To pilot and evaluate the integration of first-line response to gender- based violence (GBV), particularly intimate partner violence (IPV), sexual violence and reproductive coercion, within family planning (FP) and antenatal care (ANC) services at public health facilities in Ebonyi and Sokoto states in Nigeria. GBV first-line response in the health setting includes screening , empowerment counseling, safety planning, and support to connect to additional services needed.
This study seeks to: 1\. Assess effectiveness of an integrated service delivery model (integration of GBV first-line response and empowerment counseling in standard of care FP or ANC services) in reducing on-going experience of intimate partner violence (IPV) and increasing utilization of modern contraceptive methods among clients. 1a. Assess effectiveness of the intervention in reducing IPV, increasing utilization of modern contraceptive methods, and improving safety and self-efficacy among clients seeking interval FP services. 1b. Assess effectiveness of the intervention in reducing IPV and improving safety and self-efficacy to seek GBV care among clients seeking ANC services. 2\. Explore factors influencing feasibility, acceptability and ability to implement GBV first-line response as part of FP and ANC services.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
1,756
Providers will (1) introduce routine client screening for GBV, including intimate partner violence, sexual violence, and reproductive coercion using a standardized screening form, in FP and ANC services,(2) for individuals disclosing GBV, provide first-line response-empathetic counseling, including listening, inquiring about experiences sensitively, and validating experiences, helping clients develop safety plans, and providing support; (3) regardless of disclosure of GBV, provide counseling and information, education and communication (IEC) materials on IPV, including reproductive coercion, and FP options, to both FP and ANC clients.
Change in percentage of clients disclosing exposure to intimate partner or sexual violence in past 3 months
Disclosure will be defined by a positive response to either of the following questions: * Has your current partner ever slapped you, punched you, hit or kicked you, or done anything else to hurt you physically? * Has your current male partner ever forced you to have sex or do something sexual when you didn't want to?
Time frame: baseline to 3-months and 6-months post-intervention
Percentage of clients that report receiving a family planning method from healthcare provider
Time frame: day of intervention
Change in percentage of clients demonstrating family planning self efficacy, as measured by Contraceptive Self-Efficacy among women in sub-Saharan Africa (CSESSA) sub-scale
Family planning self-efficacy is a women's belief about her own ability to complete the actions necessary for successful family planning.
Time frame: baseline to 3-months and 6-months post-intervention
Change in demonstrated self-efficacy to access IPV services
Self-efficacy to access IPV services is an IPV survivor's confidence to develop and execute a plan when her partner becomes violent/ if her partner were to become violent. Self-efficacy will be defined by an affirmative response to the following questions: * I am confident that I could develop a plan for seeking help 'when my partner becomes violent/ if my partner were to become violent' * I am confident that I would be able to execute my plan 'in times when my partner becomes violent / if my partner were to become violent'.
Time frame: baseline to 3-months and 6-months post-intervention
Change in self-reported use of safety measures to protect respondent or her child/children from violence
Whether an IPV survivor has ever done any of the following to protect herself or her child/children for fear that her partner would become violent: * Identified a safe place to go in case she needs to leave her home ? * Identified a friend or relative to whom she could seek help? * Set aside some things she may need, such as clothes, documents in case she needs to leave in a hurry? * Set aside funds in case she needs to leave your home/partner? * Made a plan for what she would do with her child/children in case she needs to leave home?
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AZUIYIOKWU Health Center
Abakaliki, Ebonyi State, Nigeria
GMELINA Health Center
Abakaliki, Ebonyi State, Nigeria
NEW TIMBER SHADE Health Center
Abakaliki, Ebonyi State, Nigeria
AMAECHARA Primary Health Center
Afikpo North, Ebonyi State, Nigeria
Izeke Health Center
Afikpo North, Ebonyi State, Nigeria
NKAGBOGO NDEMIYI MDG Primary Health Center
Afikpo North, Ebonyi State, Nigeria
Owutu Primary Health Center
Afikpo South, Ebonyi State, Nigeria
Uwana Primary Health Center
Afikpo South, Ebonyi State, Nigeria
MDG Randa
Ebonyi, Ebonyi State, Nigeria
MCH Onueke
Ezza South, Ebonyi State, Nigeria
...and 30 more locations
Time frame: baseline to 3-months and 6-months post-intervention
Change in percentage of clients reporting experiences of reproductive coercion in 3 months prior to data collection
Reproductive coercion is behavior that interferes with the autonomous decision-making of a woman, with regards to reproductive health, including whether client felt pressured or forced by current partner to become pregnant or made it difficult to use family planning. Reproductive coercion will be defined by a positive response to either of the following questions: * Have you ever felt pressured or forced by your current partner to become pregnant when you did not want to be? * Has your current partner ever made it difficult for you to get family planning or to use family planning?
Time frame: baseline to 3-months and 6-months post-intervention