Women empowerment and practices regarding use of dual protection among family planning clients in urban Zimbabwe
Identifieur interne : 002B94 ( Pmc/Corpus ); précédent : 002B93; suivant : 002B95Women empowerment and practices regarding use of dual protection among family planning clients in urban Zimbabwe
Auteurs : Jesca Mutowo ; Christine Mary Kasu ; Esther MufundaSource :
- The Pan African Medical Journal [ 1937-8688 ] ; 2014.
Abstract
Gender related vulnerability may increase women's susceptibility to HIV infection and unintended pregnancy. The purpose of the study was to examine the relationship between women empowerment and practices regarding use of dual protection.
A non-experimental descriptive correlational study design was conducted using systematic sampling method to recruit eighty women aged 18-49 years at an urban clinic in Zimbabwe. Data was collected using a structured interview schedule and was analysed and presented using descriptive and inferential statistics.
A weak positive significant correlation existed between women empowerment and use of dual protection (r= .242, p=0.03). Findings demonstrated that as women empowerment levels increase practices regarding use of dual protection also increase. The coefficient of determination, R2=.0.058, b=0.293, indicated that the total amount of variation in utilization of dual protection explained by level of women empowerment was 5.8%. The major finding was that use of dual protection was very low (3.8%) and 67.5% had low levels of practices regarding use of dual protection. Additionally, 85.0% were not confident of using the female condom.
Gender inequality within sexual relations was associated with low levels of practices regarding use of dual protection. The study provided evidence for the need for a proactive integrated approach to empower women so that they could negotiate for safer sex practices. To increase female condom utilization, manufacturers need to redesign the female condom so that it becomes user friendly. Health personnel need to involve men for any health reproductive program to succeed.
Url:
DOI: 10.11604/pamj.2014.17.300.3282
PubMed: 25328596
PubMed Central: 4198267
Links to Exploration step
PMC:4198267Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Women empowerment and practices regarding use of dual protection among family planning clients in urban Zimbabwe</title><author><name sortKey="Mutowo, Jesca" sort="Mutowo, Jesca" uniqKey="Mutowo J" first="Jesca" last="Mutowo">Jesca Mutowo</name><affiliation><nlm:aff id="AF0001">Department of Health Sciences, Zimbabwe Open University, Harare, Zimbabwe</nlm:aff></affiliation></author><author><name sortKey="Kasu, Christine Mary" sort="Kasu, Christine Mary" uniqKey="Kasu C" first="Christine Mary" last="Kasu">Christine Mary Kasu</name><affiliation><nlm:aff id="AF0002">Department of Health Sciences, University of Zimbabwe, Harare, Zimbabwe</nlm:aff></affiliation></author><author><name sortKey="Mufunda, Esther" sort="Mufunda, Esther" uniqKey="Mufunda E" first="Esther" last="Mufunda">Esther Mufunda</name><affiliation><nlm:aff id="AF0001">Department of Health Sciences, Zimbabwe Open University, Harare, Zimbabwe</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25328596</idno><idno type="pmc">4198267</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198267</idno><idno type="RBID">PMC:4198267</idno><idno type="doi">10.11604/pamj.2014.17.300.3282</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">002B94</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002B94</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Women empowerment and practices regarding use of dual protection among family planning clients in urban Zimbabwe</title><author><name sortKey="Mutowo, Jesca" sort="Mutowo, Jesca" uniqKey="Mutowo J" first="Jesca" last="Mutowo">Jesca Mutowo</name><affiliation><nlm:aff id="AF0001">Department of Health Sciences, Zimbabwe Open University, Harare, Zimbabwe</nlm:aff></affiliation></author><author><name sortKey="Kasu, Christine Mary" sort="Kasu, Christine Mary" uniqKey="Kasu C" first="Christine Mary" last="Kasu">Christine Mary Kasu</name><affiliation><nlm:aff id="AF0002">Department of Health Sciences, University of Zimbabwe, Harare, Zimbabwe</nlm:aff></affiliation></author><author><name sortKey="Mufunda, Esther" sort="Mufunda, Esther" uniqKey="Mufunda E" first="Esther" last="Mufunda">Esther Mufunda</name><affiliation><nlm:aff id="AF0001">Department of Health Sciences, Zimbabwe Open University, Harare, Zimbabwe</nlm:aff></affiliation></author></analytic><series><title level="j">The Pan African Medical Journal</title><idno type="eISSN">1937-8688</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Introduction</title><p>Gender related vulnerability may increase women's susceptibility to HIV infection and unintended pregnancy. The purpose of the study was to examine the relationship between women empowerment and practices regarding use of dual protection.</p></sec><sec id="st2"><title>Methods</title><p>A non-experimental descriptive correlational study design was conducted using systematic sampling method to recruit eighty women aged 18-49 years at an urban clinic in Zimbabwe. Data was collected using a structured interview schedule and was analysed and presented using descriptive and inferential statistics.</p></sec><sec id="st3"><title>Results</title><p>A weak positive significant correlation existed between women empowerment and use of dual protection (r= .242, p=0.03). Findings demonstrated that as women empowerment levels increase practices regarding use of dual protection also increase. The coefficient of determination, R2=.0.058, b=0.293, indicated that the total amount of variation in utilization of dual protection explained by level of women empowerment was 5.8%. The major finding was that use of dual protection was very low (3.8%) and 67.5% had low levels of practices regarding use of dual protection. Additionally, 85.0% were not confident of using the female condom.</p></sec><sec id="st4"><title>Conclusion</title><p>Gender inequality within sexual relations was associated with low levels of practices regarding use of dual protection. The study provided evidence for the need for a proactive integrated approach to empower women so that they could negotiate for safer sex practices. To increase female condom utilization, manufacturers need to redesign the female condom so that it becomes user friendly. Health personnel need to involve men for any health reproductive program to succeed.