The distribution of condoms through Crow Wing County Community Services was halted last month, after county officials learned it was occurring in the first place.
County Administrator Tim Houle said there is no policy supported by county board authorization that allowed employees of community services to distribute condoms.
"There is a governance issue here, so it's unfortunate that we've found ourselves in this situation," Houle said Wednesday. "That is not expressing the opinions on the merits of doing so or not doing so, it is a commentary on the process."
The practice came to light last month when the Brainerd Dispatch sought confirmation of a claim made by Becky Twamley, executive director of WeARE Advocates for Reproductive Education, at a recent presentation.
Twamley told a group at a League of Women Voters of the Brainerd Lakes Area meeting that WeARE received an estimated 3,000 condoms from Crow Wing County, "because they don't give them out at their offices." Some were expired, Twamley later clarified, and were used for educational purposes as part of the organization's SxTalks at a Brainerd teen center, The Shop. The group is also in the process of raising funds to open a family planning clinic in Brainerd.
Houle initially said he was unaware the county was in possession of condoms, although later confirmed the handoff of an unknown number of condoms to the nonprofit organization occurred. He also learned the county was distributing condoms and lubrication to a targeted population of those served through the family home visiting program, one of several items included in a postpartum packet.
That practice was halted when Houle was unable to find record of board authorization. Further research revealed the last time condom distribution was explicitly mentioned in county policies was 1997, when it was listed in the annual community health services plan. Those plans are approved each year by the county board.
"It was called out and identified in those plans and approved by the board at those times," Houle said. "Subsequent plans did not include it, and those were approved by the board. ... After a certain date, authorization went away, but the program administration didn't."
Houle chalked up the mismatch to poor communication.
"Staff who were participating in that are good, high-quality staff that did not know the authorization had been removed," Houle said.
The condoms were granted to Crow Wing County from the Minnesota Department of Health through its Condom Distribution Project, a program of the Sexually Transmitted Diseases/HIV/Tuberculosis Section. Agencies are eligible by invitation, and must fill out an order form to receive condoms and lubrication. Crow Wing County ordered from the program in 2008, 2009, 2011, 2015 and 2016.
Kathy Chinn, capacity building coordinator in the STD/HIV/TB Section at MDH, said although only invited organizations are allowed to order condoms through the program, they are permitted and encouraged to distribute them to other organizations in need.
"An agency may redistribute condoms to other agencies/programs that are not eligible to participate as long as the condoms are given to individuals free of charge (and) to individuals in need, e.g. chemical dependency treatment centers, community clinics, battered women's shelters, etc.," the 2016 invitation email stated.
"We know that every county is different and every county knows the target populations that need them the most, and how to reach the people that need them the most," Chinn said. "We really want it to be determined by the need in their area."
Since 2008, Crow Wing County received 11,000 condoms as well as lubrication from MDH. In an email, program manager Kara Griffin estimated the county was distributing about 600 each year to new mothers, along with lubricant and information on the benefits of spacing pregnancies. Also handed out are brochures on Child and Teen Checkups, safe sleeping, tummy time, Parent Aware, poison control, postpartum mental and physical health and education on birth control options. The packet also contains Women, Infant and Children, or WIC, cards.
Commissioners weigh in
The matter has not come officially before the board, although Houle said commissioners were apprised of the revelation. Four of five commissioners were reached by phone and questioned about their reactions. All said they were unaware of the program prior to Houle's notification.
Chairman Doug Houge said his initial thought is the county does not belong in the area of distributing condoms.
"I would have to be persuaded by someone to continue doing it," Houge said. "I just don't think it falls under our responsibilities. ... Had we known about it, we probably would have ended it awhile back."
Houge said if there are other organizations in the private sector providing that service, he believed they were better equipped than the county. He said if there are not other organizations, he "may be convinced that we should continue to do it."
"If there aren't and we need to continue to do it ... I would just have to be sure that that's the case," Houge said.
Commissioner Paul Thiede said he was most disappointed about the fact the board was unaware of the distribution of condoms.
"For us to go 17 years without the board being aware, that is more distressing to me than anything else," Thiede said. "I'm a great believer in our reviewing our policies and our procedures and our contracts on a yearly basis for that reason. It's too easy for things like this to be presumed to be the policy of the current board, when they were approved by a previous board."
Thiede said since it has not appeared on an agenda, he has not pursued additional information than what he as provided by Houle.
"I can tell you, I would question the validity of what I understand the practice might have been, the distribution of condoms to new mothers," Thiede said. "I'm a great believer that the best condom is abstinence. ... In the context of the education that we're educating, I can't find the validity when we're dealing with pregnancy that the education is in condoms."
Commissioner Rachel Reabe Nystrom said as a member of the community health services advisory committee, she could not recall condoms being discussed at those meetings, either.
"We talk about a lot of things, but we haven't talked about that," Nystrom said.
Nystrom said until she had conversations with the nonprofit WeARE, she was unaware the nearest family planning clinic for Crow Wing County residents was a once-a-month offering across the Cass County line in Pine River.
"The good news is, this group formed and they are going gangbusters," Nystrom said. "These are smart, committed women, and I don't think they're going to need much help from the county. ... I haven't discussed with any of my colleagues about it, and I'm delighted the way things are going. That we're going to have this in our community for people who want it and need it. I think that it's appropriate. I think there are a number of people in the county that perhaps have religious or ideological thoughts against family planning. They can't say, 'Our taxes are going for this.' I think this is a great solution."
She said she believes the county needs to have a conversation after learning about the condom distribution program.
"I think we're going to have to have a discussion about what are our core values and our core services," Nystrom said. "The county can't do everything. And that's why I'm delighted about this other group, WeARE, who saw a need."
Commissioner Paul Koering did not offer an opinion, noting he would like to have more information.
"I'd like to have a presentation on it," Koering said. "Why we're doing it, and if it's something that we should continue. I guess I need more information before I tell you if I'm in favor of it or against it."
Commissioner Rosemary Franzen did not return calls for comment.
Area orgs, counties participate
Crow Wing County Community Services was one of 104 agencies to receive condoms and lubricant in 2016, according to Chinn. Other area county agencies that participated include Cass County Health, Human and Veterans Services, Wadena County Public Health, Todd County Health and Human Services and Mille Lacs County Community and Veteran Services. Also receiving condoms through the program were Minnkota Health Project, an organization based in Wadena providing services to HIV-positive people in greater Minnesota; Mahube-Otwa Community Action Partnership, which operates family planning clinics in Cass, Todd and Wadena counties; and WeARE, which Twamley said applied for an ongoing means of sourcing condoms.
Chinn said the Condom Distribution Project has been funded by HIV prevention funds since 2006. In 2016, the program cost $19,453 to operate. Distribution of free condoms is a requirement from the Centers for Disease Control and Prevention for the state agency to receive federal funding for HIV prevention, Chinn said. According to the CDC, investment in HIV prevention-including access to condoms and sterile syringes-has averted more than 350,000 HIV infections and resulted in saving more than $125 billion in medical costs.
Chinn pointed to the importance of condom access in light of the rising chlamydia rates in Minnesota.
Chlamydia is treatable, but often goes untreated because those infected have no symptoms, the CDC reports. It can cause permanent damage to a woman's reproductive system, preventing the ability to become pregnant later in life. The state as a whole and Crow Wing County in particular have seen a rise in reported chlamydia cases, MDH reports. In 2000, 48 cases were reported in the county. Fifteen years later, 137 cases were reported.
"It's one of the cheapest, most effective methods of trying to have a small impact on that increasing rate," Chinn said.