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Abstract Background Since 2013, the World Health Organization has recommended that reproductive coercion (RC) and intimate partner violence (IPV) be addressed within reproductive health services and, in 2018, the Lancet Commission on Sexual and Reproductive Health and Rights found that RC and IPV were significant contributors to unmet need for family planning (FP) and unintended pregnancy. In Kenya, the Ministry of Health (MOH) has made reduction of unintended pregnancy and gender-based violence a primary objective. Despite this need and guidance, no clinic-based intervention models outside of the U.S. (apart from the one described here) have demonstrated efficacy to improve FP use and reduce IPV or RC thereby reducing unintended pregnancy. ARCHES (Addressing Reproductive Coercion in Health Settings) is a brief, clinic-based intervention delivered by existing FP providers aiming to: (1) Increase women’s ability to use FP without interference, (2) Provide a safe and supportive environment for IPV disclosure and referral to support services, and (3) Improve quality of FP counseling, including addressing RC and IPV. The objective of this study is to generate evidence on scaling integrated FP services (including FP, RC, and IPV) in public sector health facilities in Uasin Gishu county, Kenya via adaptation and implementation of ARCHES in partnership with the Kenya MOH. Methods A cluster-randomized controlled trial paired with concurrent implementation science assessments will test effectiveness of the ARCHES model, adapted for scale by the Kenya MOH, in reducing unintended pregnancy. Female FP clients aged 15–49 years at selected sites will complete baseline surveys (immediately prior to receiving care), immediately post-visit exit surveys, and 6-month follow-up surveys. Provider surveys will assess changes in gender-equitable attitudes and self-efficacy to address violence reported by their clients. Costs associated with scaling ARCHES will be tracked and utilized in combination with results of the effectiveness trial to assess costs and cost-effectiveness relative to the standard of care. Discussion This study will provide evidence of the effectiveness of a facility-based intervention to address RC and IPV within public sector FP services at scale, as adapted and implemented in Uasin Gishu county, Kenya. Trial registration Trial registered on 28 September 2023 with clinicaltrials.gov NCT06059196.

Introduction: global studies indicate that sexual gender-based violence (SGBV) may increase during pandemics including COVID-19. The Mid-Eastern region in Uganda was of concern due to the high prevalence of intimate partner sexual violence among adolescent girls and young women (AGYW). Due to limited data, we investigated factors associated with SGBV among AGYW during the COVID-19 pandemic in Eastern Uganda, in April 2022. Methods: we listed all AGYW 10-24 years who obtained SGBV services at 10 high-volume health facilities from March 2020 to December 2021, the main COVID-19 period in Uganda. We conducted a case-control study among these AGYW. A case was =1 SGBV episode experienced by an AGYW aged 10-24 years residing in the Tororo and Busia districts. For every randomly selected case from the health facility line list, we identified two neighbourhood-matched AGYW controls who reported no SGBV. We interviewed 108 and 216 controls on socio-demographics, socio-economics, and SGBV experiences during COVID-19. We conducted logistic regression to identify associated factors. Results: among 389 SGBV cases, the mean age was 16.4 (SD± 1.6: range 10-24) years, and 350 (90%) were aged 15-19 years. Among 108 cases interviewed, 79 (73%) reported forced sex. Most (n=73; 68%) knew the perpetrator. In multivariate analysis, self-reported SGBV before the COVID-19 period [aOR=5.8, 95%CI: 2.8-12] and having older siblings [aOR=1.9, 95%: CI 1.1-3.4] were associated with SGBV during the period. Living with a family that provided all the basic needs was protective [aOR=0.42, 95%: CI 0.23-0.78]. Conclusion: previous SGBV experiences and family dynamics, such as having older siblings, increased the odds of SGBV during the COVID-19 pandemic in Uganda. Conversely, a supportive family environment was protective. Identifying, supporting, and enacting protective interventions for SGBV victims and socioeconomically vulnerable AGYW could reduce the burden of SGBV during similar events. [ABSTRACT FROM AUTHOR]