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Hope, R" uniqKey="Hope R">R Hope</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Pazol, K" uniqKey="Pazol K">K Pazol</name></author><author><name sortKey="Kramer, Mr" uniqKey="Kramer M">MR Kramer</name></author><author><name sortKey="Hogue, Cj" uniqKey="Hogue C">CJ Hogue</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kraft, Jm" uniqKey="Kraft J">JM Kraft</name></author><author><name sortKey="Galavotti, Mc" uniqKey="Galavotti M">MC Galavotti</name></author><author><name sortKey="Busan, Djj" uniqKey="Busan D">DJJ Busan</name></author><author><name sortKey="Fleming, D" uniqKey="Fleming D">D Fleming</name></author><author><name sortKey="Kilmarx, Ph" uniqKey="Kilmarx P">PH Kilmarx</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dworkin, Sl" uniqKey="Dworkin S">SL Dworkin</name></author><author><name sortKey="Kambou, Sd" uniqKey="Kambou S">SD Kambou</name></author><author><name sortKey="Sutherland, C" uniqKey="Sutherland C">C Sutherland</name></author><author><name sortKey="Khadija, M" uniqKey="Khadija M">M Khadija</name></author><author><name sortKey="Kapoor, A" uniqKey="Kapoor A">A Kapoor</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Myer, L" uniqKey="Myer L">L Myer</name></author><author><name sortKey="Morroni, C" uniqKey="Morroni C">C Morroni</name></author><author><name sortKey="Mathews, C" uniqKey="Mathews C">C Mathews</name></author><author><name sortKey="Little, F" uniqKey="Little F">F Little</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Magwali, Tl" uniqKey="Magwali T">TL Magwali</name></author><author><name sortKey="Steiner, Mj" uniqKey="Steiner M">MJ Steiner</name></author><author><name sortKey="Toms, H" uniqKey="Toms H">H Toms</name></author><author><name sortKey="Brown, Jm" uniqKey="Brown J">JM Brown</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mantell, Je" uniqKey="Mantell J">JE Mantell</name></author><author><name sortKey="Hoffman, S" uniqKey="Hoffman S">S Hoffman</name></author><author><name sortKey="Exner, Tm" uniqKey="Exner T">TM Exner</name></author><author><name sortKey="Stein, Za" uniqKey="Stein Z">ZA Stein</name></author><author><name sortKey="Atkins, K" uniqKey="Atkins K">K Atkins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Meekers, D" uniqKey="Meekers D">D Meekers</name></author><author><name sortKey="Richter, K" uniqKey="Richter K">K Richter</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Berer, M" uniqKey="Berer M">M Berer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcmahon, S" uniqKey="Mcmahon S">S McMahon</name></author><author><name sortKey="Hansen, L" uniqKey="Hansen L">L Hansen</name></author><author><name sortKey="Mann, J" uniqKey="Mann J">J Mann</name></author><author><name sortKey="Sevigny, C" uniqKey="Sevigny C">C Sevigny</name></author><author><name sortKey="Wong, T" uniqKey="Wong T">T Wong</name></author><author><name sortKey="Roache, M" uniqKey="Roache M">M Roache</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Duffy, L" uniqKey="Duffy L">L Duffy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Teklu, T" uniqKey="Teklu T">T Teklu</name></author><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Macphail, C" uniqKey="Macphail C">C MacPhail</name></author><author><name sortKey="Pettifor, S" uniqKey="Pettifor S">S Pettifor</name></author><author><name sortKey="Rees, Hv" uniqKey="Rees H">HV Rees</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Francis Chizororo, M" uniqKey="Francis Chizororo M">M Francis-Chizororo</name></author><author><name sortKey="Natshalaga, Nr" uniqKey="Natshalaga N">NR Natshalaga</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maharaj, P" uniqKey="Maharaj P">P Maharaj</name></author><author><name sortKey="Cleland, J" uniqKey="Cleland J">J Cleland</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Turmen, T" uniqKey="Turmen T">T Turmen</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Pan Afr Med J</journal-id><journal-id journal-id-type="iso-abbrev">Pan Afr Med J</journal-id><journal-id journal-id-type="publisher-id">PAMJ</journal-id><journal-title-group><journal-title>The Pan African Medical Journal</journal-title></journal-title-group><issn pub-type="epub">1937-8688</issn><publisher><publisher-name>The African Field Epidemiology Network</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25328596</article-id><article-id pub-id-type="pmc">4198267</article-id><article-id pub-id-type="publisher-id">PAMJ-17-300</article-id><article-id pub-id-type="doi">10.11604/pamj.2014.17.300.3282</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Women empowerment and practices regarding use of dual protection among family planning clients in urban Zimbabwe</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Mutowo</surname><given-names>Jesca</given-names></name><xref ref-type="aff" rid="AF0001">1</xref><xref ref-type="corresp" rid="cor1">&</xref></contrib><contrib contrib-type="author"><name><surname>Kasu</surname><given-names>Christine Mary</given-names></name><xref ref-type="aff" rid="AF0002">2</xref></contrib><contrib contrib-type="author"><name><surname>Mufunda</surname><given-names>Esther</given-names></name><xref ref-type="aff" rid="AF0001">1</xref></contrib></contrib-group><aff id="AF0001"><label>1</label>Department of Health Sciences, Zimbabwe Open University, Harare, Zimbabwe</aff><aff id="AF0002"><label>2</label>Department of Health Sciences, University of Zimbabwe, Harare, Zimbabwe</aff><author-notes><corresp id="cor1"><label>&</label>Corresponding author: Jesca Mutowo, Department of Health Science, Zimbabwe Open University, Harare, Zimbabwe</corresp></author-notes><pub-date pub-type="epub"><day>20</day><month>4</month><year>2014</year></pub-date><pub-date pub-type="collection"><year>2014</year></pub-date><volume>17</volume><elocation-id>300</elocation-id><history><date date-type="received"><day>29</day><month>8</month><year>2013</year></date><date date-type="accepted"><day>15</day><month>10</month><year>2013</year></date></history><permissions><copyright-statement>© Jesca Mutowo et al.</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0/"><license-p>The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec id="st1"><title>Introduction</title><p>Gender related vulnerability may increase women's susceptibility to HIV infection and unintended pregnancy. The purpose of the study was to examine the relationship between women empowerment and practices regarding use of dual protection.</p></sec><sec id="st2"><title>Methods</title><p>A non-experimental descriptive correlational study design was conducted using systematic sampling method to recruit eighty women aged 18-49 years at an urban clinic in Zimbabwe. Data was collected using a structured interview schedule and was analysed and presented using descriptive and inferential statistics.</p></sec><sec id="st3"><title>Results</title><p>A weak positive significant correlation existed between women empowerment and use of dual protection (r= .242, p=0.03). Findings demonstrated that as women empowerment levels increase practices regarding use of dual protection also increase. The coefficient of determination, R2=.0.058, b=0.293, indicated that the total amount of variation in utilization of dual protection explained by level of women empowerment was 5.8%. The major finding was that use of dual protection was very low (3.8%) and 67.5% had low levels of practices regarding use of dual protection. Additionally, 85.0% were not confident of using the female condom.</p></sec><sec id="st4"><title>Conclusion</title><p>Gender inequality within sexual relations was associated with low levels of practices regarding use of dual protection. The study provided evidence for the need for a proactive integrated approach to empower women so that they could negotiate for safer sex practices. To increase female condom utilization, manufacturers need to redesign the female condom so that it becomes user friendly. Health personnel need to involve men for any health reproductive program to succeed.