A Family Planning Clinic-Based Intervention to Address Reproductive Coercion

OBJECTIVE:

We assessed the effectiveness of a provider-delivered intervention targeting reproductive coercion, an important factor in unintended pregnancy.

STUDY DESIGN:

We randomized 25 family planning clinics (17 clusters) to deliver an education/counseling intervention or usual care. Reproductive coercion and partner violence victimization at one year follow-up were primary outcomes. Unintended pregnancy, recognition of sexual and reproductive coercion, self-efficacy to use and use of harm reduction behaviors to reduce victimization and contraception nonuse, and knowledge and use of partner violence resources were secondary outcomes. Analyses included all available data using an intention-to-treat approach.

RESULTS:

Among 4009 females ages 16 to 29 seeking care, 3687 completed a baseline survey prior to clinic visit from October 2011 to November 2012; 3017 provided data at 12-20 weeks post-baseline (T2) and 2,926 at 12 months post-baseline (T3) (79% retention). Intervention effects were not significant for reproductive coercion or partner violence. Intervention participants reported improved knowledge of partner violence resources and self-efficacy to enact harm reduction behaviors. In time point specific models which included moderating effects of exposure to reproductive coercion at baseline, a higher reproductive coercion score at baseline was associated with a decrease in reproductive coercion one year later (T3). Use and sharing of the domestic violence hotline number also increased.

CONCLUSION:

This brief clinic intervention did not reduce partner violence victimization. The intervention enhanced two outcomes that may increase safety for women, specifically awareness of partner violence resources and self-efficacy to enact harm reduction behaviors. It also appeared to reduce reproductive coercion among women experiencing multiple forms of such abuse.

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By:  Miller E1, Tancredi DJ2, Decker MR3, McCauley HL4, Jones KA4, Anderson H4, James L5, Silverman JG6.

• 1Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: elizabeth.miller@chp.edu.
• 2Department of Pediatrics and Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California.
• 3Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
• 4Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.
• 5Futures Without Violence, San Francisco, CA.
• 6Division of Global Public Health in the Department of Medicine & Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA. 
• Contraception. 2016 Feb 15. pii: S0010-7824(16)00056-1. doi: 10.1016/j.contraception.2016.02.009.

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