Improving Family Planning Services through IPV and Reproductive Coercion Intervention

This study evaluates a family planning clinic-based IPV and reproductive coercion (RC) intervention developed by a team of researchers, victim service advocates, and reproductive health practitioners [61 ]. Figure 3 describes the conceptual model of the ARCHES Intervention and Hypothesized Outcomes. One innovation of the ARCHES intervention is the focus on training not only clinicians, but also para-medical providers (i.e., medical assistants, health educators, and family planning counselors working in these settings) to discuss IPV and RC when counseling around contraception, pregnancy or STI testing. Additionally, the emphasis on universal provision of IPV/RC information recognizes that women often do not recognize IPV or RC and may not define sexual coercion as abuse, [62 , 63 ] particularly when the perpetrator is known to them [63 ]. The lack of recognition of abusive behaviors in relationships [42 , 43 ] has been associated with decreased IPV help-seeking, [63 –65 ] highlighting need for universal IPV/RC education and enhanced assessment.Fig. 3

Conceptual model for ARCHES

ARCHES provides universal IPV/RC education and enhanced assessment through FP provider discussion of IPV/RC with their patients in a way that highlights the prevalence of such abuse among women seen at the clinic and educates patients about the reproductive health impact of such abuse. The enhanced assessment for IPV/RC integrates into the reproductive health visit, for example, by asking a woman seeking pregnancy testing whether her partner might be pressuring her to get pregnant. This education and assessment is facilitated by the use of a palm-sized brochure which describes healthy and unhealthy relationships, offers information about harm reduction, and provides IPV related resources. Evidence that clinic-based IPV assessment can be the first step in recognizing abuse, particularly when done in a context that normalizes such abuse experiences, [42 , 66 ] strengthens the rationale for locating IPV and RC assessment within the context of supportive education for all women seeking FP services.
ARCHES also counsels women on harm reduction strategies. Harm reduction, originally used within substance abuse treatment, has been effective in managing a range of health risk behaviors [67 ] by ‘meeting clients where they are’ and assisting them with identifying strategies to decrease harm, including harms related to sexual health [68 –71 ]. IPV interventions appear to increase safety planning and harm reduction behaviors among victimized women, e.g., increase ability to refuse sex, [72 ] reduce substance use in dating contexts, [73 ] and advance preparation for safe escape should violence escalate [74 ]. Harm reduction behaviors have also been shown to protect against violence victimization among high-risk groups (i.e., women in prostitution), [75 ] and to reduce revictimization among college women [73 ]. Thus, ARCHES is designed to reduce women’s risk for violence victimization and unintended pregnancy via education regarding non-partner dependent contraceptives (longer acting reversible contraceptives such as the intrauterine device), access to emergency contraception, and provision of harm reduction strategies.
Finally, supported “warm” referrals (i.e., provider facilitation of referral to a victim service advocate via phone or in person) can assist clients in overcoming common barriers to accessing services, including self-blame, [43 , 76 ] lack of recognition of abuse, [63 , 64 ] lack of knowledge of services, [43 , 76 , 77 ] and perception that services are limited in scope (e.g., solely crisis oriented) [76 ]. Articulating the scope of services available to all women (regardless of disclosure of IPV or RC experiences), and normalizing use of these services may facilitate awareness and use of IPV services, improve mental health symptoms, [78 –81 ] and reduce revictimization [82 –84 ].