</p></sec></abstract><kwd-group><kwd>Dual protection</kwd><kwd>family planning</kwd><kwd>women empowerment</kwd><kwd>condom</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="S0001"><title>Introduction</title><p>HIV and AIDS is affecting an increasing number of women. Sexual and reproductive health rights emphasize equitable access to prevention and care. Unfortunately due to social, economic and political inequities between men and women there is unequal access to prevention, education and care [<xref rid="CIT0001" ref-type="bibr">1</xref>]. The rights of individuals and couples to enjoy a healthy sexual life includes the prevention of unwanted pregnancy and sexually transmitted infections (STIs), including HIV [<xref rid="CIT0002" ref-type="bibr">2</xref>].</p><p>HIV-related diseases are the leading causes of death among women aged between 15-49 years of age worldwide [<xref rid="CIT0003" ref-type="bibr">3</xref>]. Nearly 60% of the world's 15.5 million HIV infected women live in Sub-Saharan Africa [<xref rid="CIT0004" ref-type="bibr">4</xref>]. Rates of unintended pregnancy, HIV and other sexually transmitted infections are also high and contribute to poor health outcomes [<xref rid="CIT0005" ref-type="bibr">5</xref>]. HIV prevalence among Zimbabwean women aged 15-49 is 18% [<xref rid="CIT0006" ref-type="bibr">6</xref>] and these are current or potential users of contraceptive methods. Increased rates of unintended pregnancies and HIV infection call for use of dual protection, which combines the condom (either male or female) plus a hormonal method of contraception or permanent (sterilization) or long acting (intra-uterine device or implant) or natural methods. When used correctly and consistently, condoms alone can serve a dual purpose of protecting against unintended pregnancy and HIV and AIDS infection [<xref rid="CIT0007" ref-type="bibr">7</xref>].</p><p>Generally, motherhood is considered a feminine ideal, hence using barrier methods as a safer sex option presents a significant challenge to many married women who plan to have children. Because of this perception, coupled with unequal power relations and economic disparities, women are unable to insist on safe sexual practices, especially dual protection. Poverty increases vulnerability to unsafe sexual behaviours and practices and it also decreases access to sexual and reproductive health information and services [<xref rid="CIT0001" ref-type="bibr">1</xref>] which might expose women to unplanned pregnancies, unsafe abortions and transmission of HIV and AIDS. Women need to be economically empowered so that they can be assertive and be able to negotiate safe and responsible sexual practices, including the use of condoms. About two thirds of the illiterate adults in the world are females [<xref rid="CIT0004" ref-type="bibr">4</xref>] and this compromises their decision making power in matters that affect their sexual and reproductive health. Education empowerment enables women to make informed choices that help prevent HIV infection and unwanted pregnancy.</p><p>The Millennium Development Goal 3 addresses gender equality and women empowerment in an effort to encourage women to participate in matters concerning their lives, including making choices in sexual and reproductive health matters. Therefore, women need to be empowered in sexual and reproductive health issues to contain and reverse the AIDS epidemic [<xref rid="CIT0008" ref-type="bibr">8</xref>]. A study done in South Africa revealed a low level of dual method use of 16% [<xref rid="CIT0009" ref-type="bibr">9</xref>], while another done in Zimbabwe reported dual protection use of 38% [<xref rid="CIT0010" ref-type="bibr">10</xref>]. This figure is worrying for a country with a high HIV prevalence of 15% [<xref rid="CIT0006" ref-type="bibr">6</xref>]. The contraceptive prevalence rate for Zimbabwe is at 60.2% [<xref rid="CIT0003" ref-type="bibr">3</xref>]. However, because of the separation of services between family planning and other curative services, many women in family planning clinics are receiving contraceptive services with little attention to their need for dual protection [<xref rid="CIT0011" ref-type="bibr">11</xref>].</p><p>The female condom was developed as an alternative to male condom as a means to empower women so that they could have control over their own protection against STIs, HIV infection and unintended pregnancy [<xref rid="CIT0012" ref-type="bibr">12</xref>]. Unfortunately, female condoms are less promoted and not easily available than male condoms [<xref rid="CIT0013" ref-type="bibr">13</xref>]. In Cambodia, women demonstrated a high awareness of the benefits of condom use, but 75% were unaware of the existence of the female condom [<xref rid="CIT0014" ref-type="bibr">14</xref>]. Poor and marginalised women suffer the greater burden of sexual and reproductive ill health such as unwanted pregnancy, unsafe abortions, HIV and AIDS infection. These consequently lead to increased morbidity and mortality. There is limited literature on dual protection [<xref rid="CIT0007" ref-type="bibr">7</xref>] and a few studies have looked on how individuals perceive their own risk and the need for dual protection use [<xref rid="CIT0013" ref-type="bibr">13</xref>].</p><p>Therefore, the purpose of the study was to examine the relationship between women empowerment and practices regarding use of dual protection among women aged 18 to 49 years at a Family Health Services Clinic in Zimbabwe.</p></sec><sec sec-type="methods" id="S0002"><title>Methods</title><sec id="S20003"><title>Design</title><p>A non-experimental descriptive correlational study design was used. The design enabled the investigators to gather information and make inferences about possible relationship between women empowerment and practices regarding use of dual protection.</p></sec><sec id="S20004"><title>Participants</title><p>The study sample consisted of 80 women on family planning methods who were seeking services for their under five children during the period of data collection. The participants were recruited using systematic sampling method. The inclusion criteria were women who reported using a contraceptive method, either modern or natural, during the month of their interview or at their last intercourse in the past three months, women aged between 18 to 49 years and fluent in Shona or/ and English.</p></sec><sec id="S20005"><title>Data Collection</title><p>A structured interview schedule was used to collect data on women empowerment, practices regarding use of dual protection and demographic variables. Face to face interviews were conducted in a private room to control extraneous variables and each interview lasted 20-25 minutes. The interviews were done between 8am and 1pm during weekdays in order to maximise on the increase in the flow of clients in the morning.</p></sec><sec id="S20006"><title>Data collection instrument</title><p>A structured interview schedule was used to elicit data from the participants. Face to face interviews were conducted to provide the interviewer with the opportunity to elicit and probe for more information when participants made non-verbal cues, such as facial or body expressions and change of tone of voice. The interview guide was translated from English to Shona. Content validity of the instrument was ensured by rigorous effort in designing the questions and was assessed by a panel of experts at the clinic. Reliability of the instrument was tested using Cronbach's Alpha coefficient and it ranged between 0.7322 and 0.7350. A pilot study was conducted on 5 participants who met the inclusion criteria but were not included in the final sample. The revision was on language usage that was familiar to family planning women.