Family Planning-based Partner Abuse Intervention to Reduce Unintended Pregnancy

PI: Jay Silverman (in collaboration with Dr. Elizabeth Miller of the University of Pittsburgh)

This community-based participatory study will test, via a 2-armed cluster randomized controlled trial, ARCHES (Addressing Reproductive Coercion in HEalth Settings), a brief intervention to reduce risk for intimate partner violence and sexual assault (IPV/SA) and associated poor reproductive health outcomes (e.g., unintended pregnancy) among young women attending family planning clinics. Young adult women ages 16-29 years utilizing family planning clinics report far higher rates of IPV/SA as compared to their same-age peers. In addition, previous research has identified that experiences of IPV/SA are consistently associated with poor reproductive health outcomes, particularly adolescent and unintended pregnancy. A critical mechanism connecting IPV/SA with poor reproductive health is an abusive partner’s control of a woman’s reproduction through refusal to use male contraception, abusive responses to women’s negotiation of contraception, pressuring women to get pregnant, coercing women regarding abortion, and birth control sabotage; cumulatively, this phenomenon describes reproductive control. Identifying effective community-partnered interventions in the context of social disadvantage is critical for promoting reproductive health, particularly to reduce IPV/SA and associated male partner reproductive control. ARCHES is designed to be implemented within routine family planning, maximizing the feasibility and sustainability of this program.

ARCHES provides:

  1. Education for clients regarding male partner reproductive control followed by IPV/SA screening
  2. Discussion of harm reduction behaviors to reduce risk for unintended pregnancy and IPV/SA victimization (e.g., in visible forms of birth control, emergency contraception, safety planning)
  3. Provision of supported referrals for IPV/SA victim services via education regarding these services and reduction of barriers to utilizing such services. The RCT compares this intervention (RCPVI) delivered by family planning counselors in family planning clinics serving the medically underserved to standard-of-care family planning services among similar female clients ages 16-29 (N=3000 women across 12 clinics, the unit of randomization), assessed at baseline and 12-20 week follow up.

Dr. Silverman and colleagues are in the process of modifying this intervention model for implementation in low and middle-income countries, including Mexico and India.