Abstract:Background: Several studies have been conducted on effects of COVID-19 on health, social and economic situation. However, evidence on the African continet on the responsiveness to sexual gender-based violence during the COVID-19 pandemic has not been adequately documented. This paper systematically reviews evidence from the African context regarding how countries responded to sexual gender-based violence during the height of the COVID-19 pandemic.Results: Drivers shaping the occurrence of SGBV included social and political responsiveness. The forms of SGBV experienced during the COVID-19 pandemic included; sexual; social- economic; physical emotional and domestic violence. Factors affecting responsiveness towards SGBV includes; limited availability or accessibility to the justice system, challenges accessing health services, inadequate human resources, fear of contracting COVID-19, social and economic barriers, and breakdown of social networks. Strategies for enhancing responsiveness included; training support, status on referral and linkages systems, protection services such as shelters and safety services, helplines and hotlines/communication, and collaboration on SGBV response.Conclusion: There is need to strengthen broader systems responsiveness through collaboration by creating strategies that promote reduction of SGBV. These strategies should include; community engagement to shift social -cultural norms towards gender and sexuality, creating social development opportunities for empowering and enabling women and girls with self-help and reliant activities, leveraging on community health systems structures to detect, link and monitoring of SGBV cases as well as co-integration of traditional justice system into the mainstream.

A central objective of this research paper is to consider how research methodologies are critical to the process of decolonising research. To ensure research is designed and executed not to be exploitative, special consideration is required for proposed research (er) collaborations between the Global South and North, particularly in research which focuses on gender, violence, and justice. Understanding the positionality of all groups involved allowed for research of mutual benefit. It provided a ‘checks and balances’ process to decolonise research processes and account for historical legacies of research being ‘done to’ communities in lower and middle-income countries and settings. This paper reflects on how Covid-19 impacted the collaborative partnerships for two projects conducted between the United Kingdom and Kenya. The projects addressed two separate, but connected issues: gender-based violence and sex workers' experiences of lockdown restrictions in Kenya. Both projects adopted peer methodologies which had to be adapted due to the pandemic. During Covid-19, travel restrictions were introduced globally, directly impacting the ability to conduct field research and carry out intended joint work in the field. The British and Kenyan governments introduced domestic measures to control the pandemic, including restrictions on movement and curfews; the closure of schools and public services such as courts; reduction in public transport and service closure. Overall, there was an increased reliance on technology for communication, which enabled project outcomes in challenging and unexpected circumstances. Both projects at the heart of this reflective article were forced to switch to (and exploit) internet-based methodologies and technological innovations to ensure project delivery whilst still located thousands of miles apart.To reflect and make sense of this adaptation process, qualitative semi-structured group interviews were conducted sometime after the projects had ended between December 2021–April 2022 with researchers from Kenya and the UK. The transcripts and interview notes were analysed for common themes. Funds were secured to bring a principal researcher from Kenya to the UK to conduct a thematic analysis.The findings identified three broad themes: first, the importance of co-creation and collaboration and the need to avoid hierarchical arrangements in research collaborations. Shared learning became an important value while undertaking such research, and mutual respect and support built lasting working ties among researchers as important elements of good collaboration. Secondly, we highlight key practical issues in conducting research and the ability to adapt and innovate to the changing nature of qualitative research while focusing on the well-being of researchers and research participants; and lastly, ensuring continuity and sustainability of interventions while acquiring further funding to enhance closer collaborations. We underscore the implications of Covid-19 and the need to demand proactive consideration in such research projects to ensure equity and ethical research partnerships that foster co-learning and mentorship. This includes taking proactive steps and setting up formal and informal well-being systems. Flexible funding is also required to nurture equal opportunities for collaborative and creative research and ensure long-term partnership sustainability. This supports the cultivation of a culture of co-creation and honouring knowledge sets in collaborative research.

