Male Circumcision is Not Genital Mutilation

One evening I was dining with my anthropologist friend Natalie and I expressed just how viscerally and zealously I abhor the African practice of female genital mutilation. As a male champion of women’s rights and a lover of the female form I believe that there is no reason to hack off a pubescent girl’s clitoris and/or labia other than to make the act of intercourse painful, to deprive women of their inherent sexual freedom and to oppress them as a permanently subservient class. I think that female genital mutilation is such a patently wrong act, a reification of misogynist and phallocentric violence that should be prohibited and criminalized. Anyone who practices female genital mutilation is a menace to society, and our police forces should lock them up behind bars.

Natalie threw a wrench into my crusade for the sanctity of the clitoris; “But Zac, aren’t you Jewish?”

“Yeah, so? What’s that have to do with anything?”

She looked down in the direction under the table and cleared her throat.


At that moment I realized the hypocrisy of my zeal. I was so humbled and dressed down that I concluded that when speaking of subjects as delicate as a culture’s practices pertaining to the sexual organs – especially those of cultures that are not one’s one – perhaps one should generally abstain from casting matters in sweeping judgments of “right” and “wrong”. I’m not saying that one shouldn’t criticize the genital practices of foreign cultures; sometimes one must. But perhaps we should limit our analysis to those things that we can prove at least somewhat scientifically and avoid subjective critiques of metaphysics and postmodern gender theory.

My friend Natalie isn’t the only one who thinks that my righteous indignation against genital mutilation should apply to both genders. There is in fact a growing faction of feminists, human rights activists and lovers of the natural male form want to broaden the definition of assault to include those who circumcise the foreskin. The self-proclaimed “Intactivists” advocate for the preservation of “genital integrity” and an end to the practice of male circumcision – or “male genital mutilation” as they prefer to call it.


One such group known as the Bay Area Intactivists values the foreskin as a nerve-rich portion of the male genital organ. From their perspective, male circumcision is means of denying to a male and his future partner(s) the potential for maximum sexual satisfaction.


Other groups such as Intact America are organizing the opposition to male circumcision from comparatively more scientific, rationally more compelling grounds. If you read their literature, you get the sense that they represent a faction within the American medical community who oppose the practice under the logic that 1. the act of circumcision can be painful; 2. it can lead to infections and other harmful complications, and 3. removing the foreskin is not medically necessary.


Now the combined Intactivists of San Francisco have garnered enough signatures to put a referendum on the ballot which extend the definition of assault to those who circumcise males under the age of 18. If the proposition passes, the circumcising of a male’s foreskin would be a misdemeanor offense punishable by up to a $1,000 fine or up to one year in jail. The consent of the underage male in question would be irrelevant; a male could only consent to having his foreskin removed if he is a legal adult. There would be no religious exemptions.

The movement to utilize the compelling force of criminal law to prohibit male circumcision is not without foundation. After all, since federal legislation was passed in 1996, Section 116 of the U.S. Code has defined whomever “circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years” as a perpetrator of assault. The Intactivists make a reverse-sexist argument that by creating a set of legal protections for women – but not extending those same protections to men – the continued legality of male circumcision is a violation of the Equal Protection Clause.

As much as this blogger disagrees with the claims of the Intactivists, I am equally critical of the campaign by the Anti-Defamation League and the American Civil Liberties Union who are arguing against the San Francisco ballot measure in terms of religious freedom. If a federal judge were to strike down a municipal ordinance banning male circumcision because it is a violation of the Jewish people’s freedom to exercise our religion, then that same judge would have to uphold the right of West African Muslims to practice female genital mutilation on the same grounds. This would be an argument of cultural relativism; e.g. “Yes, it is a barbaric practice, but we live in a barbaric society in which cruelty and torture are woven into the fabric of our culture.” This is not the argument that the defenders of male circumcision ought to take.

If defenders of circumcision are going to make a valid argument based on moral logic and reason, one must contend why the practice itself is not just a tolerable tradition with religious significance but actually a positive good with secular and tangible benefits. And moreoever, it doesn't hurt to deconstruct the logic for the argument against circumcision.

From what I gather after a comprehensive reading of their literature, the moral logic of the Intactivist movement runs as following:

1. Female circumcision is a cruel, inhumane practice which can cause disease and pain over the course of the victim’s lifetime. (Given)
2. The only reason why cultures practice female circumcision is to make the act of sexual intercourse excruciatingly painful and undesirable. (Given)
3. Therefore, female circumcision is a form of assault (1, 2)
4. Gender is only a social construct, there is no substantive difference between men and women, in fact, the binary characterization of human beings as either men or women is a form of gendered chauvinism. (Given)
5. Therefore, male circumcision is also a cruel, inhumane practice (1, 4)
6. Therefore, the only reason why Western culture practices male circumcision is to make the act of sexual intercourse excruciatingly painful and undesirable (2, 4)
7. Therefore, male circumcision is a form of assault (5, 6) Q.E.D.

The crucial fallacy in this logical argument is postulate number 4. Though traditional gender roles and identities might be a mere social construction, it is more than fair to say that there is, in fact, at least one significant difference between the vast majority of individuals born as males or female; generally speaking, males are endowed with penises and females are endowed with vaginas. In light of this fundamental distinction, the removal of the clitoris and/or the labia should be banned while the removal of the foreskin should remain legal because there is in fact a very compelling case to be made that male circumcision and female “circumcision” are two very different operations performed on two very different organs which ought to be distinguished as such under law.

Intactivists’ Sophistry #1: “Surgically removing part of a baby boy’s penis causes pain.”

If one were to practice circumcision with the same crude instruments and techniques as say, the Dogon tribe of Mali, then it is indeed an unnecessary painful procedure. The Dogons gather all of the uncircumcised boys 12 years old and up and to have the village blacksmith remove the boys’ foreskins with a homemade blade which is not very sharp by Western standards – and they perform the operation without any sort of anesthetic. Perhaps this argument over pain might be valid if Jews in America were to practice circumcision in a way similar to the Dogons; if that were the case, maybe circumcision should be prohibited under law.

The modern Diasporic Jews of America, however, have developed a method of circumcising our boys at the age of eight days when the nerves of the appendage are not as sensitive as a pubescent boy and we utilize various means of anesthesia which all but eliminate pain. The most effective of these is nerve-block applied locally with a shot to the penis – a remarkably effective anesthetic which renders the applied area completely numb. Rabbinical student Josh Stanton and Dr. Anne Epstein write: “While the idea of an injection to the penis sets teeth on end, it is as close to pain-free as we can get in this sort of minor surgery… It hardly hurts.”

Just about any operation involving the cutting of flesh – even an operation as minor as a tonsillectomy or the removal of an ingrown toenail – would be painful without anesthesia. But if the prick of a needle was reason to ban a medical procedure on the basis of pain, then banning circumcision would make no more sense than banning tetanus or polio vaccinations. In this day and age of modern anesthetics, the contention that circumcision should be banned because the procedure causes pain holds little ground.

