by Omar I. Hassan
Graphic design by Ravneet Jaura
In representative politics, especially within developing regions, population size determines your political clout. Like you, and many of your fellow ambitious politicians in the Global South, this is not a burden—it’s a strategy. Bloat your constituency for a louder voice—and in turn, control over more state resources. In a postcolonial world eager to cover past injustices, international donors rush to deliver humanitarian aid with few conditions and even fewer questions. For the politically savvy, this is not solely aid; it’s an opportunity. Among the most abundant and misunderstood of these gifts are contraceptives. You might wonder, why would you invite contraceptives at all if your population size determines your power?
That is precisely why you need to not only manage this aid, but leverage it as well. These foreign-sourced tools of reproductive control may be unfamiliar to your people and you—the benevolent yet enterprising representative—are best poised to hold this aid for the ‘public good’. When leveraged, contraceptives can easily become a vehicle for your political power and profit.
Step 1: Attract Aid
Begin by appealing to state and international donors such as the United Nations Population Fund, United States Agency for International Aid (USAID), or the Global Fund. Present the situation as alarming as possible with inflated public health statistics1–3—emphasizing maternal and child mortality, HIV prevalence, and adolescent pregnancies. Pull those heartstrings enough and you will be rewarded with warehouses worth of implants, condoms, and Depo-Provera (an injectable contraceptive). Romanus Pakure, former acting director of Papua New Guinea’s National AIDS council knew this game well. During the 2008 human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics, Pakure secured millions of condoms—leaving two million of them to expire unused and undistributed, while others were sold to fund his administration’s trips abroad4 Papua New Guinea has the highest proportion of HIV cases in Oceania, accounting for more than 99% of Oceania’s HIV cases, when excluding Australia and New Zealand.5
Step 2: Direct the Flow
Having secured a steady flow of aid, centralize it. Fill key positions in Ministries of Health or Welfare Departments with loyalists—a common practice in Pakistan, where procurement of equipment is predominantly managed by political bodies instead of clinicians and hospitals.6 This allows you to strategically allocate (or misallocate) as you please. Kenya’s 2021 HIV report showed inflated demand and underreported supplies to extract more donor aid.7 Donors seem to trust local governments to “self-assess” and fulfill all their needs.8 After all, why wouldn’t they trust the loyal servant of the people that you are?
Evidently, direct distribution to your constituency is an ill-advised goal. Contraceptives marked “Not for Sale” are merely suggestions; they can be redirected quietly into black markets or resold through pharmacies that you hold stake in, generating a consistent and profitable form of revenue. Uganda has mastered this tactic, having an estimated 10% of public contraceptive stock regularly “falling off the boat” into private markets, generating a robust parallel economy3 Similar criticisms were raised in a Department for International Development (DFID) report in Nigeria, where widespread diversion of aid-funded birth control were redirected into private sectors.3 The local business will thank you, as well as your loyal retainers. (Almost) Everyone wins.
Step 3: Monetize Morality
If the public starts to question the missing aid, rising accidental pregnancies, and worsening STI-related epidemics—don’t panic.1–3,9 Instead, simply pivot. Denounce the contraceptives.10,11 They are foreign and immoral colonial impositions. Return to the embrace of tradition and faith, touting arguments against birth control while blaming strife on the misguided and insufficient aid that is being sent. Solidify the support of your conservative and rural communities. After all, these are foreign tools donated by outsiders. Who is to say they do so with your best interest in mind? Is it the supposed liberation that they tout or simply population control?11–14
Communist Romania’s 1966 ‘Anti-Abortion Decree’ (Decree 770) banned abortion outright and ran heavy slander campaigns against IUDs, condoms, and hormonal birth control methods.15 The government also de facto banned almost all access to birth control and ensured population fertility through monthly gynecological exams.15 The resulting birthrates shot up from below average to 54 percent in excess over other Eastern European countries.15 The purpose? To bolster the Romanian Communist Party numbers.
Much like Romania, your public opposition of contraceptives can nurture both the growth of your population and political base. Larger families will depend on you through state provisions—education, food, and jobs. This makes them a more pliable electorate; willing to bend to your will through your tightly bound patronage. Each redirected condom, oral pill, contraceptive injection, and IUD translates into another future voter.