Background: Since 2013, the World Health Organization has recommended that reproductive coercion (RC) and intimate partner violence (IPV) be addressed within reproductive health services and, in 2018, the Lancet Commission on Sexual and Reproductive Health and Rights found that RC and IPV were significant contributors to unmet need for family planning (FP) and unintended pregnancy. In Kenya, the Ministry of Health (MOH) has made reduction of unintended pregnancy and gender-based violence a primary objective. Despite this need and guidance, no clinic-based intervention models outside of the U.S. (apart from the one described here) have demonstrated efficacy to improve FP use and reduce IPV or RC thereby reducing unintended pregnancy. ARCHES (Addressing Reproductive Coercion in Health Settings) is a brief, clinic-based intervention delivered by existing FP providers aiming to: (1) Increase women's ability to use FP without interference, (2) Provide a safe and supportive environment for IPV disclosure and referral to support services, and (3) Improve quality of FP counseling, including addressing RC and IPV. The objective of this study is to generate evidence on scaling integrated FP services (including FP, RC, and IPV) in public sector health facilities in Uasin Gishu county, Kenya via adaptation and implementation of ARCHES in partnership with the Kenya MOH. Methods: A cluster-randomized controlled trial paired with concurrent implementation science assessments will test effectiveness of the ARCHES model, adapted for scale by the Kenya MOH, in reducing unintended pregnancy. Female FP clients aged 15–49 years at selected sites will complete baseline surveys (immediately prior to receiving care), immediately post-visit exit surveys, and 6-month follow-up surveys. Provider surveys will assess changes in gender-equitable attitudes and self-efficacy to address violence reported by their clients. Costs associated with scaling ARCHES will be tracked and utilized in combination with results of the effectiveness trial to assess costs and cost-effectiveness relative to the standard of care. Discussion: This study will provide evidence of the effectiveness of a facility-based intervention to address RC and IPV within public sector FP services at scale, as adapted and implemented in Uasin Gishu county, Kenya. Trial registration Trial registered on 28 September 2023 with clinicaltrials.gov NCT06059196. Plain language summary: This study will document evidence of the effectiveness of the ARCHES intervention, a brief, clinic-based counselling intervention demonstrated to reduce intimate partner violence and reproductive coercion and promote women's reproductive health, as scaled in government health facilities in Kenya. ARCHES aims to (1) decrease unintended pregnancy, (2) increase family planning uptake and use/continuation, (3) decrease experiences of reproductive coercion and intimate partner violence of women and girls aged 15–49 years seeking family planning services, and to (4) improve quality of care, (5) increase gender equitable attitudes, and (6) increase self-efficacy to provide comprehensive family planning counseling among providers trained in ARCHES. [ABSTRACT FROM AUTHOR]

The climate and environmental changes in the Global South have devastating effects on vulnerable populations, which have been perpetuated by socio-economic and political as well as gender inequalities and non-existent interventions to adapt and mitigate its adverse effects. Underpinned by the Protection Motivation Theory and Social-Cognitive Preparation model, this systematic literature review article depicts how vulnerable populations are impacted by climate change in the Global South. Using the empirical data from credible databases including the Web of Science and Scopus, 23 articles published since 2018 were searched, retrieved, coded, and classified with three themes emerging from the synthesised literature. The analysis of the literature confirms that climate change indeed impacts vulnerable populations adversely; the adaptability mechanisms are not applied by governments which are contrary to the international frameworks; and lastly, that such groups are discriminated against, undermined, and overlooked in societal programmes and interventions to mitigate the impacts of climate-induced disasters. Climate change impacts have severely destroyed the livelihoods of vulnerable populations and are exacerbated by socio-economic and political inequalities, with the adaptation and mitigation mechanisms deemed ineffective. Gaps in current research studies include the paucity of empirical data shedding light on the interventions provided for sexual gender-based violence victims and punitive actions issued against the perpetrators during and in the aftermath of the climate-induced disasters. There is also scant empirical data testing the adaptation and mitigation mechanisms' effectiveness. [ABSTRACT FROM AUTHOR]

This article examines the impact of the Anglophone conflict on the achievement of Cameroon's goal of gender equity and equality. Since 2016, when the conflict between the Cameroonian central government and separatists took a violent turn, civilians in the Anglophone regions of Cameroon have been subjected to acts of violence by both non-state and state actors. Like in most conflicts, women and girls have been disproportionately affected; however, even though women bear the heaviest brunt of the crisis, their voices have mostly been missing from debates about the conflict and its devastating effect. This article, therefore, gives attention to the lived experiences of women in the regions affected by the Anglophone conflict in Cameroon. This is to help make sense of the conflict's psychosocial impact on civilians, especially women and girls. The study is qualitative; it adopts a contextually grounded, intersectional approach which allows women to give an account of how the conflict has affected their lives and exacerbated forms of violence such as gender-based violence (GBV). [ABSTRACT FROM AUTHOR]