Intactivists’ Sophistry #2: “Male circumcision creates immediate health risks and can lead to serious complications.”

Indeed, a botched circumcision could lead to an infection of the penis or worse. In cultures that perform this operation with crude tools and unsanitary conditions – such as the Dogon blacksmiths with their homemade iron blades – yes, the removal of a boy’s foreskin does sometimes lead to more serious complications including not only local infections but hemorrhage, scarring, difficulty urinating, loss of part or all of the penis, and even death. According to the Center for Disease Control, between 2% and 8% of all circumcisions performed in African cultures lead to an infection or more serious complications.

However, such fears are essentially unwarranted in the developed West because we utilize modern medical practices, the doctors and mohels who perform circumcisions are rigorously trained, and we perform the operation in a sanitary environment. Even if the most basic aspect of male circumcision remains the same, the cleanliness of our foreskin-cutting arenas, our medical instruments and our practices make a world of a difference. Local infection is still nevertheless possible – but then again, even having your bellybutton pierced can lead to an infection if it is not done by the right person in the right place the right way.

Whether an adequately trained, certified mohel conducts a circumcision in a synagogue or if a bona fide doctor circumcises a baby boy in a hospital, the risk of immediate health risks with serious complications is extremely small. According to the CDC, the rate of complications due to male circumcision in the United States is around 0.2% of all cases – in other words, just about negligible.

Indeed, the medical Intactivists are correct when they argue that male circumcision can cause infections – there is that 1 case in 500 in which the circumcision does lead to a complication – but that fact cannot be adequately evaluated in isolation. In a study of circumcised boys in Washington State conducted over the course of a decade, it was found that for every circumcision complication there were 6 urinary tract infections prevented. Circumcision also reduces the chance of contracting human papillomavirus (and thereby penile cancer), genital herpes and HIV.

Intactivists’ Sophistry #3: “Male circumcision is unnecessary” because “Claims that circumcision prevents HIV have repeatedly been proven to be exaggerated or false. Only abstinence or safe sex, including the use of condoms, can prevent the spread of sexually transmitted diseases including HIV/AIDS.”

At this point in the evolution of homo sapiens, the continued possession of a foreskin actually poses a risk to the health of males and those who have sex with them. The main reason why not circumcising a boy creates a health risk is that this vestigial structure creates a cavity which can retain smegma which can sit and fester, inviting bacterial and viral infection. Uncircumcised males are more likely to contract and transmit HIV than those who are circumcised, largely because the smegma which can be retained in the foreskin allows for the transmission of the virus to and from vaginal fluids. In addition, the foreskin has considerable surface area which renders the penis more susceptible to minor trauma and ulcerative disease – thus increasing the chance of transmitting the HIV virus.

A 2000 study of the relationship between male circumcision and heterosexual transmission of HIV in Africa noted “a substantial protective effect of male circumcision on risk for HIV infection”; finding that the risk of HIV infection in circumcised men was 44% lower than those who were uncircumcised. The strongest association between circumcision or lack thereof and HIV infection rates was found in high risk populations (e.g. patients at STD clinics) for whom the adjusted relative risk was 71% lower for those who had been circumcised. Another study conducted in 2003 found that the risk of HIV infection in circumcised men was 42% lower than their uncircumcised counterparts.

More macro-level epidemiological studies indicate that the practice of circumcision is not limited to the individual men but also the population as a whole; after all, if a man has contracted HIV due to his smegma-retaining foreskin, he is then liable to transmit the virus to his sexual partner(s), who are then liable to transmit the virus to their sexual partners, etc. African and Asian countries in which less than 20% of the male population has been circumcised have HIV infection rates several times greater than comparable African and Asian countries in which more than 80% of the male population has been circumcised. Of course, there are many other variable including religious mores and sexual norms which also vary among these countries, but the link between relatively high rates of circumcision and relatively low rates of HIV infection is so strong that the value of the practice as a significant factor in reducing disease transmission cannot be ignored.

I have heard a number of objections to this kind of analysis; namely that such studies have only been performed in underdeveloped Third World nations and not the developed West. These skeptics contend that since Americans and Europeans have better hygiene than the typical African, since we generally practice monogamy, wear condoms and bathe regularly we do not need to bother with circumcision.

Such First World-centrics are faulty in their reasoning, particularly because the studies linking the lack of circumcision to higher rates of HIV infection found the greatest correlation in the most at risk populations – precisely those persons in the United States who are the most likely to have sex with multiple or even concurrent partners, those who do not wear condoms, and those who have the worst hygiene. The mere fact that one might reside in the Global North does not separate that person from the basic facts of virology which tend to be associated with the Global South. Likewise, if circumcision has been found to be an effective method of minimizing the HIV epidemic amongst homo sapiens in sub-Saharan Africa, absent any fundamental anatomical or physiological distinction between Americans and Africans, there is only reason to conclude that that practice remains effective amongst homo sapiens in the United States.

I have also heard the argument made that circumcision is unnecessary for homosexual men, because the studies cited above have only demonstrated a link between circumcision and reduced prevalence of HIV amongst heterosexual men. This Intactivist argument maintains that for a parent to decide that they will circumcise their boy to protect him from HIV and AIDS is to make a heteronormative assumption that their child is in fact straight, and that if their boy turns out to be gay then they will be deprived of sexual satisfaction due to a societal bias towards heterosexuality.

This Intactivist sophistry is not only spurious in its logic but quite dangerous in its potential for giving homosexuals a false sense of security. Though the possession of a foreskin is most likely to transmit disease via the mixing of smegma and vaginal fluids – which is exclusive to heterosexual intercourse, that is not the only reason why possession of the foreskin increases the chance of disease transmission. Disease can also be transmitted because the foreskin is more easily susceptible to tearing. One must also take bisexuality into consideration; an uncircumcised man could very easily receive the HIV virus by trading fluids with an HIV+ woman and later on transmit the virus to a male sexual partner (or the other way around) explicitly due to his possession of his original foreskin.

Read Intact America’s sophistry again: “Only abstinence or safe sex, including the use of condoms, can prevent the spread of sexually transmitted diseases including HIV/AIDS.” This is more or less the logic of abstinence-only sex education; “if you don’t have sex, then you can’t get a sexually-transmitted disease; therefore don't wear a condom”; “if you always wear a condom, then you can’t get a sexually-transmitted disease; therefore you don’t need to be circumcised.” The problem with this logic is that uncircumcised men do have sex, sometimes they use condoms, sometimes they don’t, sometimes they have sex with a condom but the condom breaks, etc. Even the highest-quality prophylactics can fail - that is why instead of relying on the effectiveness of one or two disease prevention methods, it is best to employ as many as possible.