</p><p>The dependent variable was practices regarding use of dual protection and was addressed by the Practices Regarding Use of Dual Protection Interview Schedule (Appendix B, Section B). It had 25 questions with one correct answer among the given choices, except questions 8, 9 and 15, where participants gave more than one answer. The interview also elicited information on perceived susceptibility to HIV infection and what motivated the participants to use dual protection. The last two questions were descriptive in nature and sought to find out participants’ opinion, and were not scored. All dual protection questions in the interview schedule were given scores on a continues scale up to 36. Practices regarding use of dual protection were classified into three categories; low (≤18), moderate (19-28) and high (≥29).</p><p>The independent variable was women empowerment and was addressed by the Women Empowerment Interview Schedule (Appendix B, Section C). It comprised 21 questions each with one correct answer among the given choices. Questions included information on educational level, employment status, participation in family decision making, control of economic resources, ownership of resources, intimate partner violence, sexual and reproductive health rights and care, and woman's status in the family. Women empowerment factors on the practices regarding use of dual protection were scored on a continuous scale with a maximum of 34. These were categorised to level of empowerment on practices regarding use of dual protection to: lowly empowered (0-17), moderately empowered (18-24) and highly empowered (≥25). The socio-demographic data included age, marital status, religion and place of residence.</p></sec><sec id="S20007"><title>Ethical consideration</title><p>The study was approved by the Joint Research Ethics Committee (JREC), the Medical Research Council of Zimbabwe (MRCZ) and the Director of Health Services, City of Harare. Written consent was obtained from the subjects showing their willingness to participate in the study.</p></sec><sec id="S20008"><title>Data Analysis</title><p>Statistical and descriptive analysis involved the determination of the mean, mode, medium, frequencies and standard deviation (SD). Pearson's correlation matrix was used to determine the relationship between women empowerment and practices regarding use of dual protection among women aged between 18 to 49 years. A code book was used to identify and define each variable in the study. The Statistical Package for the Social Sciences software was used to analyse the results. The test was performed with a significance level of p= 0.05.</p></sec></sec><sec sec-type="results" id="S0009"><title>Results</title><sec id="S20010"><title>Sample Demographics</title><p><xref ref-type="table" rid="T0001">Table 1</xref>, summarises the demographic profile of the participants. The age ranged between 18 to 46 years (mean 27 years, SD 6.7 years).</p><table-wrap id="T0001" orientation="portrait" position="float"><label>Table 1</label><caption><p>Sample Demographics</p></caption><table frame="border" rules="all"><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="center" rowspan="1" colspan="1">Frequency (n)</th><th align="center" rowspan="1" colspan="1">Percentage (%)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1"><bold>Age (years)</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">18-25</td><td align="center" rowspan="1" colspan="1">34</td><td align="center" rowspan="1" colspan="1">42.5</td></tr><tr><td align="left" rowspan="1" colspan="1">26-35</td><td align="center" rowspan="1" colspan="1">35</td><td align="center" rowspan="1" colspan="1">43.8</td></tr><tr><td align="left" rowspan="1" colspan="1">36-49</td><td align="center" rowspan="1" colspan="1">11</td><td align="center" rowspan="1" colspan="1">13.7</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Marital status</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Single</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">5.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Married</td><td align="center" rowspan="1" colspan="1">72</td><td align="center" rowspan="1" colspan="1">90.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Divorced</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">1.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Widowed</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">0.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Separated</td><td align="center" rowspan="1" colspan="1">3</td><td align="center" rowspan="1" colspan="1">3.8</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Religion</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Pentecostal</td><td align="center" rowspan="1" colspan="1">38</td><td align="center" rowspan="1" colspan="1">47.5</td></tr><tr><td align="left" rowspan="1" colspan="1">Catholic</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">6.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Protestant</td><td align="center" rowspan="1" colspan="1">9</td><td align="center" rowspan="1" colspan="1">11.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Other</td><td align="center" rowspan="1" colspan="1">28</td><td align="center" rowspan="1" colspan="1">35.0</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Residents</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Urban</td><td align="center" rowspan="1" colspan="1">75</td><td align="center" rowspan="1" colspan="1">93.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Rural</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">5.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Mining</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">1.2</td></tr><tr><td colspan="3" align="left" rowspan="1">N= (80)</td></tr></tbody></table></table-wrap></sec><sec id="S20011"><title>Practices Regarding Use of Dual Protection</title><p><xref ref-type="fig" rid="F0001">Figure 1</xref> shows family planning methods used by the participants. Most of the participants used the pill; very few used a natural method (lactation amenorrhea) and condoms with another family planning method.</p><fig id="F0001" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Family Planning method use</p></caption><graphic xlink:href="PAMJ-17-300-g001"></graphic></fig><p><xref ref-type="table" rid="T0002">Table 2</xref> shows that of those who reported using condoms with their partners most had received instructions on condom use from health personnel. Most of the participants reported that male condoms where user friendly. Very few were confident of using the female condom compared to the male condom. Overall the participants acknowledged that condoms were effective in preventing pregnancies and STI including HIV. A small percentage (1.2%) had high level of dual protection practices.</p><table-wrap id="T0002" orientation="portrait" position="float"><label>Table 2</label><caption><p>Practices regarding use of dual protection</p></caption><table frame="border" rules="all"><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="center" rowspan="1" colspan="1">Frequency (n)</th><th align="center" rowspan="1" colspan="1">Percentage (%)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1"><bold>Received instruction on condom use</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Yes</td><td align="center" rowspan="1" colspan="1">48</td><td align="center" rowspan="1" colspan="1">60</td></tr><tr><td align="left" rowspan="1" colspan="1">Confident in using male condom</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Yes</td><td align="center" rowspan="1" colspan="1">49</td><td align="center" rowspan="1" colspan="1">61.