Dwindling supplies. Condoms are displayed on a stand in a Los Teques, Venezuela chemist. Credit:Washington Post "We barely eat three times a day now," said a distraught Gutierrez, a former hair washer in a beauty salon who lost her job because of the economic crisis. "I don't know how we're going to feed another mouth." In Venezuela, a collapse in oil prices coupled with nearly two decades of socialist policies has sparked a severe recession and one of the world's highest inflation rates. People often wait hours in line to buy bread. Prices for staples jump almost by the day. Medical shortages range from antibiotics to cancer drugs. But the shortage of contraceptives has put Venezuelans in a particularly bleak quandary: Have sex - or don't? And for the most part they are, sometimes with dire consequences. There are no recent official statistics.

But Venezuelan doctors are reporting spikes in the numbers of unwanted pregnancies and sexually transmitted diseases that are adding to the country's deepening misery. Mainstream media outlets have published articles about the "counting method" of contraception that women can use to calculate when they are ovulating and likely to get pregnant. An article on the Venezuelan website Cactus24 offered "15 home remedies to avoid pregnancy," including eating papaya twice a day and drinking two cups of tea with ginger. Many Venezuelan women have found a solution on social media, where Facebook, Instagram and Twitter have become informal exchanges for the purchase or trading of birth control pills, intrauterine devices and implants - albeit at black-market prices. Other women beg friends and relations to bring them contraceptives from outside Venezuela. "Last time, I got them from my sister-in-law, who brought them from Colombia," said Alejandra Moran, a 27-year-old Caracas publicist. "And I'll be travelling to Spain in December, so I'll stock up for myself and my friends."

For years, oral contraceptives, IUDs and condoms were available free at many public hospitals or through government programs. But the cash-strapped government has largely suspended those handouts, leaving some forms of contraceptives impossible to find and others prohibitively expensive. "It's hard for young people especially to access them," said Vanessa Diaz, a gynaecologist at Caracas University Hospital. "Contraceptives like condoms used to be given out and there were many brands available, some of them cheap. But that's just not the case anymore." The shortage, medical experts say, has also fuelled an increase in dangerous attempts to terminate pregnancies at home - not a surprising development given that abortion is illegal in Venezuela except when the mother's life is at stake.

Marissa Loretto, an OB/GYN at Caracas's Concepcion Palacios Maternity Hospital, said she recently treated a woman who had tried to induce an abortion by forcing parsley and laundry detergent into her uterus. The young woman had arrived at the hospital bleeding, and with contractions that ultimately caused a miscarriage. As often happens in such situations, Loretto said, she subsequently suffered an infection. "We ended up having to remove her uterus," Loretto said. Officials at Venezuela's Health Ministry did not respond to emails and phone calls seeking comment. Doctors blame the situation for a worrying increase in HIV cases and sexually transmitted diseases such as gonorrhea, syphilis and herpes.

Maria Eugenia Landaeta, head of infectious diseases at Caracas University Hospital, said the number of HIV patients being treated there has surged to 5600 this year, up from 3000 in 2014. "One of the causes is the lack of prevention methods," she said For years, most pharmacies here acquired medications through a system in which the government set beneficial dollar-exchange rates for the import of foreign-made drugs. But that system has at least partly broken down, meaning pharmacies have few contraceptives to sell and often charge hundreds of times the normal price for them. Overall, stocks of oral contraceptives have fallen by as much as 90 per cent since 2015, according to the Venezuelan Pharmaceutical Federation. On a recent afternoon in central Caracas, one pharmacy said it hadn't received birth control pills in more than a year.

Two blocks away at another pharmacy, a female customer in her 20s looking for pills was told, "We only have the imported ones" - implying they would be sold at a black-market rate. The manager offered her a single pack of 21 pills for 120,000 bolivares. That's about $US4, equal to one-third of Venezuela's monthly minimum wage. "They're expensive, but I need them," the young client said, purchasing them anyway. She declined to give her name before scurrying away. Many name-brand condoms, meanwhile, have disappeared from store shelves. But the cheaper brands taking their place are still imported, and therefore still unaffordable for many. A three-pack can now cost several days' minimum-wage pay. "I inherited my best friend's condoms when he left the country to move to the United States," said Juan Noguera, 28, an unemployed economic researcher. "Sometimes we just share them packets between friends. This is the sharing economy." In Venezuela's macho society, many men refuse to wear condoms anyway. But now that they cost more, experts say, the indexes of unprotected sex are getting even worse.

The cheaper brands can also be unreliable. A few months ago, Andres Rodriguez, 28, said he was en route to his girlfriend's house when he stopped to buy a pack of condoms. All he could find was a brand he had never heard of. "I bought them anyway. I was in a hurry," he said. During sex, he said, the condom broke - although his girlfriend did not get pregnant. "Can you imagine? In this economy?" he said of the prospect of a pregnancy. "What a disaster." Washington Post