Intact America is telling the truth when its literature states that circumcision is not the only way to prevent the transmission of HIV, that abstaining from sex or practicing safe sex are alternative ways of preventing disease transmission. But they're not telling the whole truth. “Male circumcision is unnecessary”; indeed, for a practitioner of celibacy there might not be much of a benefit, but for everyone else it remains a very sound, particularly effective means of reducing the transmission of disease. There is no silver bullet which can by itself inoculate an individual from HIV/AIDS, no one is claiming that circumcision can by itself rid the world of this deadly epidemic. Rather, medical proponents of circumcision are contending that it is but one of many practices which ought to be maintained – along with fidelity to one’s partner, safe sex, regular testing – in order to defend oneself from STD transmission.

Likewise, the Intactivist movement is making a grave mistake in trying to ban male circumcision under the guise of public health; their pseudo-scientific case to ban the practice is so full of misleading language, cherry-picked half-truths and outright falsehoods that it cannot be taken seriously. Perhaps there are other reasons why a parent might reasonably decide to opt to not circumcise their male child – religious, sexual, aesthetic or otherwise – but the health of the child is not one of them. Male circumcision is not genital mutilation; it is a sound medical procedure which is safe, which does not cause undue pain, and it is still a very effective component of our society's efforts to maintain men's health and curb the spread of disease in America and throughout the world.

HIV/AIDS Activism: Lost in Translation

After dedicating two years of my life to the cause of sustainable development in the Republic of Mali, I came to loathe so-called "aid" projects which are unnecessarily expensive, relatively ineffective, and either achieve their intended goals at an obscenely high ratio of costs to benefits or they accomplish absolutely nothing at all. Perhaps the greatest potential for stupid, wasteful “aid” projects lies in the sub-field of HIV/AIDS education. Part of it is because HIV/AIDS is such a relatively trendy cause and there is simply such a volume of Western aid dollars allocated to HIV/AIDS projects that there is so much more potential for waste. Part of it is because HIV/AIDS is such an ideologically-loaded subject that Western do-gooders are wont to apply their own belief systems onto poor, unwitting Africans. And part of it is that benevolent do-gooders are so completely ignorant of their host country’s culture that when they try to intervene in matters of sexuality they are simply doomed to failure.

Imagine a couple of humanitarian aid professionals – one has a Masters in African Studies from Yale, another went to Princeton to get their Ph.D. in International Relations. A well-meaning NGO just raised $200,000 to send them to do something about AIDS in some poor West African country, say, Niger. So they are sitting around the air-conditioned boardroom of their NGO in the expatriate quarter of Niamey, brain-storming ways to raise the Nigerien people’s awareness about HIV transmission and prevention.

“What if we made a sign to raise awareness about HIV/AIDS?”

“Great idea! Let’s draw up a hundred of them and put them up along heavily-trafficked roads!”

So they will spend about $10,000 to hire a graphic designer in San Francisco who will email his design to a factory in Lyons which will manufacture a hundred or so signs for $20,000. And it will cost another $30,000 to ship the posts from Lyons to the port at Marseilles to the port at Lagos and overland to their NGO headquarters in Niamey. Another $15,000 will be lost to bribing the customs agents. And they will pay the local contractor some grossly inflated price, say, $25,000 to drive around the country, hammer posts in the ground and put up billboards along one lane-roads leading into various cities and towns in Niger.

So when everything is said and done, the perfectly benevolent NGO will have plopped down 100 billboards for a price of around $1,000 each to the grand total of $100,000. Take a hard look at this sign, scrutinize it for about a minute and try to understand why it is such a stupid, festering piece of garbage.

Every piece of information that could possibly be conveyed by this sign can only be understood by those who can read French. Officially, Niger is a Francophone country, there are indeed some people in this country who can speak French – a miniscule minority of teachers, doctors and police officers. But the overwhelming majority of the people only speak their native Hausa, Songraï, Peulh or Tamashek – it is not unfair to assume your typical market lady does not know any “White People Language” beyond “Bozu le Blanc sava sava byen”. Also, the vast majority of people in this country are absolutely illiterate; 71.3 percent of the population, according to the CIA World Factbook – and even that figure is padded by an extremely liberal definition of “literacy” which recognizes anyone who can scrawl their name as “literate”. To 9 out of 10 pedestrians who might be walking down the street in Niamey, that public service announcement might as well be written in ancient Greek.

Likewise, this billboard on the road to the Malian city of Koutiala is also a festering piece of garbage. Imagine you are an illiterate Minianka millet farmer riding your donkey cart to sell your goats at the Koutiala market – what useful lesson in disease prevention could you possibly gain from viewing this $1,000 sign?

This billboard was placed by the Christian NGO World Vision in my former home of Sanadougou. I will give them due credit for writing their public health message in Bambara – Mali’s vernacular lingua franca. It reads “Hey! Be careful, AIDS is here! There is no cure for it.”

Indeed, writing a public health message in Bambara is certainly more sensitive to the local culture compared to writing it in French. But this World Vision billboard is still fatally flawed by the fact that their message was written in any language at all; instead of writing their AIDS-prevention message in ancient Greek, they decided to write it in the equivalent of modern Greek.

To pass the time, I asked scores of my illiterate neighbors for their interpretations of this billboard on the road leading to town. Not a single person I asked was able to tell me that it had anything to do with HIV/AIDS. The closest thing to a logical response I ever heard was “don’t leave razor blades in your bed – they will cut you.”

Sometimes I wonder what part of “illiteracy ” these well-meaning Christian aid-givers don’t understand. To refer to someone as “illiterate” doesn’t me that they can’t fully appreciate the works of Proust; “illiterate” refers to an individual or a group of persons who cannot read or write anything at all. To refer to these cultures as “predominantly illiterate” is not at all a judgment of intelligence or character – it is simply a statement of fact. Likewise, one cannot mount an effective public health campaign in a country like Mali, Niger, Mauritania or Burkina Faso without taking into consideration that the vast majority of your intended audience in these countries is completely and utterly illiterate.

One time I met a World Vision missionary/humanitarian agent in Bamako and took issue with their billboard campaign. She accused me of “insulting the Malian people’s intelligence”; “I work with a number of local staff who are all very capable of reading and writing – one of my colleagues was educated at the Sorbonne and he can read English, French and German!”

This well-meaning church lady’s response was quite telling. When practitioners of “humanitarian aid” and “economic development” live in the expatriate Green Zones of their respective African capitols, they can manage to go months at a time interacting with only the extremely-Westernized, French- or even English-speaking, literate elite, completely sheltered from the social and economic realities of the other 99.999 percent of the population. Such an experience establishes an absurdly rose-tinted perspective of a country’s predominant living conditions – and it allows these naïve, bumbling do-gooders to waste all of their funds on projects which could only benefit the 0.001 percent of the indigenous population with whom they interact at official state functions and the American Club racquetball courts.

Here is another one of my favorite signs posted in the city of Koutiala. If you were a simple unlettered shepherd who speaks the hyper-literal Bambara language completely devoid of metaphor or simile, what would you interpret it to mean?

