Rumbold, Tori, John Skibiak, and Jill Keesbury. "Dual protection: Single figures in Zambia’s Copperbelt."

Abstract

BACKGROUND AND OBJECTIVES: Dual protection (DP)—defined as strategies that offer simultaneous protection against STI/HIV infection and unplanned pregnancy—is an increasingly relevant concept in all areas of the world. However, proportions of DP users are dramatically lower than the proportions of populations at risk from the negative consequences of sexual intercourse. Zambia is no exception—in a context of evolving contraceptive behavior and services in Zambia’s Copperbelt region, it is especially significant that the uptake of dual protection under a pilot initiative did not correspond to the efforts invested in its promotion. Adoption of DP paled in comparison to the dramatic increases in overall contraceptive prevalence, and even lagged behind the acceptance of relatively novel contraceptive options. The disparities in contraceptive uptake prompted this review, as the context represented an ideal opportunity to explore the wider significance of limited DP adoption and to consider the implications for subsequent efforts to promote DP.

FINDINGS: Findings are drawn from a rapid assessment of efforts to promote DP in the Copperbelt that incorporated quantitative and qualitative research methods, and sought input from both the providers and users of dual protection. A significant proportion of factors that inhibit the uptake of DP emerged at the systemic level, reflecting inadequacies in resources and personnel. Community perceptions of contraception and the cultural context of contraceptive use also impeded DP use in the study area.

• Dual methods are primarily used in new or non-cohabiting relationships, and then exchanged for a single contraceptive method (or none at all) once trust develops. Condoms are associated with infidelity and STIs, and their use is perceived as inappropriate within stable relationships.

• Contraceptive perceptions and patterns of use are linked to gender dynamics. Men are rarely constructively involved in sexual and reproductive health, and women find it difficult to negotiate condom or contraceptive use with their partners.

• The use of two contraceptive methods is perceived as impractical and unnecessary. Moreover, the concept of dual protection is neither widely nor consistently understood among family planning providers.

CONCLUSIONS: The data provide insights into the motivating and inhibiting factors affecting DP uptake, and have important implications for subsequent efforts—both within and outside Zambia—to promote DP. The absorption of DP into contraceptive culture depends not only on systemic factors, but is also contextually influenced by local interpretations of gender, sexuality, and sexual health. The design of future DP initiatives should reflect an understanding of the socioeconomic context in which people make decisions about dual protection, and revisions of delivery systems should sensitively respond to community perceptions and needs.

Print this page

@ E-mail this page

This page updated 30 May 2006

---