Fernando, a 21-year-old Cuban, has seen his sex life change over the past five years. Contraception shortages aren’t anything new in Cuba’s recent history, but Fernando remembers that “drugstores in Havana still had condoms” before the COVID-19 pandemic.

When he and his partner started dating in 2018, some friends would tell them when condoms came into the drugstores:

“We started off buying boxes of 30 and we always had them, but then things got harder. They started disappearing, we had to buy them at the markup price when they did appear.”

The only solution they found was to buy condoms on the illicit market for a high price. Sellers justified the price with where the condoms were coming from: “they’re from abroad.”

First, they paid 20 Cuban pesos for a condom and 80 for a strip of three, until they pretty much all disappeared. Then, prices shot up to 100 pesos or more. 

Fernando has had to buy them with different textures and flavors, but not because he wants to. They’re the only ones that show up. He now describes his sex life as “less active” and even has a conspiracy theory linked to the Government: “Maybe this is their plan because the population is aging, everybody is leaving and nobody is stopping.” 

“Safe sex”, a recurring problem 

In a context like Cuba’s, where shortages are a constant variable, systemic shortages of male condoms – as well as other contraceptive methods – aren’t surprising. Condom shortages, recorded in reports for just over a decade, contrast with repeated government campaigns on social media to prevent sexually transmitted infections. “Safe sex”, but how?

In 2021, condoms cost between 15 – 60 pesos each on the black market. Lots of them were brought over from abroad or “diverted” from donations from international organizations such as the WHO/PAHO or the UN Population Fund (UNFPA). Prices increased the more they were missing from store shelves, in both drugstores and international clinics. According to the director of the National HIV/AIDS Prevention and Control Program, Manuel Romero Placeres, available condoms were distributed directly to vulnerable or high-risk groups for free.

A year before, a donation of over 500,000 male condoms arrived on the island thanks to the UNFPA office in Havana’s own efforts. However, this number only represents 8% of the approximately 5-6 million condoms that Cubans were buying in the country every year. The UNFPA office cooperated in March 2023 by distributing 1,785,600 condoms around the country.

“A total of 2800 packs of 144 condoms were sent to municipalities in Artemisa and Pinar del Rio that were the hardest-hit by Hurricane Ian. Another 9,600 packs will go to the rest of the country’s municipalities,” UNFPA wrote on Twitter. 

Beyond donations, most condoms sold on the nationwide drugstore network are imported by the Medical Supplies Company. This entity has recorded lower purchases of these products abroad ever since late 2019. Onecys Perdomo, commercial director at the Medicines Marketing and Distribution Company, confirmed that only 53% of purchases planned were actually made in 2019; which contrasted with high demand. 

Pro-government political forces claim that lower condom purchases have been directly linked to the “stricter US blockade against the island.” In a conversation with Alma Mater magazine, Angel Chacon Padron, the Medical Supplies Company director, explained that sanctions have had a negative impact on the biopharmaceutical industry – including sexual health – with regular partners pulling out of contracts and having to constantly look for new markets. The result? A significant delay in distribution.

In 2014, Granma newpaper published the article What’s going on with condoms? about the “considerable” drop in condoms on the national drugstore network. Then, Rafael Perez de la Iglesia, coordinator of the condom hotline at the National Center for STI and HIV/AIDS Prevention, explained to the magazine that shortages were partly due to the fact that condoms bought from China in 2009 reached the island with a three-year expiration date, instead of five. 

“When they expired in 2013, we were faced with the challenge of having a product in good condition, ready for use, but with the alleged expiration date printed on them. They couldn’t be distributed like that, so we had to follow protocol outlined by regulatory agencies, to prove that the condoms passed quality assurance tests,” the expert pointed out.

Beyond rhetoric from the Government and Health organizations, the reality is that contraceptive coverage hasn’t surpassed 77% of demand, since 1995. This is what the 2020 Statistical Yearbook of Health states. 

The story continues today. According to a survey carried out by elTOQUE, approximately 44% of readers said they hadn’t used male condoms during their sexual relations in the past five months. Meanwhile, 73% said they managed to get condoms on the “informal market” j”, followed by 20% who said they managed to get condoms thanks to help from relatives or friends living abroad. Only 2% said they managed to purchase them in drugstores or via public health practitioners or healthcare centers. 

The survey also revealed that condoms cost between 50-100 Cuban pesos, when you could purchase them, when available, at state-led establishments for 1 peso, before the Tarea Ordenamiento (economic reforms) and rampant inflation. 

