Effects of a clinic-based reproductive empowerment intervention on reproductive coercion, intimate partner violence, and pregnancy outcomes: A cluster-controlled trial in Nairobi Kenya
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Background
To address reproductive coercion and intimate partner violence, the ARCHES (Addressing Reproductive Coercion in Health Settings) intervention was adapted for clinics in Nairobi, Kenya and evaluated to assess impacts on reproductive coercion (primary outcome), physical and sexual intimate partner violence (primary outcomes) and incident pregnancy (secondary outcome).
Methods
A parallel, non-blinded, non-randomized, cluster-controlled trial in six health clinics (1:1 allocation) was conducted. Clinics were allocated to receive ARCHES provider training or no additional training based on feasibility. Non-pregnant, non-sterilized female clients seeking family planning services were recruited. Inverse probability by treatment weighting (IPTW) used in difference-in-differences modified intent-to-treat (mITT) and as-treated approaches to assess the change in primary outcomes.
Results
A total of 659 women were recruited (328 ARCHES, 331 control). ARCHES was associated with significantly greater reductions in physical intimate partner violence compared to controls [mITT beta -0.98 (-1.58, -0.39), as-treated beta -0.56 (-1.19. 0.07)]. Both groups experienced reductions in reproductive coercion and sexual intimate partner violence decreased in both groups but controls showed greater reductions in reproductive coercion, and differences in sexual violence were not significant in as-treated models. ARCHES participants had lower odds of incident pregnancy at six-month follow-up [mITT AOR 0.42 (0.27, 0.67), as-treated AOR 0.29 (0.08. 1.02)].
Conclusions
ARCHES may improve women’s safety and reproductive agency in Nairobi. Further study is required to clarify effects on reproductive coercion and sexual intimate partner violence.
Trial registration
ClinicalTrials.gov [ NCT03534401 ]
