1. Effectiveness of the Addressing Reproductive Coercion in Health Settings (ARCHES) intervention among abortion clients in Bangladesh: a cluster-randomized controlled trial
- Author
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Pearson, Erin, Paul, Dipika, Menzel, Jamie, Shakhider, Mohammad Abdul Hannan, Konika, Rabeya Akter, Uysal, Jasmine, and Silverman, Jay G
- Subjects
Biomedical and Clinical Sciences ,Health Services and Systems ,Public Health ,Clinical Sciences ,Health Sciences ,Clinical Trials and Supportive Activities ,Contraception/Reproduction ,Women's Health ,Social Determinants of Health ,Health Services ,Violence Research ,Clinical Research ,Violence Against Women ,Behavioral and Social Science ,Reproductive health and childbirth ,Good Health and Well Being ,Peace ,Justice and Strong Institutions ,Gender Equality ,Reproductive coercion ,Intimate partner violence ,Abortion ,Bangladesh ,South Asia ,Clinical sciences ,Health services and systems ,Public health - Abstract
Background: The Addressing Reproductive Coercion in Health Settings (ARCHES) intervention trains existing providers to address reproductive coercion (RC) and intimate partner violence (IPV) within routine family planning counseling. This study evaluated the effectiveness of a single ARCHES counseling session as adapted for use with abortion clients in Bangladesh. Methods: In this cluster-randomized controlled trial conducted between January 2019 and January 2021, health facilities with an abortion clinic with infrastructure for private counseling and onsite violence support services were eligible. Six facilities in Bangladesh met inclusion criteria, and matched pairs randomization with parallel assignment and a 1:1 allocation ratio was used to randomize three facilities to ARCHES and three facilities to control, which implemented standard counseling. Blinding was not possible as providers in intervention facilities participated in a three-day ARCHES training. Participants were abortion clients aged 18–49 years who could provide safe recontact information and be interviewed privately. The primary outcome was past three-month modern contraceptive use without interruption or interference. The trial was registered on clinicaltrials.gov (NCT03539315) on 29 May 2018. Findings: A total of 1492 intervention participants and 1237 control participants were enrolled. Available data were analyzed at each follow-up period: 1331 intervention and 1069 control participants at the three-month follow-up, and 1269 intervention and 1050 control participants at the twelve-month follow-up. ARCHES was associated with higher likelihood of modern contraceptive use at the three-month follow-up (adjusted RR = 1.08, 95% CI: 1.06–1.10) and the twelve-month follow-up (adjusted RR = 1.06, 95% CI: 1.02–1.10). ARCHES was also associated with decreased incident pregnancy, decreased IPV, and increased knowledge of IPV support services. Interpretation: The ARCHES intervention is effective in increasing post-abortion modern contraceptive use and decreasing incident pregnancy and IPV among abortion clients in Bangladesh. Implementation of ARCHES should be considered in facilities with sufficient privacy for counseling. Funding: Society of Family Planning (#SFPRF11-07) and Ipas.
- Published
- 2024