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      Opportunities and challenges for the introduction of a new female condom among young adults in urban Zambia

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          Abstract

          Background

          Expanding contraceptive method choices for sexually active youth is critical to prevent STIs/HIV and unintended pregnancies. However, preferences and decision making around contraception among young adults are not well understood. A new female condom (FC), the Woman’s Condom (WC), features an improved design and is marketed as a premium product at a higher price point. We conducted a qualitative study to examine the underlying knowledge, attitudes, and perceptions around the FC generally, the WC specifically, and to explore the opportunities and challenges of introducing the WC to young adults in urban Zambia.

          Methods

          Thirty focus group discussions comprised of 245 men and women aged 18–24 years were facilitated by local moderators in Lusaka, Zambia between August and December 2016. Data were analyzed using thematic content analysis using ATLAS.ti (Version 7.5.17).

          Results

          While interest in the newly launched WC was high, few participants recognized it, so discussion was framed around FCs more generally. The decision to use a FC is challenged by misconceptions regarding safety and correct use, cost, and women’s limited power over decision making in relationships. Participants also reported low availability of the product. Several opportunities for FC uptake were discussed, including the perception that FCs provide better sensation during intercourse compared with male condoms, and women reported enthusiasm for the opportunity to be the partner responsible for contraception. Some women expressed interest in the WC in order to ensure it was not tampered with by their partner, a practice commonly reported by both genders that reflects high levels of mistrust.

          Conclusions

          Findings suggest the FC, including the new WC, has potential to increase gender equity by giving women a product they are comfortable buying and being able to control to ensure correct use; however, future programming should address high perceived cost of the WC and women’s limited decision making power in relationships. Findings also highlight the need for interventions that include product demonstration and promote the WC as a method that provides better sensation during sex than male condoms. To increase voluntary uptake, the challenges identified here should be incorporated into future social marketing campaigns.

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          Most cited references19

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          The case for addressing gender and power in sexuality and HIV education: a comprehensive review of evaluation studies.

          Curriculum-based sexuality and HIV education is a mainstay of interventions to prevent STIs, HIV and unintended pregnancy among young people. Evidence links traditional gender norms, unequal power in sexual relationships and intimate partner violence with negative sexual and reproductive health outcomes. However, little attention has been paid to analyzing whether addressing gender and power in sexuality education curricula is associated with better outcomes.
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            Progress and challenges to male and female condom use in South Africa.

            South Africa has responded to the sexually transmissible infection and HIV epidemic with a rapid expansion of its national-level public sector condom program. Male condoms are available widely at no cost in the public sector, with expanded access via social marketing and the private sector. The female condom program is one of the largest and best established globally. National surveys show progressive increases in rates of condom use at last sex. However, inconsistent and incorrect condom use and the likelihood that condoms are discontinued in longer-term partnerships are some of the challenges impeding the condom program's successes in the fight against sexually transmissible infections and HIV. This article reviews the current condom program, related guidelines and policies, and the existing data on male and female condom use, including distribution and uptake. We discuss the main challenges to condom use, including both user and service-related issues and finally how these challenges could be addressed.
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              The female condom: the international denial of a strong potential.

              The female condom has received surprisingly little serious attention since its introduction in 1984. Given the numbers of women with HIV globally, international support for women's reproductive and sexual health and rights and the empowerment of women, and, not least, due to the demand expressed by users, one would have expected the female condom to be widely accessible 16 years after it first appeared. This expectation has not materialised; instead, the female condom has been marginalised in the international response to HIV and AIDS. This paper asks why and analyses the views and actions of users, providers, national governments and international public policymakers, using an analytical framework specifically designed to evaluate access to new health technologies in poor countries. We argue that universal access to female condoms is not primarily hampered by obstacles on the users' side, as is often alleged, nor by unwilling governments in developing countries, but that acceptability of the female condom is problematic mainly at the international policy level. This view is based on an extensive review of the literature, interviews with representatives of UNAIDS, UNFPA and other organisations, and a series of observations made during the International AIDS Conference in Mexico in August 2008. Copyright 2010 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                kgambir@gmail.com
                jpinchoff@popcouncil.org
                olasubomi.obadeyi@gmail.com
                tngo@popcouncil.org
                Journal
                Reprod Health
                Reprod Health
                Reproductive Health
                BioMed Central (London )
                1742-4755
                3 December 2019
                3 December 2019
                2019
                : 16
                : 175
                Affiliations
                [1 ]Independent Consultant, One Dag Hammarskjöld Plaza, New York, NY 10017 USA
                [2 ]ISNI 0000 0004 0441 8543, GRID grid.250540.6, Poverty, Gender, and Youth Program, Population Council, ; New York, NY 10017 USA
                [3 ]Innovations for Poverty Action – Zambia Office, Plot 26, Mwambula Street, Jesmondine, Lusaka, Zambia
                Author information
                http://orcid.org/0000-0003-3491-0582
                Article
                839
                10.1186/s12978-019-0839-x
                6891955
                31796046
                9d405320-1c2b-46e6-8335-2faa06fd78e3
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 April 2019
                : 20 November 2019
                Funding
                Funded by: USAID
                Award ID: AID-OAA-A-13-00088
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Obstetrics & Gynecology
                female condom,zambia,young adults,adolescents,urban,contraception,reproductive health,family planning

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