If I were an illiterate goat-herder, I would think that this billboard meant that AIDS is an anthropomorphic fire demon with a face and arms and legs. In a society where grown men are genuinely afraid of witches, warlocks, hairy field demons, mischievous forest demons and dwarf spirits with backwards feet, it makes perfect sense that benevolent Tubabs would seek to warn the Malian people about the anthropomorphic fire demons which have been wreaking havoc upon America. Likewise, I would interpret this billboard to mean that if this fire demon were to ever try to get into my house, I should push the door shut.

My all-time favorite HIV/AIDS public service announcement is the one line of billboards in Bamako which actually dares to show the image of a condom. Take a look at this public health campaign and try your best to imagine its unintended consequences.

Hardly any Malian men in Bamako ever buy condoms to wear while engaging in sexual intercourse, but – thanks to this fiasco of a public service announcement – when they do buy a condom they are likely to wear it on their two fingers. So they go to the brothel, they fuck a prostitute for 500 francs (~$1), they wear a 100 franc (~20¢) condom on their fingers, and – big surprise – they still contract HIV! So now if any of men or women ever get tested and discover that they are HIV+, they are going to go around telling everyone that either condoms don’t work or that it was the condom itself that transmitted HIV, and any lesson that the well-meaning NGOs might wish to convey will be thoroughly discredited in the public mind.

A ham-handed public health campaign like the infamous “finger bang” billboard is not merely ineffective in combating the transmission of HIV/AIDS – it actually makes the problem worse. Partly thanks to this train wreck of a public health campaign, many young men in Mali think that AIDS is just a hoax. Some have concluded that since people have followed the “finger condom” billboard’s instructions and contracted HIV, The White People are telling Black Africans to wear condoms because we want them to stop reproducing. Others think that AIDS is real, that it was concocted by the CIA to decimate the black population of Africa. Word on the street is that it’s the reservoir tip of the condom which contains the deadly virus; so some people actually buy condoms and cut off the very part of the prophylactic which makes it functional. Since these Western public health campaigns have crashed and burned so egregiously, it figures that polygamous young men resort to “traditional” i.e. witch doctor-prescribed methods like drinking snake oils, herbal teas and having unprotected sex with virgins.

So if these billboards are such absolutely ineffective pieces of garbage, why on Earth do humanitarian aid organizations waste their money on them? Part of the reason is surely that some of the individuals implementing these humanitarian aid campaigns simply don’t get it. But these professional aid-givers with their Ivy League graduate degrees are generally intelligent people – I can’t imagine that all of them are so dense that they don’t understand the folly of expressing public health messages with the written word in a thoroughly illiterate culture.

A more rational explanation for this embarrassing waste might be that Foreign Service Officers and professional development agents are often so lazy that they can’t be bothered to learn the local tribal language(s) of the culture they’re working in – the vernacular tongues without which they can’t possibly engage in any meaningful health education campaign. But they need to demonstrate to their superiors that they did something, anything constructive with their time in Namibia other than gallivanting around on the taxpayers’ dime. Constructing 100 undecipherable billboards – though they might be utterly useless for the Namibian people – at least makes for a solid bullet point on a professional aid-giver’s résumé.


But an even more rational explanation might lie in the political/economic interests of the rent-seeking aid agencies, private aid contractors and NGOs themselves. The unfortunate metric by which they all measure success is not the number of HIV infections averted or the number of Africans educated but the sheer volume of funds dispersed – the more money they spend, the more “successful” they can claim to be; e.g. “This year we spent $100,000 on a campaign to raise awareness about HIV/AIDS”. It doesn’t matter if that $100,000 was spent on a particularly ineffective awareness-raising campaign, or if it didn’t reap any positive health-related results. All that matters on the bottom line is how much money they spent, because the more funds they spend one year, they more funds they can justify raising from donor agencies, banks and private donors the next year.

So do I think that we – the vanguard of humanity who genuinely care about alleviating the disease and misery which defines life in so much of the world – should just give up on teaching Africans about HIV and AIDS? Not at all. I just think that we should stop throwing our money away on such unforgivably stupid wastes of finite resources as visual media which Westerners will never be able to produce for the consumption of peoples who do not understand our system of symbols and imagery, who cannot read our language, who cannot read any language at all – not even their own.

After spending two years living amongst the Minianka tribe in Mali, one lesson I came to understand is that though a literate culture remains alien to these people that have only begun to enjoy access to books, pens and paper, the Miniankas do have a rich and vibrant oral culture. This is a culture in which farmers will dispatch their child from one village to another to rely a simple message, in which virtually all business is transacted through oral contracts, the theology of the Qur’an is disseminated from the mouth of the imam to the ears of the faithful, and where griot troubadours transmit the tribal history from one generation to another through song. If you want to get a message across in the Minianka culture, the only appropriate medium for doing so is the spoken word.

Likewise, you can’t possibly hope to impart unto the Miniankas any useful lessons about health and hygiene unless you speak Minianka. This is one area in which I believe that the Peace Corps is leaps and bounds beyond any other development agencies and NGOs in the field because we are the only organization which bothers to learn the local tribal languages and live out in the field where we can practice them to fluency. I myself did not spend a whole lot of time disseminating seeds of knowledge about HIV/AIDS – I was much more preoccupied with the more ubiquitous scourges of diarrhea, giardia and dysentery. And it took me untold months of building up my language skills, sitting around the teapot chatting with the locals, gradually gaining their trust until I could convince anyone to take even the most modest steps to treat their drinking water.

Teaching the Miniankas about HIV/AIDS is a whole lot trickier because you have to have an exceptional command of the local tongue before you can gracefully converse with the locals about their most intimate relations. And even though my language skills might have been good enough by the end of my two years, I would have never become comfortable enough to talk to conservative Muslim Minianka women about their vaginas. The only people in Sanadougou with whom I could converse about matters of the nether-regions were the teenage-to-twenty-something boys who couldn’t stop asking me about penises, vaginas, and the various other instruments with which Americans engage in sexual relations.

“So Madu, how do Americans do it? Y’know, putting the penis into the vagina?” (Amadou demonstrates by inserting his index finger in and out of a curled fist)

“Well, in America the men have to always wear a condom on our penises before we engage in any sort of hanky-panky. You have to wear a condom every single time – unless, of course, you and your wife are married, you have a lucrative career, a good health insurance plan and enough funds in your savings account to have a baby.”

“But I do not want to wear a condom on my penis. It is not natural!”

“In America you would not have a choice. You must wear a condom on your penis every time you have sex. If you have sex with anyone and you don’t wear a condom – even just once - then everyone will think that you might have AIDS and no one will want to have sex with you ever again.”

“But I am a good Muslim! American women should trust me that I do not have AIDS.”

“Just about every American woman whom you will ever meet in Africa is here to work on HIV/AIDS projects. Hate to break it to you, Amadou, but you live in Africa. You are an African. If you have ever had sex without a condom, and you are open and honest with an American woman about your sexual history, then you have zero chance of ever having sex with her.”

“Hm… maybe I should start wearing condoms - that way I could convince an American woman to sleep with me!”

“That's awful, Amadou. I have just lost a lot of respect for you as a human being. But you know what? There's no such thing as a bad reason to start wear condoms!”