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Confident in using female condom</td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Yes</td><td align="center" rowspan="1" colspan="1">12</td><td align="center" rowspan="1" colspan="1">15.0</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Condom effectiveness in preventing pregnancy</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Effective</td><td align="center" rowspan="1" colspan="1">49</td><td align="center" rowspan="1" colspan="1">61.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Fairly effective</td><td align="center" rowspan="1" colspan="1">26</td><td align="center" rowspan="1" colspan="1">32.5</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Condom effectiveness in preventing STI including HIV</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Effective</td><td align="center" rowspan="1" colspan="1">44</td><td align="center" rowspan="1" colspan="1">55.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Fairly effective</td><td align="center" rowspan="1" colspan="1">28</td><td align="center" rowspan="1" colspan="1">35.0</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Condom use a sign of mistrust</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Yes</td><td align="center" rowspan="1" colspan="1">28</td><td align="center" rowspan="1" colspan="1">35.0</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Level of dual protection Practice</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">High</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">1.2</td></tr><tr><td colspan="3" align="left" rowspan="1">N=(80)</td></tr></tbody></table></table-wrap></sec><sec id="S20012"><title>Women Empowerment</title><p>The age range at first marriage was 15 to 28 years. Fifty percent of the participants were younger than their partners/husbands with an age difference of 5 years or less, while (6.2%) were more than 10 years younger than their partners/husbands. The majority (91.2%) of the participants were educated up to secondary level. Most (68%) of the participants were unemployed and none of the participants contributed significantly to the total family income. Most of the participants were not empowered economically, socially and culturally (<xref ref-type="table" rid="T0003">Table 3</xref>). Fifty-four (67.5%) of the subjects had a low level of empowerment as they scored <17. The rest were moderately empowered 25 (31.3%) to highly empowered 1 (1.2%) and scored between 18-24 and >25 respectively.</p><table-wrap id="T0003" orientation="portrait" position="float"><label>Table 3</label><caption><p>Women empowerment factors</p></caption><table frame="border" rules="all"><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="center" rowspan="1" colspan="1">Frequency (n)</th><th align="center" rowspan="1" colspan="1">Percentage (%)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1"><bold>Who makes economic decisions?</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Partner</td><td align="center" rowspan="1" colspan="1">39</td><td align="center" rowspan="1" colspan="1">48.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Self</td><td align="center" rowspan="1" colspan="1">12</td><td align="center" rowspan="1" colspan="1">15.0</td></tr><tr><td align="left" rowspan="1" colspan="1">Both</td><td align="center" rowspan="1" colspan="1">29</td><td align="center" rowspan="1" colspan="1">36.2</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Owns assets</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">No</td><td align="center" rowspan="1" colspan="1">53</td><td align="center" rowspan="1" colspan="1">66.2</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Ability to refuse unprotected sex if partner had a sexually transmitted infection</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Yes</td><td align="center" rowspan="1" colspan="1">69</td><td align="center" rowspan="1" colspan="1">86.2</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Have a say on Family Planning</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Yes</td><td align="center" rowspan="1" colspan="1">60</td><td align="center" rowspan="1" colspan="1">75.0</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Easiness in negotiating safe sex</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">Easy</td><td align="center" rowspan="1" colspan="1">29</td><td align="center" rowspan="1" colspan="1">36.2</td></tr><tr><td align="left" rowspan="1" colspan="1">Fairly easy</td><td align="center" rowspan="1" colspan="1">23</td><td align="center" rowspan="1" colspan="1">28.8</td></tr><tr><td align="left" rowspan="1" colspan="1">Not easy</td><td align="center" rowspan="1" colspan="1">28</td><td align="center" rowspan="1" colspan="1">35.0</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Culture supportive of women assertiveness on sexual matters</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">No</td><td align="center" rowspan="1" colspan="1">71</td><td align="center" rowspan="1" colspan="1">88.8</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Would justify partner/husband beating you if you refuse sex</bold></td><td align="center" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1">No</td><td align="center" rowspan="1" colspan="1">75</td><td align="center" rowspan="1" colspan="1">93.8</td></tr><tr><td colspan="3" align="left" rowspan="1">N=80</td></tr></tbody></table></table-wrap></sec><sec id="S20013"><title>Study correlation coefficient measurements of women empowerment and practices regarding use of dual protection</title><p><xref ref-type="table" rid="T0004">Table 4</xref> shows the Pearson correlation coefficient analysis for examining the relationship between women empowerment practices regarding use of dual protection and their p values. A positive significant correlation existed (r= .242, sig 5%, p=.03). at (sig 5%).</p><table-wrap id="T0004" orientation="portrait" position="float"><label>Table 4</label><caption><p>Pearson's correlation matrix of practices regarding use of dual protection and women empowerment</p></caption><table frame="border" rules="all"><tbody><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Y</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>X</bold></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">.242*</td></tr><tr><td align="left" rowspan="1" colspan="1">*p<.05</td><td align="left" rowspan="1" colspan="1">**p<.01</td><td align="left" rowspan="1" colspan="1">***p<.001</td></tr><tr><td colspan="3" align="left" rowspan="1">Y= practices regarding use of dual protection; X= women empowerment</td></tr></tbody></table></table-wrap><p>Factors that were significantly correlated with women empowerment in use of dual protection were age difference at marriage, level of education, employment status, income, economic decisions, ability to refuse sex if partner had a sexually transmitted infection, having a say in family planning matters, awareness of sexual and reproductive health rights, protection of reproductive health rights, ability to make health decisions and easiness of negotiating for safe sex.