Abstract Background Reproductive coercion (RC) and intimate partner violence (IPV) are prevalent forms of gender-based violence (GBV) associated with reduced female control over contraceptive use and subsequent unintended pregnancy. Although the World Health Organization has recommended the identification and support of GBV survivors within health services, few clinic-based models have been shown to reduce IPV or RC, particularly in low or middle-income countries (LMICs). To date, clinic-based GBV interventions have not been shown to reduce RC or unintended pregnancy in LMIC settings. Intervention ARCHES (Addressing Reproductive Coercion in Health Settings) is a single-session, clinic-based model delivered within routine contraceptive counseling that has been demonstrated to reduce RC in the United States. ARCHES was adapted to the Kenyan context via a participatory process to reduce GBV and unintended pregnancy among women and girls seeking contraceptive services in this setting. Core elements of ARCHES include enhanced contraceptive counseling that addresses RC, opportunity for patient disclosure of RC and IPV (and subsequent warm referral to local services), and provision of a palm-sized educational booklet. Methods A matched-pair cluster control trial is being conducted to assess whether the ARCHES intervention (treatment condition), as compared to standard-of-care contraceptive counseling (control condition), reduces RC and IPV, and improves contraceptive outcomes for woman and girls of reproductive age (15 to 49 years) seeking contraceptive services from community-based clinics in Nairobi, Kenya. All six clinics were assigned to intervention-control pairs based on similarities in patient volume and demographics, physical structure and neighborhood context. Survey data will be collected from patients immediately prior to their clinic visit (baseline, T1), immediately after their clinic visit (exit), and at 3- and 6-months post-visit (T2 and T3, respectively). Discussion This study is the first to assess the efficacy of an adaptation of the ARCHES model to reduce GBV and improve reproductive health outside of the U.S., and one of only a small number of controlled trials to assess reductions in GBV associated with a clinic-based program in an LMIC context. Evidence from this trial will inform health system efforts to reduce GBV, and to enhance female contraceptive control and reproductive health in Kenya and globally. Trial registration Registered May 23, 2018 - ClinicalTrials.gov , NCT03534401 . Unique Protocol ID: 170084.

Background: Reproductive coercion (RC) and intimate partner violence (IPV) are prevalent forms of gender-based violence (GBV) associated with reduced female control over contraceptive use and subsequent unintended pregnancy. Although the World Health Organization has recommended the identification and support of GBV survivors within health services, few clinic-based models have been shown to reduce IPV or RC, particularly in low or middle-income countries (LMICs). To date, clinic-based GBV interventions have not been shown to reduce RC or unintended pregnancy in LMIC settings. Intervention: ARCHES (Addressing Reproductive Coercion in Health Settings) is a single-session, clinic-based model delivered within routine contraceptive counseling that has been demonstrated to reduce RC in the United States. ARCHES was adapted to the Kenyan context via a participatory process to reduce GBV and unintended pregnancy among women and girls seeking contraceptive services in this setting. Core elements of ARCHES include enhanced contraceptive counseling that addresses RC, opportunity for patient disclosure of RC and IPV (and subsequent warm referral to local services), and provision of a palm-sized educational booklet. Methods: A matched-pair cluster control trial is being conducted to assess whether the ARCHES intervention (treatment condition), as compared to standard-of-care contraceptive counseling (control condition), reduces RC and IPV, and improves contraceptive outcomes for woman and girls of reproductive age (15 to 49 years) seeking contraceptive services from community-based clinics in Nairobi, Kenya. All six clinics were assigned to intervention-control pairs based on similarities in patient volume and demographics, physical structure and neighborhood context. Survey data will be collected from patients immediately prior to their clinic visit (baseline, T1), immediately after their clinic visit (exit), and at 3- and 6-months post-visit (T2 and T3, respectively). Discussion: This study is the first to assess the efficacy of an adaptation of the ARCHES model to reduce GBV and improve reproductive health outside of the U.S., and one of only a small number of controlled trials to assess reductions in GBV associated with a clinic-based program in an LMIC context. Evidence from this trial will inform health system efforts to reduce GBV, and to enhance female contraceptive control and reproductive health in Kenya and globally. Trial registration: Registered May 23, 2018 - ClinicalTrials.gov, NCT03534401. Unique Protocol ID: 170084. [ABSTRACT FROM AUTHOR]

INTRODUCTION: In Zimbabwe, there is a gap between sexual violence (SV) survivors' health care needs versus the existing facilities. Harare city started Sexual Gender Based Violence (SGBV) project in 2011, with the aim to reduce SV morbidity.Only 592 (42%) of 1425 SV survivors reported for medical services within 72 hours in 2015. HIV post-exposure prophylaxis (PEP) is effective within 72hours of post exposure. We evaluated the program performance in Harare city. METHODS: We conducted a process-outcome evaluation using a logic model. We purposively recruited all eight SGBV sites and key informants. We randomly selected 27nurses into the study. Interviewer-administered questionnaires and checklists were used to collect data. To generate frequencies, means and proportions we used Epi info 7. RESULTS: The program adequately received inputs except for counselling rooms (1/8). About 4285 survivors were recorded from 2013-2016. Of these, 97% were counselled, 93% received HIV test, 41% reported to the clinic within 72hrs of post-rape, and 12% received PEP. About 16% of the total survivors were followed up. The programme failed to meet its targets on decentralised sites (8/10), awareness campaigns(16/32) and sensitisation activities(16/32). About 500(12.5%) IEC materials were distributed. All 96-targeted supervisory visits were achieved. Two ofeight district supervisors were trained. Majority of health workers(25/35) citedlack of awareness as major reasons for underperformance. CONCLUSION: Availability of resources did not translate to program performance. Most survivors were not reporting to the clinic timeously due to the low level of awareness of the programme to the community, hence were not protected from getting HIV through PEP. The programme was not well disseminated, as most supervisors were not trained. Following this evaluation, we distributed150 IEC materials to each of the eight facilities. A follow-up study on outcomes of clients referred for services and training of district officers were recommended.

