DOI: 10.5061/dryad.9zw3r22n1
title: Participation in self-help groups among women seeking contraceptives in Nairobi

description: Reproductive coercion (RC) is a prevalent form of gender-based violence
 that interferes with female reproductive agency and is highly associated
 with intimate partner violence (IPV). Women’s self-help groups are a
 promising avenue to increase support and coping for violence, but little
 research exists to describe how survivors participate in women’s self-help
 groups nor how they may discuss RC within these groups. This study aims to
 quantitatively assess the potential of women’s-only self-help groups as a
 platform for reaching women in need of support for RC and IPV among a
 sample of reproductive-aged women seeking contraceptive services from
 private, community-based clinics in Nairobi, Kenya (n=659). To do this, we
 (1) described women’s use of self-help groups and (2) examined
 associations of women’s experience of RC and IPV with self-help group
 participation and discussion of RC within self-help groups. We also
 assessed differences in discussion of RC by group type (loans and savings
 clubs, charitable/social work, religious group, sports/hobbies, others).
 We found that more than half of women participated in self-help groups,
 with most of these women participating in economic self-help groups (63%),
 and that self-help group participation was not associated with prior
 experience of RC or IPV. Women who had ever experienced RC were more
 likely to report discussing RC within women’s self-help groups (AOR 1.82
 95% CI 1.06-3.14), and RC discussion was less commonly reported in
 economic groups compared to charitable/social work groups.
  Findings highlight that participation in and discussion of RC
 within women’s-only self-help groups is common and acceptable to
 survivors, and supports the need to integrate RC and IPV programming,
 particularly within the common, sustainable, and scalable structure of
 economic women’s self-help groups.
description: <strong>Data Source</strong> This
 study utilizes cross-sectional data from women seeking family planning
 services from six private clinics in Nairobi, Kenya between July 2018 and
 December 2018, collected as part of the baseline questionnaire of the
 ARCHES (Addressing Reproductive Coercion in Health Settings) Kenya
 adaptation and evaluation study. ARCHES is a brief intervention delivered
 within routine family planning services to increase women's ability
 to cope with experiences of IPV and RC and improve family planning use.
 Details on the study protocol and design have been published elsewhere
 (Uysal, Carter, et al. 2020). Briefly, the baseline
 survey included women aged 15 to 49 years attending study clinics who
 reported interest in receiving family planning services at their
 appointment that day and not being currently pregnant or sterilized, were
 able to communicate in English or Kiswahili, were planning to remain in
 the area for a period of six months (duration of the study) and had a
 phone that would allow them to be re-contacted for follow-up surveys.
 Women completed a baseline survey immediately prior to their appointment
 and a short exit interview immediately following their appointment before
 leaving the clinic; any women who reported not speaking with their
 provider about family planning during their appointment were excluded from
 the study. We included all women who provided baseline survey responses
 and reported any family planning discussion at their appointment at the
 exit in the present analysis.
 <strong>Measures</strong> We
 examined two aspects of self-help group involvement as our outcomes of
 interest, self-help group participation and discussion of RC topics within
 self-help groups. Self-help group participation was asked directly: “Do
 you attend any group meetings or activities that are for women only?”
 Among those who responded ‘yes’, they were asked how many times they
 attended this group in the prior three months. Women who indicated
 participation in a group were also asked the type of group they attend
 most frequently, with answer options: religious group, charitable/social
 work, sports/hobbies, loans/savings clubs, or other. Discussion of RC
 topics within self-help groups was assessed among women who responded that
 “yes” they attended group meetings or activities for women only. To assess
 discussion on RC topics participants were asked whether they discussed the
 following topics in any of the group meetings they attended within the
 past three months: 1) Male partners or in-laws that pressure or force
 women to stop using family planning (Family planning related RC), 2) Male
 partners or in-laws that pressure or force women to become pregnant
 (Pregnancy-related RC), 3) How to use family planning without a partner or
 other family member knowing (Covert family planning use). Responses were
 binary (yes/no). Women who indicated ‘don’t know’ were coded as ‘no’ for
 analyses (n selecting ‘don’t know’ &lt;1%). We examined these items
 separately and as a combined ‘participated in any of the three discussion
 topics’ (yes/no) variable. We examined participation in
 self-help groups and discussion of RC across two independent variables,
 ever and past-year experience of reproductive coercion (RC) victimization
 and intimate partner violence (IPV) victimization. RC was evaluated based
 on 11 items capturing contraceptive sabotage and pregnancy coercion
 (Uysal, Carter, et al. 2020).