Against this backdrop, it seems that controlling ejaculation or coitus interruptus might be becoming more important among the sexually active population. Sixty-nine per cent of readers confirmed this, who identified the pull-out method as an alternative to contraception. 

Ejaculating outside the vagina is not a 100% foolproof form of contraception and it doesn’t prevent sexually transmitted infections from spreading. Fernando’s story pays testament to this. When the country locked down during the pandemic, him and his partner stopped using protection. They got used to practicing coitus interruptus until his girlfriend got pregnant and was in danger of losing her artistic career.

“We had a really bad time. She had to have an abortion and the recovery process was tough. She didn’t even want to say anything at work because she could have lost her job,” he remembers.

A promise to the wind 

Systemic condom shortages have exposed people to unsafe practices. Without condoms, the country’s expressed will to reduce STIs, human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS), as well as encouraging the drop in teenage pregnancies, would seem like a “promise to the wind.” This is one of Cuba’s commitments with the Millenium Development Goals; the country has some alarming statistics. 

According to the Statistical Yearbook of Health, there were 398 HIV/AIDS-related deaths of both men and women in 2021. 

According to the Cuban News Agency (ACN), there was an upturn in HIV/AIDS incidence in Santiago de Cuba in 2022, with 307 cases being detected. The STI incidence rate in the province also increased with 894 patients being diagnosed with syphilis, 91 more than in 2021. It was also noted that complaints- such as genital herpes, urethral discharge, vaginal discharge and lower abdominal pain -, also increased. 

Meanwhile, the number of unintended pregnancies shot up, especially in girls under 18 years old. In 2023, Santiago de Cuba’s Sierra Maestra newspaper reported that 827 out of 4610 pregnant women in the province were minors. 

A year before, official statistics pointed out that the adolescent fertility rate in Cuba had reached 17.8%, “well above the expected and desired” figure, and that it had barely changed in the past decade. During the national plenary session of the Federation of Cuban Women (FMC), it was pointed out that 14,994 pregnant teenage girls were recorded in 2022. During the meeting, it was recognized that the vast majority of these pregnancies were the rest of the non-utilization or improper use of contraceptive methods. 

These numbers led health authorities to admit the existence of a “serious social problem.” Back then, the Government’s goal was to reduce this indicator by 50% and ensure 80% of contraceptive coverage in medical practices. This target was not met.

Where do sexual and reproductive rights stand in Cuba? 

In early 2019, during a panel at the National Center for Sex Education (CENESEX) in Havana, Arie Hoekman, the UNFPA representative for Mexico and director for Cuba and the Dominican Republic at the time, warned about the growing number of unintended pregnancies in different regions across the planet, especially because of the “limited range of contraceptive methods available or because of a lack of information.”

Meanwhile, Hoekman said that Cuba was working to guarantee Cuban citizens’ sexual and reproductive rights.

A news item by the Cuban News Agency about this meeting said that Cuba had “high levels of contraception use and free universal and free access to abortions.” However, the company that imports the majority of condoms in Cuba, has recorded lower purchases of male condoms abroad since 2019.

In 2022, the digital magazine Cubahora stated that Cubans have the right to make “free and responsible” reproductive decisions. That same year, the minister of Public Health Jose Angel Portal Miranda backed this in statements to the press.

One of the key requirements to exercise your right to make free and responsible reproductive decisions is access to fertility regulating methods. These can be divided into two groups, barrier or hormonal; although they also include sterilization and abstinence.

The absence of contraceptive pills is a reality in the post-pandemic world. While it isn’t as widely used in Cuba as the male condom, it may perhaps be the most widely used barrier method in Cuba and it is pretty much never present on the state-controlled distribution network. There are other methods such as the female condom and intrauterine devices (IUD), which is used a lot less.

The Cubahora article highlights the fact that the Cuban State guarantees abortion to teenagers with the consent of their legal tutors, and to women over 18 up until the tenth week of pregnancy. Cuba was the first country in Latin America and the Caribbean to decriminalize abortion; but that doesn’t mean that the procedure should be used as a form of contraception. It is a complex and dangerous procedure, and in some cases can put the patient’s life in danger.

According to the health minister, institutions insist on preventing unintended pregnancies and using abortion as a last resort, “if contraceptive methods fail to work.” But these methods have been systematically in shortage in Cuba for decades, harming people’s reproductive and sexual health.

But for those who have access to “hard currency” or have friends and family living abroad, the situation can vary. The condom market has shifted from the public to the private sector, so access to male condoms and other contraceptive methods has become another mirror of social divides on the island. So, where do sexual and reproductive rights stand in Cuba? In your pocket, in the power of your pocket.

This article was translated into English from the original in Spanish.