Abstract
INTRODUCTION: Despite the high rates of intimate partner violence (IPV) globally and the negative impact of IPV and reproductive coercion (RC) on reproductive and maternal health outcomes, few clinic-based interventions to address IPV and RC in clinical contexts have demonstrated effectiveness. The WHO's LIVES (Listen, Inquire, Validate, Enhance safety, Support), and the Addressing Reproductive Coercion in the Health Setting (ARCHES) intervention have been tested with mixed effects. Our study tested the effectiveness of a combination of LIVES and ARCHES within family planning (FP) and antenatal care (ANC) services at public health facilities in Ebonyi and Sokoto, Nigeria. METHODS: The study used a quasi-experimental, matched-pair, cluster-controlled design to assess the effectiveness of LIVES and ARCHES interventions including empathetic listening and care, safety planning and referrals to other specialised services. The outcomes of experience of IPV, RC and modern contraceptive use (for FP cohort) were measured pre-intervention (baseline) and 9 months post-intervention for participants in 20 intervention clinics compared with participants in 20 comparison clinics. Multilevel models with a random intercept for health-facility and adjusted for individual level variables were used to estimate the intervention effect (time × intervention) on the outcomes. RESULTS: 1617 clients were enrolled in the study. Comparing the intervention participants to the comparison participants, between baseline and endline, there was a relative decrease in exposure to IPV (beta=0.54 (95% CI 0.30 to 0.98)) and RC (beta=0.51(95% CI 0.28 to 0.94)) in the last 6 months. There was no difference in the modern contraceptive use comparing FP cohort participants at intervention clinics to comparison participants over time. CONCLUSION: Integration of IPV and RC screening and first-line response in FP and ANC services can reduce risk of violence in women not already experiencing it as well as reduce risk of reoccurrence. TRIAL REGISTRATION NUMBER: NCT05331508.