In such a fashion, development agencies and NGOs should make greater efforts to utilize the mass media potential of radio and television – media which are lapped up readily by even the most illiterate Minianka. This is a culture in which an entire village will sit around the car battery-powered TV set watching the soap commercials as raptly as their dubbed Telemundo soap operas. If there is ever to be a cost-effective means to encourage Africans to practice safe sex, it would be stop selling them prophylactics the way we sell them rheumatism ointment and arthritis palliatives and to start selling them prophylactics the way we sell them beer, soda and powdered milk – by insinuating that this product will help the consumer to get laid. After all, this is how Trojan and Durex market condoms in the developed West – it’s absolutely bizarre that the one product that should be sold with sex appeal isn’t marketed in Africa as a catalyst for more frequent and more enjoyable sex.

So if there is one thing that we Tubabs should be doing in Africa to halt the spread of HIV/AIDS, I would say it would be to start aggressively marketing condoms to Africans. USAID and the World Bank should start underwriting the filming of commercials with Akon, Jay-Z and the entire Ghanaian soccer team making culture-sensitive advertisements for these wonderfully cost-effective products, perhaps even buying advertising time on the various African radio TV stations. Such a marketing strategy might be aiming for the lowest common denominator, it might be completely bereft of science, and it might not be as intellectually sound as a bona fide public health announcement. And free market fundamentalists might shudder at public subsidies to benefit certain for-profit corportions. But in consequentialist terms I can’t help but think that it would be the most cost-effective strategy to encourage Africans to practice safe and hygienic sex.

Do You Cause More Harm than Good by Giving TOMS Shoes to the Poor?

After returning from a two-year tour with the Peace Corps I have only been home in New York for three weeks, and over the course of these three weeks at least a dozen people have told me to check out this new brand of TOMS Shoes and their “One for One” campaign – leading me to believe that this is the new trendy thing in humanitarianism. If you haven’t heard the pitch already;

In 2006, American traveler Blake Mycoskie befriended children in Argentina and found they had no shoes to protect their feet. Wanting to help, he created TOMS Shoes, a company that would match every pair of shoes purchased with a pair of new shoes given to a child in need… Blake returned to Argentina with a group of family, friends and staff later that year with 10,000 pairs of shoes made possible by TOMS customers.

Now in its fifth year of operations, TOMS has given away more than 1 million alpargata shoes to children and adults in Argentina and more impoverished, even more trendy Third World societies where the poor go shoeless such as Haiti, South Africa, Rwanda, Ethiopia, Guatemala, Kentucky, Louisiana and Mississippi. Blake does not consider himself to be just another businessman selling a product to make a profit, but as the CEO of a “movement”.
After all, an Argentinean alpargata shoe is not just a fashion choice to impress your Williamsburg hipster friends with your awareness of the oppressed indigenous peoples of the world. So their Birkenstocks were made by high-paid union workers and their Chacos were manufactured with limited carbon footprints – that’s so bourgeois! But if you buy a pair of TOMS Shoes for yourself, you’re directly helping the poor because Blake is going to give another pair to a child running barefoot through the rubble-strewn streets of Port-au-Prince!



The way the TOMS system works is very straightforwardly the way that it is advertised. Similar alpargatas of comparable quality sell for a retail price of $20 to $25, so when TOMS sells their shoes for $38, $44 or $54 the consumer is essentially buying one for the price of two. So yes, TOMS is giving half of their shoes away to the poor, but its not like those donations are coming out of corporate profits - all of the charity is paid for by the Western consumer. TOMS Shoes is profiting from both the shoe the wealthy Western consumer buys for his- or herself and TOMS Shoes is profiting from the second shoe the wealthy Western consumer buys for the person in need.

All through the promotional materials, Blake Myscoskie lays out the case that his shoes are not mere fashion items but humanitarian supplies necessary to promote health and education;

A leading cause of disease in developing countries is soil-transmitted diseases, which can penetrate the skin through bare feet. Wearing shoes can help prevent these diseases, and the long-term physical and cognitive harm they cause.

For those Westerners who have never stubbed their toe, Blake explains how the shoeless suffer from mundane ailments;

Wearing shoes also prevents feet from getting cuts and sores. Not only are these injuries painful, they also are dangerous when wounds become infected.

Furthermore, the lack of children wearing adequate footwear impedes education;

Many times children can’t attend school barefoot because shoes are a required part of their uniform. If they don’t have shoes, they don’t go to school.

Blake seems to have an adequate understanding of the importance of wearing shoes in the developing world. Though I feel the need to elaborate upon one particular “soil-transmitted disease” to which the One for One media implicitly refers: hookworm. If you talk to any doctor familiar with tropical diseases, they will tell you that there are many reasons why one should always wear shoes outdoors; ants, snakes, scorpions, ascariasis, schistosomiasis, rusty nails, broken glass, splinters, etc. But if there is one danger that a doctor is going to cite as a reason to wear shoes in the tropics, it is probably going to be hookworm.


The hookworm is a parasitic nematode which lives in the bodies of carriers and the soil, or to be more precise, in soil soiled with fecal matter. There are many species of hookworm which inhabit different kinds of mammals. People who walk barefoot around places where pigs and humans shit freely are prone to stepping in dirt teeming with larvae of the hookworm species Ancylostoma duodenale or Necator americanus which prefer to reside in our digestive tracts. The larvae need a host in order to feed so they penetrate the skin – usually the underside of the foot. Hookworm larvae then migrate under the skin through the vascular system and into the lungs, and from there they crawl all the way up to the trachea where they are eventually swallowed. The larvae then travel down through the esophagus and the digestive system until they finally reach the intestine where they mature into adult hookworms and grow to a size of 5 to 13 millimeters. Once female hookworms have reached reproductive maturity they can lay as many as 30,000 eggs a day – or 15 to 54 million eggs over the course of a single worm’s lifetime. Hookworm eggs pass through the host’s feces, and once they hatch a pig will eventually lay in the muck or a barefoot child in Nigeria will walk through a schoolyard without adequate latrines… and the life cycle of the hookworm continues…

Hookworm causes a host of physical symptoms among its human hosts, including nausea, fevers, painful diarrhea and anemia. Children born to mothers who were also incubating hookworm eggs in their intestine tend to suffer from low birth weight and prematurity. And I am inclined to assume that Blake Mycoskie’s One for One campaign is referring to hookworm when it invokes the “long-term physical and cognitive harm” caused by diseases incurred by barefoot-walking poor people; after all, hookworm is by far the most widespread ailment which causes cognitive harm which could be prevented by wearing shoes. Especially if contracted at a young age, unwitting hookworm hosts become increasingly more unwitting as the natural development of their brain is retarded and their cognitive abilities either level off at early childhood or they pointedly regress. This is among the many reasons why adequate sanitation and hygiene is so vital for improving education in the developing world, because when children are shitting all over the schoolyard and walking barefoot across the contaminated soils at least a quarter of the student body will probably contract hookworm and become neurologically incapable of learning.

