Adapting, Expanding, and Evaluating ARCHES in Kenya

Situation or Background
The 2022 Kenya DHS reports that 43% of Kenyan women of reproductive age have experienced intimate partner violence (IPV), and about 1 in 10 have faced pregnancy coercion, a form of reproductive coercion (RC) where male partners or family members pressure women into pregnancy against their wishes. RC, a type of gender-based violence, undermines women’s reproductive autonomy. Over half of Kenyan women report unintended pregnancies, with RC and IPV significantly increasing this risk. Given the impact of RC and IPV on women’s health, the WHO recommends regular screening for both within reproductive health services.

Our Goal or What We’re Doing
We aim to adapt, implement, and test ARCHES, an evidence-based intervention, in one Kenyan county, to lay the foundation for county-by-county scale-up. ARCHES (Addressing Reproductive Coercion in Health Settings) is a brief intervention within family planning services that trains providers to address RC and IPV. It involves counseling on covert family planning methods, IPV screening with referrals, and an educational mini booklet. Trials show ARCHES improves women’s reproductive autonomy, quality of care, and reduces IPV.

Approach or Methodology
We’re conducting a cluster randomized control trial (cRCT) in 24 health centers in Uasin Gishu (12 intervention, 12 control), involving 3,540 women aged 15-49 seeking family planning. Data is collected at baseline, immediately post-visit, and 6 months later. Implementation assessments with women, providers, and stakeholders evaluate scalability, feasibility, acceptability, fidelity, and cost-effectiveness of ARCHES in reducing unintended pregnancies and IPV.

Impact and What We’re Learning
ARCHES has proven scalable with tools like a provider-facing mobile app. Effectiveness findings reveal increased family planning self-efficacy, improved quality of care, and reduced IPV. Insights from this project will guide national implementation in Kenyan health centers and potential adaptation in other low- and middle-income countries.