</p><p>The Regression analysis coefficient (b=0.293) showed a weak positive relationship showing its statistically significant effect on the dependent variable. The regression showed that empowerment level was a significant predictor of practices regarding use of dual protection. The total amount of variation in practices regarding use of dual protection explained by level of women empowerment was 5.8%.</p></sec></sec><sec sec-type="discussion" id="S0014"><title>Discussion</title><p>The overall dual protection use and practices regarding use of dual protection in this sample was very low as evidenced by only 3, 8% participants using effective dual protection. This prevalence figure is lower than populations studied in South Africa [<xref rid="CIT0009" ref-type="bibr">9</xref>] and in Zimbabwe [<xref rid="CIT0010" ref-type="bibr">10</xref>] in which 16% and 38% used dual protection respectively. The majority of the participants in this study were married. The very low prevalence of dual protection use within marriage in this study is an important indicator of how difficult it is to use condoms within marriage. This assumption is supported by [<xref rid="CIT0009" ref-type="bibr">9</xref>, <xref rid="CIT0015" ref-type="bibr">15</xref>, <xref rid="CIT0016" ref-type="bibr">16</xref>] who also assert that condom use within marriage is uncommon and is highly stigmatized. These results show that there is a high HIV risk in married women. The results also showed that the majority of the participants were using hormonal methods of contraception instead of natural methods. The results concur with results from a study in South Africa [<xref rid="CIT0017" ref-type="bibr">17</xref>] in which most of the participants used hormonal methods of contraception. Exposure to both electronic and print media on health related education and information was likely to have had a positive influence on the participants as most of them lived in urban areas.</p><p>Participants in this study preferred the male condom. This is in contrast to a study done in Zimbabwe [<xref rid="CIT0018" ref-type="bibr">18</xref>], in which most male and female participants preferred female condom to male condom. In terms of empowerment levels, participants in this study had reduced empowerment levels as they preferred the male condom which they had little or no control over its use and application. Preference for male condom could also be due to the fact that male condom has been in existence since time immemorial and change to female condom might be difficult to implement. These results are cause for concern for policy makers as the female condom was developed as an alternative to male condom as a strategy to empower women so that they could have control over their own protection against STIs, HIV infection and unintended pregnancy thereby reducing mortality and morbidity.</p><p>Though most of the participants had received instructions on condom use this was not converted to an increase in condom use. Fifty-four (67.5%) reported that male condoms were user friendly and only 15 (18.7%) said female condoms were user friendly. The results show that the male condoms were easy to use for many couples hence increased preference, which hopefully would subsequently lead to utilization. There was an increased perceived efficacy of condom as a protective measure against pregnancy and STI including HIV. These results are similar to those from a study done in KwaZulu Natal [<xref rid="CIT0019" ref-type="bibr">19</xref>], in which condoms were widely viewed as an effective method of preventing HIV infection. Therefore low usage of condom in this study is not due to perception of effectiveness but rather attitudes towards it and probably perceived reduced self efficacy. A low proportion of the participants reported that they consistently (always) used condoms with their partners/ husbands. The results were consistent with study findings from KwaZulu Natal [<xref rid="CIT0019" ref-type="bibr">19</xref>] in which only 15% men and 18% women reported consistent use of condoms. The results of this study show that some married couples are willing to use condoms at least some of the time if they perceive there is a risk of infection or getting pregnant. Hence there is need to target these women in HIV prevention programs because condoms can be used in some marriages. According to [<xref rid="CIT0016" ref-type="bibr">16</xref>], couples who communicate openly about safer sex practices are more likely to reduce behavioural risks than couples who do not discuss. In this study, very few participants had discussed dual protection with partner/ husband. With the identification of discordant couples there is need for midwives to reinforce the need for couple counselling and testing and greater condom use in stable relationships. In order for any interventions to achieve its goal there is need to involve men, so that they can also take responsibility.</p><p>Contrary to results from a study carried out in South Africa [<xref rid="CIT0015" ref-type="bibr">15</xref>], where participants’ perceived risk of infection was predictor to condom use, participants in this study's perceived risk of STI including HIV infection from partner/ husband and access to condoms did not emerge as the predictor of condom use. It is important to note that the majority of participants in this study had never suffered from a sexually transmitted infection. These results may indicate positive behavioural changes in light of the HIV and AIDS epidemic.</p><p>The majority of the participants were unemployed. Therefore they were economically dependent. This may negatively affect their ability to make independent decisions including safer sex practices. Poverty increases incidences of sexual and reproductive ill health, such as unsafe abortions and exposure to HIV infection leading to maternal morbidity and mortality. Some form of assertiveness was shown in the majority (86.2%) of the participants as they were able to refuse unprotected sex if their partner/ husband had a sexually transmitted infection, which shows some level of empowerment. Women need to be empowered with negotiation skills to cater for those who fail to negotiate effectively.</p><p>Cultural practices such as subservient role in sexual relations are not favourable to women empowerment in terms of use of dual protection. The majority 71 (88.8%) reported that their culture did not support assertiveness in women on sexual matters. These results echo the sentiments expressed by [<xref rid="CIT0020" ref-type="bibr">20</xref>], who noted that women are expected to be passive and assertiveness on sexual issues would be viewed unfeminine. This means that traditional factors should be addressed as they have a strong effect on women's autonomy and ability to negotiate safe sex practices. The majority had low empowerment levels and this could be explained by the influence of culture on sexual and reproductive issues, which detects what is expected of women.</p><p>The results revealed that family planning clients in this study were not empowered economically, socially and culturally. This lack of empowerment might have contributed to reduced practices regarding use of dual protection exposing the women to unintended pregnancy and transmission of STI including HIV infection.</p><p>The results also identify gaps in reproductive health programmes that do not involve men. There is need for midwifery practice to advocate for male involvement in sexual and reproductive health programmes in order to ensure male support, especially in dual protection programmes.