Step 4: Sustain the Cycle
By jeopardizing reproductive autonomy, population counts will rise, and so too will your aid shipments. Donors will be instilled with a sense of urgency to meet the needs of your rapidly growing constituency and worsening epidemics. Bangladesh, Malawi, Guinea, and the Central African Republic have all successfully employed this model of redirecting over-ordered reproductive health supplies into local markets.8 Multiple sub-Saharan African countries had contraceptives diverted by local officials for resale and were rarely penalized. Such corruptions are often chalked up to a mere consequence of weak supply chain oversight, low salaries among health workers, and collusion between vendors and government employees.16 A harmonious cycle is created; as more contraceptive aid is misdirected, donors increase aid, and the opportunities to convert contraceptive supplies into monetary profit expand. Each link in the cycle is designed to feed the next phase of the swindle.
Step 5: Fight Reforms
Sadly, this eloquent system now faces grave threats from those who seek to undermine it. Donors are increasingly suspicious. Some are demanding increased transparency through third-party audits or whistle blower campaigns such as the Global Fund’s “I Speak Out Now!.”17 Even more threateningly, they have been shown to try and subvert your own civil society to oversee your actions.18,19 Foreigners stoking a betrayal from your own people! Still, this is not a cause for alarm. Keep a tight hold on the press and question the legitimacy of observers. Always remember: you alone know what the people need.
The Caution of Satire
Although fictitious in tone, this guide is grounded in very tangible patterns of aid theft and misuse, corruption, and political manipulation that stunts the development of many struggling countries. The redirection of [KG26] contraceptive aid through unchecked donations is not only ineffective, but harmful to the very communities this aid seeks to serve. The result of exacerbated health crises and undermined reproductive autonomy remains insufficiently addressed. With such little oversight, there are few tangible reports—other than those made by third-party observers. These observers are often impeded with restrictions by local governments, corruption, or coercion. [KG27] The purpose of this piece is not to denounce donations or advocate for withholding them, but rather to increase conditions[KH28] [OH29] [KH30] and enforcement as part of the emergency response. Here, satire seeks to reflect the very real detriments of perverse incentives, rampant institutional corruption, and weak oversight in turning critical aid supplies into tools of profit and power.
References
1. Noel S. US says it will reduce health aid to Zambia because medicines were stolen and sold. 2025 May 8.
2. Druce N & Oduwole Y. Reproductive Health Commodity Security Country Case study: Nigeria. 2005 October.
3. Republic of the Philippines. RA 10354 “RESPONSIBLE PARENTHOOD AND REPRODUCTIVE HEALTH ACT OF 2012”. January 1.
4. AlJazeera. People in Kenya say lives at risk as HIV drugs run short. 2021 24 Apr.
5. O’Brien J. Pope Francis Should Lift Abortion Bans to Fight Zika. 2016 February 10.
6. UNAIDS. AIDS Epidemic Update. 2009.
7. Talbot M. Is Contraception Under Attack? 2024 Dec 3;
8. UNHCR. Procurement of Medical Equipment for Hospitals in KPK-Pakistan. 2020; Available at: https://www.ungm.org/Public/Notice/112194.
9. The Global Fund of the Inspect General. I Speak Out Now! Available at: https://www.ispeakoutnow.org/.
10. Tomlinson BAC. Working with Civil Society in Foreign Aid: Possibilities for South-South Cooperation? 2013 June.
11. Schoeberlein J. Corruption and the right to sexual and reproductive health in sub-Saharan Africa. 2021.
12. Philipovic J. How American Women Could Lose the Right to Birth Control. 2024 May 20.
13. Weber L. Conservative Attacks on Birth Control can Threaten Access. 2024 June 5.
14. Friedman W. Corruption and averting AIDS deaths. World Dev 2018;110:13–25.
15. Berelson B. Romania’s 1966 Anti-Abortion Decree: The Demographic Experience of the First Decàde. Population Studies 1979;33(2):209–222.
16. International Rescue Committee. How U.S. aid cuts impact public health. 2025 March 19.
17. CDC National Prevention Information Network. AIDS Explosion Warning for Papua New Guinea. 2002 Mar 13.
18. Kohler JC, Pico CT, Vian T, et al.. The Global Wicked Problem of Corruption and Its Risks for Access to HIV/AIDS Medicines. Clin Pharmacol Ther 2018 Dec;104(6):1054–1056.
19. Organisation for Economic Co-operation and Development. Civil Society and Aid Effectiveness: Findings, Recommendations, and Good Practice. 2009.
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