Gender-based Violence, Intimate Partner Violence, Reproductive Coercion
Conditions
Brief summary
To pilot and evaluate the integration of first-line response to gender- based violence (GBV), particularly intimate partner violence (IPV), sexual violence and reproductive coercion, within family planning (FP) and antenatal care (ANC) services at public health facilities in Ebonyi and Sokoto states in Nigeria. GBV first-line response in the health setting includes screening , empowerment counseling, safety planning, and support to connect to additional services needed.
Detailed description
This study seeks to: 1\. Assess effectiveness of an integrated service delivery model (integration of GBV first-line response and empowerment counseling in standard of care FP or ANC services) in reducing on-going experience of intimate partner violence (IPV) and increasing utilization of modern contraceptive methods among clients. 1a. Assess effectiveness of the intervention in reducing IPV, increasing utilization of modern contraceptive methods, and improving safety and self-efficacy among clients seeking interval FP services. 1b. Assess effectiveness of the intervention in reducing IPV and improving safety and self-efficacy to seek GBV care among clients seeking ANC services. 2\. Explore factors influencing feasibility, acceptability and ability to implement GBV first-line response as part of FP and ANC services.
Interventions
BEHAVIORALgender-based violence screening, first-line support (LIVES) and reproductive coercion empowerment counseling (ARCHES)
Providers will (1) introduce routine client screening for GBV, including intimate partner violence, sexual violence, and reproductive coercion using a standardized screening form, in FP and ANC services,(2) for individuals disclosing GBV, provide first-line response-empathetic counseling, including listening, inquiring about experiences sensitively, and validating experiences, helping clients develop safety plans, and providing support; (3) regardless of disclosure of GBV, provide counseling and information, education and communication (IEC) materials on IPV, including reproductive coercion, and FP options, to both FP and ANC clients.
Sponsors
Jhpiego
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 49 Years
Healthy volunteers
Yes
Inclusion criteria
* Woman of reproductive age (18 to 49 years) seeking FP or ANC services at study sites * Women who believe they are able to conceive (i.e. who have not undergone a tubal ligation, hysterectomy, or oophorectomy, or are menopausal) (for FP clients) * Have a male partner they currently have sex with * Have a mobile phone that can be safely used for re-contacting for follow-up surveys * Do not have any accompanying male partners or family members aged 5 or above present
Exclusion criteria
* Any individuals that do not meet all of the above inclusion criteria or do not agree to participate in the study will be excluded from data collection. * In addition, individuals with impaired cognitive abilities (I.e. unable to make decisions/respond to questions on their own without assistance by someone else)will also be excluded from the data collection. * Finally, women who share a mobile phone with their partner/husband or another family member will also be excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in percentage of clients disclosing exposure to intimate partner or sexual violence in past 3 months | baseline to 3-months and 6-months post-intervention | Disclosure will be defined by a positive response to either of the following questions: * Has your current partner ever slapped you, punched you, hit or kicked you, or done anything else to hurt you physically? * Has your current male partner ever forced you to have sex or do something sexual when you didn't want to? |
| Percentage of clients that report receiving a family planning method from healthcare provider | day of intervention | — |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in demonstrated self-efficacy to access IPV services | baseline to 3-months and 6-months post-intervention | Self-efficacy to access IPV services is an IPV survivor's confidence to develop and execute a plan when her partner becomes violent/ if her partner were to become violent. Self-efficacy will be defined by an affirmative response to the following questions: * I am confident that I could develop a plan for seeking help 'when my partner becomes violent/ if my partner were to become violent' * I am confident that I would be able to execute my plan 'in times when my partner becomes violent / if my partner were to become violent'. |
| Change in percentage of clients demonstrating family planning self efficacy, as measured by Contraceptive Self-Efficacy among women in sub-Saharan Africa (CSESSA) sub-scale | baseline to 3-months and 6-months post-intervention | Family planning self-efficacy is a women's belief about her own ability to complete the actions necessary for successful family planning. |
| Change in self-reported use of safety measures to protect respondent or her child/children from violence | baseline to 3-months and 6-months post-intervention | Whether an IPV survivor has ever done any of the following to protect herself or her child/children for fear that her partner would become violent: * Identified a safe place to go in case she needs to leave her home ? * Identified a friend or relative to whom she could seek help? * Set aside some things she may need, such as clothes, documents in case she needs to leave in a hurry? * Set aside funds in case she needs to leave your home/partner? * Made a plan for what she would do with her child/children in case she needs to leave home? |
| Change in percentage of clients reporting experiences of reproductive coercion in 3 months prior to data collection | baseline to 3-months and 6-months post-intervention | Reproductive coercion is behavior that interferes with the autonomous decision-making of a woman, with regards to reproductive health, including whether client felt pressured or forced by current partner to become pregnant or made it difficult to use family planning. Reproductive coercion will be defined by a positive response to either of the following questions: * Have you ever felt pressured or forced by your current partner to become pregnant when you did not want to be? * Has your current partner ever made it difficult for you to get family planning or to use family planning? |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change in self-reported communication with partner about family planning | baseline to 3-months and 6-months post-intervention | Couple communication about family planning will be defined by a positive response to the following question: • In the last 3 months, did you discuss whether to use a family planning method with your husbands/partner? |
| Change in self-reported communication with partner about birth plan | baseline to 3-months and 6-months post-intervention | Couple communication about birth plan will be defined by a positive response to the following question: • In the past 3 months, did you discuss your birth plan with your partner? |
| Knowledge of intimate partner violence (IPV) and sexual violence (SV) related services | baseline to 3-months and 6-months post-intervention | Knowledge will be defined as a positive response to whether client thinks a woman experiencing physical or sexual violence from her male partner could get help at specified services (health services, law enforcement, legal aid services, psychosocial support services, shelter/temporary accomodation, economic reintegration services). |
| Clients perception of quality of services provided | day of intervention | Perception of service quality will be defined by a positive or negative response to the following question: • Has any provider from this clinic made you feel uncomfortable or treated you badly (e.g. insulted or disrespected you) for wanting to use or for using a family planning method? |
Countries
Nigeria
Outcome results
None listed