Accordingly, one must understand that the combination of people walking barefoot, inadequate sanitation infrastructre and open defecation is one of the primary reasons why all of the above symptoms are so pervasive in the developing societies of Africa, South Asia, Latin America and Oceania. It is estimated that 576 to 740 million people are afflicted with hookworm worldwide; a stunning majority of 198 million are estimated to reside in sub-Saharan Africa (about a quarter of the total population of 800 million). If you haven't digested that statistic thoroughly enough, that means that - in addition to Down Syndrome and Klinefelter's Syndrome and general malnutrition - as much as a quarter of sub-Saharan Africans might be suffering from some degree of mental disability because they have been walking barefoot in fecal matter.

However, after a thorough reading of all of TOMS Shoes’ literature, I could only find indirect allusions to and one single fleeting mention of what is perhaps the gravest reason why anyone who walks around in the tropics should not walk barefoot. The sole explicit mention of hookworm I can find in the entire plethora of One for One materials is presented in such a way – buried in a misleading post titled “Let’s Talk About Podoconiosis” – that the symptoms of hookworm can be easily confused with this very completely different disease that is only related in that it can also be prevented by wearing shoes.

The One for One campaign explains the relevance of shoes to public health by focusing on podoconiosis – an illness which causes the grotesque swelling and deformity in the feet and legs properly known as elephantiasis.

Not to be confused with lymphatic filariasis – the elephantiasis-causing disease caused by parasitic worms transmitted via mosquito bite – podoconiosis is the significantly more obscure elephantiasis-causing disease found almost exclusively in certain populations of people who walk around barefoot over red clayish soils associated with volcanic activity and thereby rich with the alkali silicon dioxide. Repeated absorption of alkalis into the skin causes the lymphatics to form fibrous tissue and block and for the femoral nodes to enlarge; eventually the skin of the infected area swells with fluid, and it becomes thicker, nodular and rough like the skin of an elephant (hence “elephantiasis”). Podoconiosis disables its victims to such an extent that they cannot work and it disfigures them in a way that they are usually shunned as social outcasts.

Since the environment for this disease exists only in remote mountainous areas, podoconiosis is found almost exclusively amongst isolated subsistence agriculturalist and pastoralist societies in places like Sudan, Kenya, Uganda and especially Ethiopia. In certain pockets of the Ethiopian Highlands where the soils are particularly rich with volcanic alkalis and the traditional farmers and herders walk around their fields barefoot, as much as 6 percent of the population is thought to suffer from podoconiosis. It is very difficult to conduct an accurate census in these parts of the world where such a significant part of the population migrates with the seasons or is properly nomadic, so compiling reliable statistics on this particular disease is a rather arduous task; nonetheless, epidemiologists estimate that anywhere from 500,000 to 1 million people worldwide currently suffer from podoconiosis.



Let’s say that you were looking for a way to reduce the spread of disease in Ethiopia. If you buy a pair of TOMS Shoes it will cost you anywhere from $38 for a pair of Youth Canvas Classics to $79 for a pair of Highlands Botas - plus shipping and handling. Equivalent products cost $20 to $25, so the cost of manufacturing a cheap shoe like this cannot possibly be more than $10 - it's probably closer to $5. The average markup from American shoe retailer to the consumer price is around 40 percent, the average markup from a shoe company to a retailer is around 50 percent. What that means is that even if you're buying two of these shoes, TOMS is making oodles of money on both the shoes you buy for yourself as well as the shoes you buy for charity. Yes, a single pair of these shoes per se is really only worth about $5 - but that figure is only applicable if Blake Mycoskie is manufacturing these shoes and sending them to the Third World himself; but if you buy a pair of Pink Murray Organic Cotton Men's Vegans online for $54 the cost which you pay to give a pair of shoes to Ndugu the Amhara cattle herder is more or less half that - or $27.

If there are 1,000 children at a school in an Ethiopian village, for you to provide TOMS alpargatas for the entire student body should cost about $27,000. I will be generous and assume that these foam-and-rubber-soled, twill and suede-topped shoes will last their wearer an average of 2 years before they inevitably rip, degrade and fall apart to the point that they either no longer serve any protective function or they cannot be worn at all – seeing that these kids will be walking over rough terrain and doing heavy labor in the fields, 2 years is an extremely generous estimate. And I’ll be even more generous and assume that 100 percent of the recipients of these free shoes will be protected from contaminated soil as long as their shoes remain intact and wearable. So by handing out 1,000 pairs of free shoes to the sum total of $27,000, you could theoretically protect 1,000 children from hookworm, ascariasis, podoconiosis and stubbed toes for about 2 years.

Another way to improve public health would be for you to donate to a reputable non-profit on the ground in Ethiopia to build latrines at a public schoolyard so the students wouldn’t have to walk through each other’s feces in the first place. I’ve built a row of latrines at a school in Mali for a total price of $1,969, and I've built latrines in private homes for an individual price of $41 per latrine. Though I have never built a latrine in Ethiopia, my understanding of cement prices gives me no reason to think that the cost of latrine construction there should be all that much more expensive than in Mali. Even if no one ever conducts any repairs beyond superficial maintenance, a decently-built concrete latrine should last for about 25 years. Though it would not protect them from disease transmission outside the schoolyard, a disproportionate amount of disease transmission is concentrated around schoolyards without adequate sanitation - so these $1,969 latrines could thoroughly reduce the chances tens of thousands of children contracting hookworm, ascariasis, giardia, dysentery, cholera and schistosomiasis over the course of a quarter century.

For $1,969 you could give 72 kids in Ethiopia a pair of shoes which will inevitably rip and degrade into rags within a few years – or you could send your money to a Peace Corps Volunteer or Oxfam or Water Aid to build one row of concrete latrines at a school which should last for decades. For the price of sending TOMS Shoes to a school of 1,000 kids for 2 years, you could build 13 latrines at 13 schools to benefit the health of tens of thousands if not a hundred thousand kids over the course of 25 years.

Giving a child in Ethiopia a pair of shoes might very well be a moral thing to do, but when a development agency or NGO is pursuing some sort of public health agenda they have to do these kinds of calculations to determine which of many policy options available to them are worth the expenditure of finite financial resources. If you are going to donate your money to some sort of humanitarian cause, you should do the same kind of math to determine which charity you feel best deserves your money.

Even if cement prices fluctuate and building latrines becomes relatively more expensive, it’s fair to say that – dollar-for-dollar – you could reduce the incidence of disease incredibly more cost-efficiently if you were to stop giving away free shoes and use that money to contribute to the construction of latrines at public schools. Or you could contribute to the construction of a water pump so people don't have to drink unpotable water contaminated with guinea worm. Or you can pay to build a hangar at the clinic so that parents don't have to stand in the blistering sun for hours at a time during polio vaccinations and more kids will get vaccinated. Or you could pay for a village community health organization to get their hands on visual educational materials so they can train illiterate people to recognize the warning signs of tuberculosis. Or you could pay for the training of midwives in a rural village. No matter how expensive constuction materials might become in Ethiopia, the fundamental issue is that money spent on public sanitation infrastructure or education programs is going to be inherently more cost-effective than money spent on personal hygiene products because they last much longer for the direct benefit of a much greater number of people.

