title: A family planning clinic-based intervention to address reproductive coercion: a cluster randomized controlled trial.
abstract: We assessed the effectiveness of a provider-delivered intervention targeting reproductive coercion, an important factor in unintended pregnancy.
  
  
  
  We randomized 25 family planning clinics (17 clusters) to deliver an education/counseling intervention or usual care. Reproductive coercion and partner violence victimization at 1 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.
  
  
  
  Among 4009 females ages 16 to 29 years seeking care, 3687 completed a baseline survey prior to clinic visit from October 2011 to November 2012; 3017 provided data at 12-20weeks post-baseline (T2) and 2926 at 12months post-baseline (T3) (79% retention). Intervention effects were not significant for reproductive coercion [adjusted risk ratio (ARR) 1.50 (95% confidence interval 0.95-2.35)] or partner violence [ARR 1.07 (0.84-1.38)]. Intervention participants reported improved knowledge of partner violence resources [ARR 4.25 (3.29-5.50)] and self-efficacy to enact harm reduction behaviors [adjusted mean difference 0.06 (0.02-0.10)]. 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 1 year later (T3). Use and sharing of the domestic violence hotline number also increased.
  
  
  
  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.
authors.affiliation: Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: elizabeth.miller@chp.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Miller
authors.affiliation: Department of Pediatrics and Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tancredi
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Decker
authors.affiliation: Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: McCauley
authors.affiliation: Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Kelley A
authors.initials: KA
authors.lastname: Jones
authors.affiliation: Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Anderson
authors.affiliation: Futures Without Violence, San Francisco, CA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: James
authors.affiliation: Division of Global Public Health in the Department of Medicine & Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000328:Adult; D003068:Coercion; D003268:Contraception Behavior / Q000523:psychology; D003376:Counseling; D017579:Domestic Violence / Q000706:statistics & numerical data*; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D000066511:Intimate Partner Violence / Q000706:statistics & numerical data*; D010414:Pennsylvania; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012747:Sexual Partners / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Domestic violence; Family planning; Partner violence; Reproductive coercion; Screening; Unintended pregnancy