</p><p>The research findings have shown that any 5.8% change or variation in practices regarding use of dual protection was explained by women empowerment levels. This implies that poor practices and utilization of dual protection may be due to other factors other than lack of empowerment.</p></sec><sec sec-type="conclusion" id="S0015"><title>Conclusion</title><p>Although the use of modern methods of family planning has been embraced by many the uses of dual protection and practices regarding use of dual protection was very low among the study sample. The study provided evidence for the need for a proactive integrated approach to empower women economically, socially and culturally so that they could be able to negotiate for safer sex practices. Effective intervention programmes need to encourage men and women to talk openly about use of dual protection. There is need for a cultural paradigm shift that transforms relations from male domination to mutual ones where discussions about sexual issues are encouraged and are not construed to be a sign of infidelity. Nurses and midwives could conduct community awareness campaigns especially at the work place emphasizing the effectiveness of simultaneous use of family planning methods and condoms to combat the spread of HIV and reduce incidences of unintended pregnancy. Intensive health education campaigns concentrating on demonstrations and return demonstrations on female condom application should be carried out in order to improve skills on proper use and build confidence in the use of the female condom. Manufacturers of the female condom may need to redesign it so that it becomes user friendly to increase its acceptability. Further research on a broader scale need to be conducted in other settings to investigate other factors affecting practices regarding use of dual protection since this study indicated that only 29% change in utilization was explained by change in women empowerment, so that any gaps in practice can be identified and addressed so as to improve the body of knowledge.</p><p>The major limitations of the study were that although the content validity of the instrument was rigorously assessed by clinical experts, it was used for the first time in this study and it did not undergo psychometric test. The sample size was small and this reduces generalizability of the findings to the entire population of Zimbabwe. Data was obtained through self-reports given by the subjects and this may have introduced bias as socially desirable responses may have been given.</p></sec></body><back><ack><title>Acknowledgments</title><p>Our sincere gratitude goes to City of Harare, Health Department for allowing us to conduct the research at Edith Oppermann Family Health Services Clinic.</p></ack><sec id="S0016"><title>Competing interests</title><p>The authors declare no competing interests.</p></sec><sec id="S0017"><title>Authors’ contributions</title><p>Mutowo Jesca: Conception and design of the study, data collection, analysis and interpretation of results; drafting and preparation of the manuscript for publication. Kasu Christine Mary: Conception and design of the study, analysis and interpretation of results; critical revision of the article. Mufunda Esther: Critical revision of the article and final approval of the manuscript for publication.</p></sec><ref-list><title>References</title><ref id="CIT0001"><label>1</label><element-citation publication-type="web"><person-group person-group-type="author"><name><surname>Hope</surname><given-names>R</given-names></name></person-group><article-title>Women's empowerment and HIV prevention-donor experience</article-title><year>2007</year><month>6</month><day>27-29</day><comment>Available at <ext-link ext-link-type="uri" xlink:href="http://www.oecd.org/social/gender-development/38759356.pdf">www.oecd.org/social/gender-development/38759356.pdf</ext-link>. Accessed 14 November 2011</comment></element-citation></ref><ref id="CIT0002"><label>2</label><element-citation publication-type="book"><collab>International Planned Parenthood (IPPF)</collab><article-title>Statement on dual protection against unwanted pregnancy and sexually transmitted infections, including HIV</article-title><publisher-name>International Medical Advisory Panel (IMAP)</publisher-name><comment>Available at <ext-link ext-link-type="uri" xlink:href="http://www.codesign.it/hiv/pdf/medical/IMAP-statement-Dual-Protection-May00">http://www.codesign.it/hiv/pdf/medical/IMAP-statement-Dual-Protection-May00</ext-link>. Accessed 22 November 2011</comment></element-citation></ref><ref id="CIT0003"><label>3</label><element-citation publication-type="web"><collab>World Health Organization</collab><article-title>Gender, women and HIV/AIDS-Gender inequalities and HIV WHO Geneva</article-title><year>2011</year><comment><ext-link ext-link-type="uri" xlink:href="http://www.who.int/gender/hiv-aids">http://www.who.int/gender/hiv-aids</ext-link>. Accessed 1 October 2011</comment></element-citation></ref><ref id="CIT0004"><label>4</label><element-citation publication-type="book"><collab>World Health Organization</collab><article-title>Integrating gender into HIV/AIDS programmes in the health sector: Tool to improve responsiveness to women's needs WHO</article-title><year>2011</year><publisher-loc>Geneva</publisher-loc><comment><ext-link ext-link-type="uri" xlink:href="http://www.who.int/gender/hiv-aids/5B258KB">http://www.who.int/gender/hiv-aids/5B258KB</ext-link>. Accessed 1 October 2011</comment></element-citation></ref><ref id="CIT0005"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pazol</surname><given-names>K</given-names></name><name><surname>Kramer</surname><given-names>MR</given-names></name><name><surname>Hogue</surname><given-names>CJ</given-names></name></person-group><article-title>Condoms for Dual Protection: Patterns of use with highly effective contraceptive methods</article-title><source>Public Health Reports Journal.</source><year>2010</year><volume>125</volume><issue>2</issue><fpage>208</fpage><lpage>217</lpage></element-citation></ref><ref id="CIT0006"><label>6</label><element-citation publication-type="book"><collab>Zimbabwe National Statistics Agency</collab><article-title>Zimbabwe demographic and health survey</article-title><year>2010-2011</year><publisher-loc>Harare</publisher-loc><publisher-name>Zimbabwe Government Printers</publisher-name></element-citation></ref><ref id="CIT0007"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kraft</surname><given-names>JM</given-names></name><name><surname>Galavotti</surname><given-names>MC</given-names></name><name><surname>Busan</surname><given-names>DJJ</given-names></name><name><surname>Fleming</surname><given-names>D</given-names></name><name><surname>Kilmarx</surname><given-names>PH</given-names></name></person-group><article-title>Condoms for dual protection</article-title><source>Studies in Family Planning.</source><year>2009</year><volume>40</volume><issue>4</issue><fpage>319</fpage><lpage>328</lpage><pub-id pub-id-type="pmid">23012727</pub-id></element-citation></ref><ref id="CIT0008"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dworkin</surname><given-names>SL</given-names></name><name><surname>Kambou</surname><given-names>SD</given-names></name><name><surname>Sutherland</surname><given-names>C</given-names></name><name><surname>Khadija</surname><given-names>M</given-names></name><name><surname>Kapoor</surname><given-names>A</given-names></name></person-group><article-title>Gendered empowerment and HIV prevention: policy and programmatic pathways to success in the MENA region</article-title><source>Journal of Acquired Immune Deficiency Syndrome.