Testing Gender-based Violence Response in Family Planning and Antenatal Care Services in Nigeria

Study Overview
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Brief Summary
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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
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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.

Official Title
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Testing the Integration of Gender-based Violence First-line Response in Family Planning and Antenatal Care Services in Nigeria

Conditions
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Gender-based Violence, Reproductive Coercion, Intimate Partner Violence

Intervention / Treatment
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* Behavioral: gender-based violence screening, first-line support (LIVES) and reproductive coercion empowerment counseling (ARCHES)


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 49 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment group<br>Prior to commencement of the study, providers responsible for FP and ANC service provision will participate in a 3-day competency-based skills-building training activity on Caring for women subjected to violence: A WHO curriculum for training health-care providers and the ARCHES intervention. Following the training, 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. | Behavioral: gender-based violence screening, first-line support (LIVES) and reproductive coercion empowerment counseling (ARCHES)<br>* 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.<br>* Other names: GBV screening, LIVES and ARCHES;|
| No Intervention: Control group<br>FP clients and ANC clients will receive standard care. For FP services, this includes standard contraceptive care provided by personnel who have completed training on contraceptive service delivery by the Nigerian Federal Ministry of Health and partners. For ANC services, the standard is a minimum of 8 visits with health personnel trained on ANC care during pregnancy. This includes identification of women and girls at increased risk of developing complications during labor and childbirth; prevention, detection, and management of pregnancy-related and concurrent conditions; health education and promotion; promotion of the use of skilled attendance at birth and healthy behaviors such as breastfeeding, early postnatal care, and planning for optimal pregnancy spacing, routine examinations, detection of complications, prevention of malaria in pregnancy and other infections; provision of holistic care to ensure normal progression of the baby and good health of the mother. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in percentage of clients disclosing exposure to intimate partner or sexual violence in past 3 months | 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? | baseline to 3-months and 6-months post-intervention | 
| Percentage of clients that report receiving a family planning method from healthcare provider |  | day of intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | Family planning self-efficacy is a women's belief about her own ability to complete the actions necessary for successful family planning. | baseline to 3-months and 6-months post-intervention | 
| Change in demonstrated self-efficacy to access IPV services | 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'. | baseline to 3-months and 6-months post-intervention | 
| Change in self-reported use of safety measures to protect respondent or her child/children from violence | 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? | baseline to 3-months and 6-months post-intervention | 
| Change in percentage of clients reporting experiences of reproductive coercion in 3 months prior to data collection | 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? | baseline to 3-months and 6-months post-intervention |