Adaptation and Testing of the Addressing Reproductive Coercion in HEalth Settings (ARCHES) Intervention in Bangladesh
Condition: Violence, Domestic
Study type: Interventional

Summary: 
      The primary purpose of this research is to conduct a brief project to adapt and evaluate an
      evidence-based intervention model to address reproductive coercion and unintended pregnancy
      (ARCHES - Addressing Reproductive Coercion within Healthcare Settings) to the Bangladesh
      cultural context and for use with abortion clients (i.e., develop ARCHES Bangladesh) so as to
      provide initial assessment of acceptability, feasibility and effectiveness in this high-need
      LMIC context. Globally, addressing violence and coercion from male partners is considered key
      to reducing unintended pregnancy among adult and adolescent women. This has led to multiple
      efforts to integrate IPV screening and counseling in health settings, particularly in the
      context of family planning, across a range of middle and low-income countries. However, to
      date, no existing model addressing reproductive coercion has demonstrated reduction in risk
      for unintended pregnancy, either for Bangladesh or any other country.
    

Detailed description: 
      Reproductive coercion and partner violence are associated with unwanted pregnancy and
      abortion globally. In Bangladesh, women reporting partner violence are more likely to access
      abortion outside the health system and less likely to access post-abortion contraception,
      especially if accompanied to the clinic by their partner, which suggests additional
      intervention is needed to support clients' reproductive autonomy and ultimately their ability
      to safely control their fertility. ARCHES (Addressing Reproductive Coercion in HEalth
      Settings) is a clinic-based harm reduction intervention that empowers women to implement
      strategies that mitigate the impact of reproductive coercion on their reproductive health.
      ARCHES has been shown to reduce reproductive coercion among family planning clients in the
      U.S., but it has not previously been used in Asia or specifically with MR/PAC clients. This
      study seeks to adapt the ARCHES intervention for use with MR/PAC clients in Bangladesh and to
      test its effectiveness through a cluster randomized controlled trial. Overall, this study is
      expected to result in 1) evidence of the effectiveness of the adapted ARCHES intervention in
      increasing contraceptive use and reducing reproductive coercion, and ultimately in reducing
      the risk for future unintended pregnancy and unsafe abortion, and 2) evidence on the elements
      required for successful implementation in high volume MR/PAC clinics.

      The aims of this study are:

        1. To conduct formative work to inform the adaptation of the ARCHES intervention to the
           Bangladesh context and for use with abortion clients.

        2. To pilot the adapted intervention

        3. To test the effect of the adapted ARCHES intervention on uninterrupted contraceptive use
           and reproductive coercion, and ultimately reduction in future unintended pregnancy and
           unsafe abortion, among abortion clients in Bangladesh.

        4. To evaluate implementation of the ARCHES intervention using an implementation science
           approach.

        5. To understand out of clinic abortion attempts and how these attempts interact with
           women's experiences of violence.

        6. To assess structural, community-related, and cultural barriers to accessing MR, methods
           of self-induced abortion, and abortion care received prior to presenting for MR/PAC.
    

Intervention name(s): ARCHES
Intervention type(s): Behavioral
Intervention description(s): Addressing Reproductive Coercion within Healthcare Settings (ARCHES) is a clinic-based intervention developed in the U.S., and involves training existing health providers to identify RC and IPV during standard family planning clinic-based counselling interactions. The intervention seeks to empower women with harm reduction strategies that minimize their risk for unintended pregnancy by offering a wide range of contraceptive options, providing counseling on correct and consistent use of contraception, and counseling on contraceptive methods that are difficult for a male partner to detect or block such as injectables or IUDs. ARCHES also facilitates access to violence support and counselling services by connecting women with community-based IPV services.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care