</source><year>2009</year><volume>51</volume><fpage>S111</fpage><lpage>S11</lpage></element-citation></ref><ref id="CIT0009"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Myer</surname><given-names>L</given-names></name><name><surname>Morroni</surname><given-names>C</given-names></name><name><surname>Mathews</surname><given-names>C</given-names></name><name><surname>Little</surname><given-names>F</given-names></name></person-group><article-title>Dual method use in South Africa</article-title><source>International Family Planning Perspectives.</source><year>2002</year><volume>28</volume><issue>2</issue><fpage>119</fpage><lpage>121</lpage></element-citation></ref><ref id="CIT0010"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Magwali</surname><given-names>TL</given-names></name><name><surname>Steiner</surname><given-names>MJ</given-names></name><name><surname>Toms</surname><given-names>H</given-names></name><name><surname>Brown</surname><given-names>JM</given-names></name></person-group><article-title>How are condoms used in a family planning setting: evidence from Zimbabwe?</article-title><source>Central African Journal of Medicine.</source><year>2005</year><volume>51</volume><issue>7/8</issue><fpage>79</fpage><lpage>84</lpage><pub-id pub-id-type="pmid">17849824</pub-id></element-citation></ref><ref id="CIT0011"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mantell</surname><given-names>JE</given-names></name><name><surname>Hoffman</surname><given-names>S</given-names></name><name><surname>Exner</surname><given-names>TM</given-names></name><name><surname>Stein</surname><given-names>ZA</given-names></name><name><surname>Atkins</surname><given-names>K</given-names></name></person-group><article-title>Family planning providers’ perspectives on dual protection</article-title><source>Perspectives on Sexual and Reproductive Health.</source><year>2003</year><season>Mar-Apr</season><volume>35</volume><issue>2</issue><fpage>71</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">12729136</pub-id></element-citation></ref><ref id="CIT0012"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Meekers</surname><given-names>D</given-names></name><name><surname>Richter</surname><given-names>K</given-names></name></person-group><article-title>Factors associated with use of the family condom in Zimbabwe</article-title><source>International Family Planning Perspectives.</source><year>2005</year><volume>31</volume><issue>1</issue><fpage>30</fpage><lpage>37</lpage><pub-id pub-id-type="pmid">15888407</pub-id></element-citation></ref><ref id="CIT0013"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Berer</surname><given-names>M</given-names></name></person-group><article-title>Dual protection: More needed than practised or understood</article-title><source>Reproductive Health Matters.</source><year>2006</year><month>11</month><volume>14</volume><issue>28</issue><fpage>162</fpage><lpage>170</lpage><pub-id pub-id-type="pmid">17101435</pub-id></element-citation></ref><ref id="CIT0014"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>McMahon</surname><given-names>S</given-names></name><name><surname>Hansen</surname><given-names>L</given-names></name><name><surname>Mann</surname><given-names>J</given-names></name><name><surname>Sevigny</surname><given-names>C</given-names></name><name><surname>Wong</surname><given-names>T</given-names></name><name><surname>Roache</surname><given-names>M</given-names></name></person-group><article-title>Contraception</article-title><source>Bio Medical Central Women's Health.</source><year>2004</year><volume>4</volume><issue>Supplementary 1</issue><fpage>S25</fpage></element-citation></ref><ref id="CIT0015"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Duffy</surname><given-names>L</given-names></name></person-group><article-title>Culture and context of HIV prevention in rural Zimbabwe: The influence of gender inequality</article-title><source>Journal of Transcultural Nursing.</source><year>2005</year><volume>16</volume><issue>1</issue><fpage>23</fpage><lpage>31</lpage><pub-id pub-id-type="pmid">15608096</pub-id></element-citation></ref><ref id="CIT0016"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Teklu</surname><given-names>T</given-names></name><name><surname>Davey</surname><given-names>G</given-names></name></person-group><article-title>Which factors influence North Ethiopian adults’ use of dual protection from unintended pregnancy and HIV/AIDS?</article-title><source>Ethiopian Journal of Health Development.</source><year>2008</year><volume>22</volume><issue>3</issue><fpage>226</fpage><lpage>231</lpage></element-citation></ref><ref id="CIT0017"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>MacPhail</surname><given-names>C</given-names></name><name><surname>Pettifor</surname><given-names>S</given-names></name><name><surname>Rees</surname><given-names>HV</given-names></name></person-group><article-title>Contraception use and pregnancy among 15-24 year old South African women: A nationally representative cross-sectional survey</article-title><source>Bio Medical Central Medicine.</source><year>2007</year><volume>5</volume><fpage>31</fpage></element-citation></ref><ref id="CIT0018"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Francis-Chizororo</surname><given-names>M</given-names></name><name><surname>Natshalaga</surname><given-names>NR</given-names></name></person-group><article-title>The female condom acceptability and perception among rural women in Zimbabwe</article-title><source>African Journal of Reproductive Health.</source><year>2003</year><volume>7</volume><issue>3</issue><fpage>101</fpage><lpage>116</lpage><pub-id pub-id-type="pmid">15055153</pub-id></element-citation></ref><ref id="CIT0019"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Maharaj</surname><given-names>P</given-names></name><name><surname>Cleland</surname><given-names>J</given-names></name></person-group><article-title>Risk perception and condom use among married and cohabiting couples in Kwazulu Natal, South Africa</article-title><source>International Family Planning Perspectives.</source><year>2005</year><volume>31</volume><issue>1</issue><fpage>24</fpage><lpage>29</lpage><pub-id pub-id-type="pmid">15888406</pub-id></element-citation></ref><ref id="CIT0020"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Turmen</surname><given-names>T</given-names></name></person-group><article-title>Gender and HIV /AIDS</article-title><source>International Journal of Gynaecology and Obstetrics.</source><year>2003</year><volume>82</volume><fpage>411</fpage><lpage>418</lpage><pub-id pub-id-type="pmid">14499987</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaSubSaharaV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 002B94 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 002B94 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= SidaSubSaharaV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:4198267
|texte= Women empowerment and practices regarding use of dual protection among family planning clients in urban Zimbabwe
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:25328596" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a SidaSubSaharaV1
| This area was generated with Dilib version V0.6.32. |  |