If Blake Mycoskie were running a non-profit charity mandated to reduce disease as effectively and as efficiently as he could on a dollar-for-dollar basis, then he would be spending money on sustainable water and sanitation infrastructure or rural health clinics or AIDS education materials in public schools. But he’s not – he’s a shoe salesman. As much as TOMS Shoes considers itself to be a “movement” rather than a mere profit-based firm, let us not forget that they are a shoe company first and a humanitarian aid agency second. And their niche in the galaxy of non-profits and quasi-non-profits-that-are-actually-for-profits is that if you buy a pair of TOMS Shoes, they give a pair to a poor person in Haiti or South Africa. Epidemiological or economic data be damned, their policy is to give away shoes.

But unless you yourself own stock in the TOMS Shoes company, you don't have any vested interest in sending a Tutsi girl a pair of shoes. You can donate to one of infinite charitable causes. Why not pay for her to have clean water? Or a mosquito net? Or a year's worth of antiretroviral treatment?

So what if we assume that podoconiosis is the only disease that you care about, that you are dead-set on contributing to that one particular cause - and the only way to prevent podoconisis is to get more Ethiopian Highlanders to wear shoes? Or let’s even forget about disease transmission and assume that you want to decrease the number of people without shoes as an end unto itself. Does that mean that giving away shoes is the best way to clothe the naked? Not necessarily.

To shed some light on my own point of view, as of late I have developed a strong sense of skepticism towards rich people who aim to improve the lot of the poor by simply giving things away because I have seen firsthand how such acts of well-intended charity can all-too-often result in painful belly flops of failure and can even be counterproductive to its stated goals.

While I was a Peace Corps Volunteer in Mali from 2008 to 2010 I lived in a concrete home built by the Christian NGO World Vision to house its own development extension agents (missionaries with secular humanitarian agendas) who lived there from 1988 to 1998. Though World Vision’s personnel had never returned since they closed down operations in Sanadougou in 1998, 10 years later the legacy of their actions remained tangibly apparent. Not only had they built the house I lived in, but they had built a clinic across the street from my house which was full of patients and decently staffed every day. They built a kindergarten which was still used despite the fact that it was falling to pieces. They built a solar pump system which could provide the town with potable water, but it was never managed, never maintained, in need of serious repairs and was for all practical purposes non-functional. They built a library that no one ever borrowed books from. They built a dance hall that was used a total of 4 times in 2 years. And even more durable than their legacy of steel and concrete structures, the well-intentioned NGO had completely distorted the incentive for perfectly rational economic actors to spend their own money to buy shoes for their children.

Every Christmas countless churches throughout the affluent West decide that they should spread their love for all of God’s children by putting together boxes of gifts to send to poor kids in Africa. By May or June hundreds of these boxes of gifts would have arrived in World Vision’s Bamako bureau and eventually a portion of them would make it to Sanadougou and the World Vision agents who lived in my house would go out and distribute these gifts to Christian children in villages around the area. As I have been told by my neighbors in Sanadougou, these gift boxes contained soccer balls for boys, baby dolls for girls, and every gift box contained an age- and gender-appropriate pair of shoes. Depending who was telling the story, I was told that “the White People gave us cadeaux” on various years with occasional differentiations in the contents of the box – my understanding is that the Christian NGO personnel distributed shoes to kids around the village to celebrate a number of Christmases in June.

None of these shoes from Christmases past still existed for me to see in 2008 – even the most professionally child-sewn Nikes could never last a decade’s worth of wear in Africa. The enduring legacy of these well-meaning Christian philanthropists was rather the dog that did not bark; at least part of the multitude of bare feet. In Sanadougou all but the poorest adults would walk around in a pair of shoes, so did most kids 12 or older – those old enough to work in the fields. But the majority of kids younger than that – young enough that they are most susceptible to serious complications of hookworm, ascariasis, etc. – always walked barefoot. Of course, part of this is because many a farmer did not have all that much monetary income to spend on shoes for every single one of his 9, 12, 15, 20 children. But there were also a lot of people who did have enough income from cash-cropping, livestock sales, blacksmithing, carpentry and assorted other trades, people who could most certainly afford to pay for shoes for their kids but decided to spend their money elsewhere.

In Sanadougou’s market a pair of the cheapest, lowest-quality Chinese-manufactured plastic shoe costs 800 francs CFA (~$1.60). The equivalent pair of flip-flops costs 500 francs (~$1). A packet of tea costs 200 francs, a kilogram of sugar costs 450 francs, a cigarette costs 100 francs, and a full motorcycle gas tank costs 2,000 francs – 3,000 if it’s a Yamaha. In a small town like this, phone cards are sold for denominations of 1,000 or 2,000 francs. 500 francs for a pair of flip-flops is not so unaffordable to explain why so many kids in my village walked around barefoot.

Some adults in Sanadougou were very, very poor and could not afford shoes even for themselves – but they could afford to brew three rounds of tea and sugar every night. I’d go to the butigi to buy some matches and there would be Nouhoume sitting in his place as usual enjoying his afternoon cigarette and he’d point at his cracked, broken feet,

“Madu, you have so much money! Why don’t you buy me a pair of shoes?”

“Y’know, Nouhoume, if you forego cigarettes from today until Thursday, on Thursday you will have saved enough money to buy a pair of shoes yourself!”

What really infuriated me was when people would show off to me their conspicuous consumption of top-of-the-line Western electronics that they absolutely could not afford – because it was always shamelessly juxtaposed with the abject want of necessity. In particular I remember this one guy Sori Sogoba; Sori is a 22-year-old who farms millet and peanuts and goes to Bamako every cold season to sell phone cards, and he has a wife and three kids who walk around town barefoot. And he has an iPhone. Just about every time I saw him he would always steer the conversation to “My iPhone is better than your dinky Nokia. Your telephone can’t even play music videos!”

“Yeah, but everyone in my family has a pair of shoes.”

I would try to make the connection between the abundance of unaffordable luxuries and paucity of necessities like shoes and mosquito nets whenever granted the opportunity. And I pissed off a good many people in the process – especially Sori.

He would respond, “Yeah, well, I don’t have to buy them shoes because one day The White People are going to come back and give shoes to the children. My kids don’t have shoes because The White People haven’t come yet!”

In so many inversions, dozens of Malian parents have told me this same sorry excuse on even more numerous occasions. They would always cite the fact that once upon a time the World Vision gift-givers drove around the village in their big SUV and handed out shoes to a couple dozen children every other year or so from 1988 to 1998. The Time That the White People Came and Gave Shoes to the Children is one of the few legends of Sanadougou lore that is recounted over the teapot on a fairly regular basis, and in accordance with their Messianic creed they had every reason to have faith that one day The White People shall return – with shoes, of course. Back in 1997 many of today’s fathers were then among the recipients of the White People’s Christmas gift drive, so it seems only natural that this formative experience has made a lasting impression on their parenting now that they have kids of their own.

