This is a second submission of a New Investigator-initiated community-based participatory study to test, via a 2-armed cluster (RCT), a brief intervention to reduce risk for intimate partner violence (IPV) and associated unintended pregnancy among young, medically underserved women attending family planning (FP) clinics. Women ages 16-29 years utilizing FP clinics report higher rates of IPV compared to their same-age peers, experiences associated with unintended pregnancy. A critical mechanism connecting IPV with poor reproductive health is abusive partners'control of women's reproduction through condom refusal, pressuring women to get pregnant, and birth control sabotage, a phenomenon described as reproductive coercion. In our pilot intervention study (NICHD R21 HD057814-01), 53% of young women using FP clinics reported ever experiencing IPV, and 25% reported reproductive coercion, the combination of which was strongly associated with unintended pregnancy. The proposed reproductive coercion/partner violence intervention (RCPVI) was developed collaboratively by community-based practitioners, advocates, and researchers, with significant input from FP clients. Designed to be implemented within routine FP care, maximizing feasibility and sustainability of this program, the RCPVI provides 1) client education and assessment regarding IPV and reproductive coercion;2) discussion of harm reduction behaviors to reduce risk for unintended pregnancy and IPV victimization;3) supported referrals to IPV victim services. In the pilot, women in the intervention arm experiencing recent IPV reported a 71% reduction in a key element of reproductive coercion, pregnancy coercion, highlighting the potential for significant impact of this intervention. Based on this pilot, we are proposing a full-scale RCT (i.e., sufficiently powered and of adequate duration) to conclusively assess the effects of this innovative program on IPV, reproductive coercion and unintended pregnancy, major health threats for medically underserved women. Evaluation of this RCPVI will involve random assignment of 16 FP clinics in Northern California to either intervention or control (i.e., standard-of-care) conditions. Female FP clients ages 16-29 (N=3600) will be assessed at baseline, 12-20 weeks (FU1), and 12 months (FU2) to assess intervention effects on knowledge and behaviors related to IPV, reproductive coercion and related harm reduction, as well as unintended pregnancy. Data at each time point will be collected via audio computer- assisted self-interview in English or Spanish. Chart extraction will track clinic utilization, pregnancy testing, and diagnosed pregnancies. Intervention effects on patient-level follow-up outcomes will be assessed using multilevel regression analyses that account for clustering of individual participants within clinics. All project partners, including client and clinician advisors, will participate in implementation, interpretation of results, and dissemination of findings.
Intimate partner violence (IPV) and male partners'attempts to control women's reproductive health are associated with unintended pregnancy. Identifying community-partnered interventions to reduce IPV and associated reproductive coercion, particularly those effective in the context of social disadvantage, is critical. The proposed community-based participatory study will test, via a 2-armed cluster randomized controlled trial, a brief intervention integrated into family planning clinics to reduce risk for IPV and associated unintended pregnancy, both major public threats that disproportionately affect young women in medically underserved communities.
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