Introduction: In Zimbabwe, there is a gap between sexual violence (SV) survivors' health care needs versus the existing facilities. Harare city started Sexual Gender Based Violence (SGBV) project in 2011, with the aim to reduce SV morbidity.Only 592 (42%) of 1425 SV survivors reported for medical services within 72 hours in 2015. HIV post-exposure prophylaxis (PEP) is effective within 72hours of post exposure. We evaluated the program performance in Harare city. Methods: We conducted a process-outcome evaluation using a logic model. We purposively recruited all eight SGBV sites and key informants. We randomly selected 27nurses into the study. Interviewer-administered questionnaires and checklists were used to collect data. To generate frequencies, means and proportions we used Epi info 7. Results: The program adequately received inputs except for counselling rooms (1/8). About 4285 survivors were recorded from 2013-2016. Of these, 97% were counselled, 93% received HIV test, 41% reported to the clinic within 72hrs of post-rape, and 12% received PEP. About 16% of the total survivors were followed up. The programme failed to meet its targets on decentralised sites (8/10), awareness campaigns(16/32) and sensitisation activities(16/32). About 500(12.5%) IEC materials were distributed. All 96-targeted supervisory visits were achieved. Two ofeight district supervisors were trained. Majority of health workers (25/35) citedlack of awareness as major reasons for underperformance. Conclusion: Availability of resources did not translate to program performance. Most survivors were not reporting to the clinic timeously due to the low level of awareness of the programme to the community, hence were not protected from getting HIV through PEP. The programme was not well disseminated, as most supervisors were not trained. Following this evaluation, we distributed150 IEC materials to each of the eight facilities. A follow-up study on outcomes of clients referred for services and training of district officers were recommended. [ABSTRACT FROM AUTHOR]

This article will first describe the problem of Sexual and Gender-based Violence (SGBV) in Liberia, its history to views of its current status, and the debate about its cause. It will discuss the problems that result through trying to address the problem of SGBV through both formal and informal rule of law development strategies, including both traditional and customary dispute resolution processes within the Liberian setting. It will also describe the reasoning behind The Carter Center (TCC's) support of traditional and community-based projects, including its use of NGO social science research in helping it monitor the progress being made in fighting SGBV. It will be a tale of discouragement as assessment showed the continuing prevalence of SGBV. Next the paper will discuss what led TCC to develop its Community Justice Advisor (CJA) Project. It will describe the project and its implementation. Finally it will look at the research attempts to measure CJA's success and predict whether funding of additional CJAs will likely be effective in combating SGBV. It will conclude by making some modest observations about whether CJAs might work elsewhere in Africa, or in the developing world, and the promise and dangers of using individual paralegals as a major tool in combating SGBV. [ABSTRACT FROM AUTHOR]

Context: National and international strategies were implemented in eastern Democratic Republic of Congo (DRC) to address sexual and gender-based violence (SGBV)., Objectives: The objective was to assess community attitudes of SGBV and health facility capacity to address SGBV in eastern DRC., Design and Setting: The design and setting are as follows: a cross-sectional, population-based cluster survey of 998 adults in eastern DRC territories, a convenience sample of 27 adults using semi-structured directed interviews, qualitative data from 37 focus groups conducted in three health zones, assessment of 64 health facilities and a comparative analysis of SGBV strategies., Main Outcome Measures: The main outcome measures opinions regarding SGBV prevention and justice and health facility capacity to address SGBV., Results: The majority of respondents favored the legal system over community mediation to obtain justice for SGBV. However, 61.1% (95% CI, 51.8-70.5%) of SGBV survivors reported being forced to accept community mediation. Among SGBV survivors, 81.2% (95% CI, 74.5-87.8%) reported no available mental health care. Less than half of all respondents reported access to a hospital, clinic or pharmacy. The analyses and facility assessment reinforce the need to improve SGBV care., Conclusions: Mixed methodologies point to the complexities of addressing SGBV, assess key elements of SGBV prevention, justice and response, and may ultimately inform national and international strategies., (Copyright © 2012 John Wiley & Sons, Ltd.)