Of course this is a completely unscientific survey, but from my casual conversations with dozens and dozens of poor Minianka farmers in Mali, I only have reason to think that a significant number of people were telling me the truth when they told me that they had decided upon the inaction of not splurging 500 francs on a pair of shoes for their child at least partly because of the expectation that The White People would take care of this expenditure for them – and therefore they consider that to spend their own money on shoes would be a waste of 500 francs that could otherwise be spent on… say, five cigarettes. Likewise, I don’t think I’m going out on too far of a limb when I conclude that there exists a significant population of children running around Sanadougou barefoot and contracting hookworm, ascariasis, etc. who are lacking shoes precisely because once upon a time between 10 and 20 years ago World Vision decided to give away shoes for free.

Indeed, it is also quite likely that a number of men who told me that they didn’t need to buy their children shoes because in the past a Christian charity gave away free shoes were just making sorry excuses and that they would have never bought their kids shoes even if this precedent of Western intervention in the local shoe market had never been set. Even so, these men were still able to abdicate personal responsibility for the welfare of their children by citing the (in their minds reasonable) expectation that someone else would do their job for them – because this one time they did.

The incentive problem caused by the free distribution of shoes in Sanadougou seems quite similar to the problem with the free distribution of mosquito nets. As I have written in prior musings, every year the Sanadougou clinic gets a shipment of a few hundred mosquito nets from UNICEF which they give for free to every pregnant mother whom they admit to the maternity. Even though the overwhelming majority of the population is never going to be eligible for one of these free mosquito nets, the fact that some people are getting free mosquito nets allows for an economy in which no one – not even the wealthy and educated who do understand the value of this product and have more than enough money to obtain one by their own means – will ever feel obligated to buy mosquito nets for themselves and for their children. Even though sleeping under a mosquito net is the simplest, cheapest, most cost-effective way of preventing malaria, the knowledge that foreign charities are intervening to help some people obtain a mosquito net for free allows everyone else to completely relinquish any self-determination of their own health and well-being. Once a precedent like this has been established in the collective mind of the tribe, it’s really difficult to undo.

Philanthropic Westerners must understand that even though their intentions in giving might be perfectly benevolent, in practice just giving things away to people can have destructive implications. Before you give to a certain charity or purchase a pair of TOMS Shoes, it is imperative to comprehend that in these parts of the world where people have next to nothing, incentives can work in such ways that the recipients of your aid might adopt behaviors that Western do-gooders simply cannot conceive. I’m not saying that you should not give to charity – all I’m saying is that before you give whimsically to just any humanitarian-sounding cause, first take into consideration that it is possible that your unconditional generosity might just distort incentives to such a perverse extreme that any good that they might have achieve in the short run might be negated by the greater harm that they might cause in the long run.

So should Blake Mycoskie get out of the business of distributing shoes to poor people? Not at all. I do think, however, that he should consider getting out of the business of giving away shoes for free. Blake Mycoskie is a shoe salesman – he should be selling shoes to poor people.

In a study by Population Services International, a campaign to distribute free mosquito nets in Zambia resulted in only 30 percent of all recipients ever actually using their free mosquito net. However, as economist William Easterly describes the effort in culturally-similar Malawi:

PSI sells bed nets for fifty cents to mothers through antenatal clinics in the countryside, which means it gets the nets to those who both value and need them… The nurse who distributes the nets gets nine cents per net to keep for herself, so the nets are always in stock. PSI also sells nets to richer urban Malawians through private-sector channels for five dollars a net. The profits from this are used to pay for the subsidized nets sold at the clinics, so the program pays for itself. PSI’s bed net program increased the nationwide average of children under five sleeping under nets from 8 percent in 2000 to 55 percent in 2004, with a similar increase for pregnant women. A follow-up survey found nearly universal use of the nets by those who paid for them.

If people are still going to buy their $20 shoes for $54, TOMS Shoes should consider tinkering with the current “One for One Movement” and replacing it with some sort of distribution method that aims to decrease the number of people who are shoeless and nevertheless abstain from doing anything that might create a perverse incentive for people to not buy shoes with their own money. Why not try to emulate PSI’s successful Malawi Model? Step up efforts to sell alpargatas directly to Guatemalan and Rwandan and Haitian elites at a price that they can most likely afford – and only after the style catches on amongst the trend-setting upper class reach out to potential middle class and working class and subsistence agricultural class customers and set prices accordingly at levels that each respective class can most likely afford. Sell a pair of alpargatas to the poor for one dollar or fifty cents – a price that is low enough that it is within their price range and yet somewhat more expensive than free.

If TOMS is making profits giving away a free pair of shoes for every pair they sell, I find it difficult to believe that they could run into financial trouble by charging a nominal price for the shoes they now distribute pro bono. The only way that selling shoes to the poor could possibly be detrimental to the company’s bottom line is that a significant number of wealthy Westerners are buying alpargatas solely because of the premise that they are giving a pair to a barefoot kid in Ethiopia. But TOMS Shoes doesn’t even have to abandon the “One for One Movement” – only now, their slogan should be “For every pair you buy, we will sell a pair of shoes to someone in need for only fifty cents.” I find it hard to believe that the class of customers who will buy a pair of shoes because they want to make a political statement with their wallet is going to abandon the TOMS line if they're only selling shoes to the poor at 95 percent off.

Selling a quality product for a profit in places like Ethiopia and Rwanda is nothing to sneeze at. There are already shoes for sale there – the problem is that the only shoes that most people can afford are cheaply-made Chinese shoes that are of poor quality and they do not last through the rigors of farm work and they break too easily. Some people can afford decent shoes, but too many cannot. That is why the world needs entrepreneurs like Blake Mycoskie to devise a successful business model to sell durable shoes to the poor at prices that they can afford.

Nevertheless, as the company’s policies now stand, at the moment I remain a skeptic of TOMS Shoes and the “One for One Movement” because I think that its goals are misdirected and that its model does not seem to be cost-effective compared to viable and proven alternatives for reducing disease. I believe that at best this company is selling its customers a bunch of overpriced earth shoes whose expense can only be justified because they come with the satisfaction of thinking that one has made a difference, and at worst they might actually be increasing the likelihood that more children will walk around barefoot. But I also believe that this basic premise of TOMS Shoes is not without hope, and with some structural changes to the way that they do business in the developing world this firm can make a much better long-term, sustainable change in the clothing market which allows for more of the world’s poor to afford a decent pair of shoes.

In the meantime, I think that anyone who is buying one pair of mediocre shoes for the price of two is just wasting their money. If you want to spend your money in a way that helps the world's poor, you might as well just buy another brand of alpargatas for $20 and take that other $34 you would have spent had you bought a pair of TOMS and donate it to Oxfam, Habitat for Humanity, Doctors Without Borders or some other genuine non-profit that is more likely going to spend it on more worthwhile projects that will make a much greater impact.