribute the condoms with a specific mandate to reach sex workers. Each group is responsible for distribution within a certain geographical zone of the country. The condoms are sold at locations where concentrations of sex workers are high, such as small corner stores and also in pay-by-the-hour motels, which are required by law to have two free condoms in each room. By virtue of not being illegal, sex work in the Dominican Republic is essentially legal. Police crack down on motels not to arrest sex workers, but rather to check if each room contains the mandated two free condoms.

The PSI condom brand name is Panté, a carryover from PSI Haiti and therefore hugely popular, accounting for 65 percent of the market share. In 2004, PSI sold 12 million Panté condoms. At 10 pesos for a pack of four (about US$0.28), they are the cheapest brand in the Dominican Republic. Profamilia, buying the condoms directly from the supplier, markets the next cheapest brands, Escudo and Protector, at a pack of three for 20 pesos (about US$0.57). Other brand names sell a pack of three for between 70 and 100 pesos (about US$3.23). Profamilia is the only group marketing condoms to youth in the Dominican Republic, and many youth still lack access to and education on methods of contraception and prevention of HIV and other STIs. The reproductive health statistics for youth are bleak: The adolescent pregnancy rate is 23 percent and the second pregnancy of most teenagers (57 percent) occurs within two years of the first. It is estimated that 20 percent of maternal deaths are among adolescents.

In neighboring Haiti, PSI has been forced to stop targeting youth with condoms despite overwhelming need. This has come as a result of the policy shift in the U.S. administration and USAID’s ensuing reluctance to promote the marketing of condoms to youth. In fact, none of PSI’s programs worldwide market condoms to youth any longer, neglecting an entire sector at high risk for unplanned pregnancy and STIs.

While lead NGOs such as PSI and Profamilia contend that they have sufficient reproductive health supplies to accomplish their work, there are supply shortages on a national scale, especially in public hospitals and in the bateyes, where the need is immense and is not being filled. Across the country more generally, the greatest demand is for pills and injectables—USAID does not fund contraceptive methods other than condoms in the Dominican Republic. Supply shortages have worsened since UNFPA began cut backs to its country program, which coincided with the U.S. withdrawal of funds for UNFPA beginning in 2002.

UNFPA's country program is scaled back

UNFPA is the only contraceptive supplier to the government and a significant supplier to Profamilia and other smaller NGOs. However, UNFPA has had to drastically reduce the amount of contraceptive supplies it donates to the Dominican government. The government responded by buying supplies two years ago, but only a very small quantity. Then, in early 2005, the government made its first significant purchase of reproductive health supplies through UNFPA. UNFPA buys the contraceptives from a central procurement office in New York, and it then takes several months for the supplies to reach the Dominican Republic. The government spent a total of 300,000 pesos (less than US$10,000) on the supplies, which included pills, condoms and Depo Provera (injectables). This single purchase, of enough supplies to last two or three months, remains highly insufficient. As a UNFPA representative said, "Then what? They’ll have to buy more. Then they’ll say there’s no money…and so on."

UNFPA is the largest supplier of contraceptives to the most impoverished areas of the Dominican Republic. Throughout the past eight years, UNFPA has been the primary supplier for the government along the Haitian border and in disadvantaged areas of Santo Domingo. However, UNFPA is unable to sustain this work on a long-term basis, let alone scale-up to meet the growing demand. In the past, UNFPA worked in 250 bateyes but today works only in 10 to 12. UNFPA previously worked in all 33 provinces of the Dominican Republic; currently they work in only 11. No other organizational or government effort has compensated for the loss of funds and services in the other 22 provinces.

In addition, UNFPA was forced to cancel its program working on HIV prevention among unionized men, including truck drivers, firemen and policemen. These men, many of whom were illiterate, were learning how to prevent pregnancy and HIV infection. Due to embedded gender inequities and el machismo, programs such as this one that target men are very important and can yield enormous behavior change success. However, the program was cancelled when cut backs were made to the country program. UNFPA will guarantee family planning methods in all of their work through 2006, at which point the UNFPA country program ends, and the entire program will be re-negotiated.

“Through the National Family Planning Council, we were the suppliers for the whole country with regards to the impoverished people. Now, our focus has shrunk because of lack of funds.” Staff, UNFPA

Is the Dominican Republic Ready for USAID to Graduate Family Planning Assistance?

With the support of USAID throughout the past 30 years, Dominican NGOs have advanced family planning tremendously. However, no NGO at this time is capable of sustaining its work without USAID support. One health worker said, “I don’t know when we’ll be ready for USAID to graduate its assistance to the Dominican Republic. We work with people who are poor and in great need. They can’t pay for the services…These people will always need to be subsidized.” This is especially true in the bateyes, the problems of which the Dominican Republic cannot manage apart from Haiti. The burden is on the Dominican Republic to create an ethical response to its neighbor in crisis, and particularly to the Haitians and Dominican-Haitians living in extreme poverty within the Dominican borders.

As such, support from USAID remains critical. The Dominican government has not demonstrated a serious commitment to family planning nor is it prepared to implement a family planning program capable of meeting the needs of the 30 percent of the population that lives in poverty. Furthermore, damaging agendas handed down by the United States continue to increase the polarization and politicization of reproductive health issues, and challenge progress made. USAID’s decision to graduate the Dominican program must take into account the political will of the Dominican government and the growing reproductive health needs of the poor—as well as ensure that this move is truly in line with U.S. development goals. Graduating the Dominican Republic prematurely could have disastrous results.

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