Protocol for a matched-pair cluster control trial of ARCHES (Addressing Reproductive Coercion in Health Settings) among women and girls seeking contraceptive services from community-based clinics in Nairobi, Kenya

Abstract

Background: Reproductive coercion (RC) and intimate partner violence (IPV) are prevalent forms of gender-based violence (GBV) associated with reduced female control over contraceptive use and subsequent unintended pregnancy. Although the World Health Organization has recommended the identification and support of GBV survivors within health services, few clinic-based models have been shown to reduce IPV or RC, particularly in low or middle-income countries (LMICs). To date, clinic-based GBV interventions have not been shown to reduce RC or unintended pregnancy in LMIC settings. Intervention: ARCHES (Addressing Reproductive Coercion in Health Settings) is a single-session, clinic-based model delivered within routine contraceptive counseling that has been demonstrated to reduce RC in the United States. ARCHES was adapted to the Kenyan context via a participatory process to reduce GBV and unintended pregnancy among women and girls seeking contraceptive services in this setting. Core elements of ARCHES include enhanced contraceptive counseling that addresses RC, opportunity for patient disclosure of RC and IPV (and subsequent warm referral to local services), and provision of a palm-sized educational booklet.

Gendered power dynamics and threats to sexual and reproductive autonomy among adolescent girls and young adult women: A cross-sectional survey in three urban settings

“…WHO guidelines for violence assessment and response within health settings [ 40 ] should be integrated within youth-serving clinics and can be adapted for community-based support programs focused on AGYW. Contraceptive-related discussions in both clinical settings and in sexual health promotion for lay audiences must address the risks of partner violence, reproductive coercion and stealthing [ 41 ]. Promotion of highly effective, non-coital-dependent methods can additionally serve to protect sexual and reproductive health for this population.…”

From non-use to covert and overt use of contraception: Identifying community and individual factors informing Nigerian women’s degree of contraceptive empowerment

“…Covert use, the use of a contraceptive method without the knowledge of a woman's partner, may represent her attempt to maintain reproductive autonomy in the face of reproductive coercion and potential violence by her partner [1][2][3][4][5]. Beyond autonomy, covert use may also be due to misperceptions of partners' views of contraceptive use and desired family size [6,7].…”

Prevalence and correlates of reproductive coercion across ten sites: commonalities and divergence

“…Moreover, in high RC prevalence contexts, such as DRC and Uganda, screening for RC must be institutionalized within all SRH services, and specifically family planning services; protection against unintended pregnancy is imperative when nearly one in five women are experiencing this form of reproductive violence. Interventions such as Addressing Reproductive Coercion within Healthcare Settings (ARCHES) [27,28] can provide a framework for training family planning providers on how to recognize, screen, and prevent recurrent RC; this intervention has been implemented in the United States, Kenya, and Bangladesh and may prove useful to other contexts if culturally adapted. Though RC prevalence and correlates vary across contexts, this form of abuse is ultimately rooted in power and controlcounteracting harmful norms will require both empowering women and girls in their reproductive choices and bolstering men as supportive partners in reproductive decision-making.…”