In Kenya, up to 37% of women seeking family planning (FP) services report experiencing reproductive coercion (RC; behaviors by male partners or family members designed to control women’s family planning and pregnancy decisions) and 47% report physical or sexual intimate-partner violence (IPV). Moreover, over 50% of women report their most recent pregnancy as unintended with those reporting RC or IPV at significantly greater risk. ARCHES (Addressing Reproductive Coercion in Health Settings) is a brief, single-session intervention delivered within routine family planning services by existing providers with demonstrated efficacy to reduce RC, IPV and improve FP use. This three-year study builds on The Center on Gender Equity and Health’s (GEH) prior successful adaptation and evaluation of ARCHES in private, community-based clinics in Nairobi Kenya conducted in partnership with IPPF, Population Council, and Family Health Options Kenya. Based on the success of this study, the Kenya Ministry of Health (MOH) has decided to partner with GEH and Population Council to scale ARCHES nationally within the public health system. The Bill and Melinda Gates Foundation is funding GEH to lead this effort, with an initial focus on a large county, Uasin Gishu. To determine the scalability and effectiveness of the adapted intervention, a cluster randomized control trial (cRCT) will be conducted in 24 health centers in Uasin Gishu (12 intervention – receiving ARCHES; 12 control – receiving standard FP counseling) among 3,540 women and girls aged 15 to 49 years old seeking FP services. Survey data will be collected at baseline, exit (i.e., immediately post-visit before leaving the clinic), and 6 months post-baseline. Implementation science assessments with women, providers, stakeholders and MOH administrators will be used to determine scalability including feasibility, acceptability, fidelity, sustainment, and cost-effectiveness of the approach to increase FP uptake and reduce unintended pregnancy. Learnings from this project will inform development of the national strategy to institutionalize ARCHES in government health centers across all 47 counties in Kenya, as well as plans to adapt and scale-up ARCHES to other low and middle-income countries.

Jay Silverman, PhD – Primary Investigator
Rebecka Lundgren, PhD – Co-Investigator
Jasmine Uysal, MPH – Project Manager, Pre-Doctoral Fellow
Melanie Maino Vieytes – Research Project Coordinator
Erin Pearson, PhD, MPH – Research Supervisor

Relevant Materials:

ARCHES Project Brief

Slide Doc: Cross-continental Lessons in Addressing Reproductive Coercion

Uasin Gishu County, Kenya

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