Abstract
BackgroundWomen ages 16–29 utilizing family planning clinics for medical services experience higher rates of intimate partner violence (IPV) and reproductive coercion (RC) than their same-age peers, increasing risk for unintended pregnancy and related poor reproductive health outcomes. Brief interventions integrated into routine family planning care have shown promise in reducing risk for RC, but longer-term intervention effects on partner violence victimization, RC, and unintended pregnancy have not been examined.Methods/DesignThe ‘Addressing Reproductive Coercion in Health Settings (ARCHES)’ Intervention Study is a cluster randomized controlled trial evaluating the effectiveness of a brief, clinician-delivered universal education and counseling intervention to reduce IPV, RC and unintended pregnancy compared to standard-of-care in family planning clinic settings. The ARCHES intervention was refined based on formative research. Twenty five family planning clinics were randomized (in 17 clusters) to either a three hour training for all family planning clinic staff on how to deliver the ARCHES intervention or to a standard-of-care control condition. All women ages 16–29 seeking care in these family planning clinics were eligible to participate. Consenting clients use laptop computers to answer survey questions immediately prior to their clinic visit, a brief exit survey immediately after the clinic visit, a first follow up survey 12–20 weeks after the baseline visit (T2), and a final survey 12 months after the baseline (T3). Medical record chart review provides additional data about IPV and RC assessment and disclosure, sexual and reproductive health diagnoses, and health care utilization. Of 4009 women approached and determined to be eligible based on age (16–29 years old), 3687 (92 % participation) completed the baseline survey and were included in the sample.DiscussionThe ARCHES Intervention Study is a community-partnered study designed to provide arigorous assessment of the short (3-4 months) and long-term (12 months) effects of a brief, clinician-delivered universal education and counseling intervention to reduce IPC, RC and unintended pregnancy in family planning clinic settings. The trial features a cluster randomized controlled trial design, a comprehensive data collection schedule and a large sample size with excellent retention.Trial RegistrationClinicialTrials.gov NCT01459458. Registered 10 October 2011.
Highlights
Women ages 16–29 utilizing family planning clinics for medical services experience higher rates of intimate partner violence (IPV) and reproductive coercion (RC) than their same-age peers, increasing risk for unintended pregnancy and related poor reproductive health outcomes
In the initial pilot randomized intervention trial, among women who at baseline reported experiencing IPV in the past 3-months, the original version of Addressing Reproductive Coercion in Health Settings (ARCHES) reduced the odds of recent pregnancy coercion at follow-up assessment (3 to 6 months post-baseline) by 71 % compared to the control, highlighting the potential impact of this intervention [26]
Description of intervention Relevant rationale, history and format of the ARCHES intervention This study evaluates a family planning clinic-based IPV and reproductive coercion (RC) intervention developed by a team of researchers, victim service advocates, and reproductive health practitioners [61]
Summary
This community-partnered study tests a brief intervention to reduce risk for intimate partner violence (IPV) and reproductive coercion, with the goal of reducing unintended pregnancy among young, medically-underserved women attending family planning (FP) clinics. While the survey was available in Spanish, almost all the participants were English speaking, predominantly White, with very small numbers of non-African American minorities in this sample, limiting the generalizability of study findings to more diverse settings across the U.S. In summary, the results of this RCT will address the question of whether brief universal IPV/RC education and counseling intervention for IPV and RC in family planning clinic settings can help to reduce risk for IPV and RC and, in turn, decrease unintended pregnancy. EM, DJT, KAJ, MRD, HLM, JGS and LJ made substantial contributions to the analysis and interpretation of study data.
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