 RC was indicated if the respondent indicated ‘yes’ to any item. Women who
 responded yes to any RC item were also asked when the last time a partner
 did any of these things to them was; we used this to determine past year
 experience. IPV was assessed as experience of physical or sexual violence,
 including whether a male partner had ever: “pushed you, shaken you, or
 thrown something at you,” “slapped you,” “twisted your arm or pulled your
 hair,” “hit you with his fist or with something that could hurt you,”
 “kicked you, dragged you, or beat you up,” “choked you or tried to burn
 you,” or “forced you to have sex or do something sexual with you when you
 didn’t want to.” IPV was indicated if the respondent indicated ‘yes’ to
 any item. As with RC, women who indicated every experience of any form of
 IPV were asked when the most recent experience was, from which past year
 experience was determined. Women missing information on RC or IPV items
 were excluded from the respective analyses. Demographic
 characteristics included women’s age (years), education (primary or less,
 secondary, higher than secondary), literacy (yes/no), marital status
 (married or cohabitating with a partner, not married), parity (0, 1, 2+),
 past year employment (yes/no), and past 30 days food insecurity
 (yes/no). <strong>Statistical
 Analyses</strong> We first present descriptive
 statistics regarding demographics and outcomes of women’s self-help group
 participation ever, and within the past three months. Chi-square tests
 were used to evaluate differences in participation for categorical and
 binary measures, and t-tests (assuming unequal variances) were used for
 continuous measures. We then present descriptive statistics regarding the
 frequency of participation, group type, and discussion within groups.
 Next, we present unadjusted bivariate comparisons (using chi-squared
 tests) and unadjusted and adjusted mixed-effects logistic regression
 models to examine the relationship between women’s self-help group
 participation ever and outcomes (RC ever and past year, IPV ever and past
 year); these analyses utilize the full sample. Next, we repeat these
 unadjusted bivariate comparisons and unadjusted and adjusted mixed-effects
 logistic regression models with any discussion of RC in the prior three
 months as the predictor of interest; these analyses were limited to women
 who reported participating in self-help groups within the past three
 months. These analyses were conducted for discussion of any RC topic, as
 well as for each of the three specific topics. Adjusted models accounted
 for clinic-level similarities via clinic random intercept specifications,
 and controlled for age, education, literacy, marital status, parity,
 employment, and food security via fixed effects.  Finally, we assessed
 discussions of RC (any and specific topic) by women’s self-help group
 type, using bivariate chi-squared test comparisons; due to small numbers
 of sports/hobbies group participants (n=3) and ‘other’ type group
 participants (n=7), only religious groups, charitable/social work, and
 loans/savings clubs were included in these comparisons. All analyses were
 completed on non-missing data (complete cases); no imputation was
 performed. Significance was set at p&lt;0.05 for
 all comparisons and marginal significance at p&lt;0.1; odds ratios
 (ORs) and adjusted odds ratios (AORs), along with 95 percent confidence
 intervals (CIs) are reported for regression results. All analyses were
 conducted using STATA 15.1.
description: # Participation in self-help groups among women seeking contraceptives in
 Nairobi --- This is a cross-sectional dataset from women seeking family
 planning services from six private clinics in Nairobi, Kenya between July
 2018 and December 2018. These data were collected as part of the baseline
 questionnaire of the ARCHES (Addressing Reproductive Coercion in Health
 Settings) Kenya adaptation and evaluation study. This dataset contains
 only those variables included in the analysis examining women's
 self-help group participation and discussion as well as prior history with
 reproductive coercion (RC) and intimate partner violence (IPV). ##
 Description of the data and file structure The data file contains 659
 observations and 20 variables. The data file includes variable and value
 labels for all variables. The corresponding.do file includes all commands
 used for presented analyses in text and tables. * Note 1: Six variables
 used in the analysis (Literacy, Martial status, Age married, Parity,
 Employment status, and Food insecurity) have been removed from the data
 file for anonymity. * Note 2: All missing data [indicated by
 "." for numeric variables and blanks for string variables] is
 due to skip patterns (i.e., not applicable). For analysis, variables
 marked as declined to answer (i.e., 99) should be set to missing. ##
 Sharing/Access information Data were derived from the full ARCHES Kenya
 adaptation and evaluation study dataset which is not currently publicly
 available. For questions regarding the full data, including potential
 access, please contact
 [nejohns@health.ucsd.edu](mailto:nejohns@health.ucsd.edu) or
 [juysal@health.ucsd.edu](mailto:juysal@health.u). ## Code/Software Data
 preparation and analyses were conducted using STATA 15.1.