Original research article| Volume 94, ISSUE 1, P58-67, July 2016

A family planning clinic-based intervention to address reproductive coercion: a cluster randomized controlled trial



      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 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 12–20 weeks post-baseline (T2) and 2926 at 12 months 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.


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        • Keeling J.
        • Birch L.
        The prevalence rates of domestic abuse in women attending a family planning clinic.
        J Fam Plann Reprod Health Care. 2004; 30: 113-114
        • Miller E.
        • Decker M.R.
        • McCauley H.L.
        • Tancredi D.J.
        • Levenson R.R.
        • Waldman J.
        • et al.
        Pregnancy coercion, intimate partner violence, and unintended pregnancy.
        Contraception. 2010; 81: 316-322
        • Miller E.
        • Decker M.R.
        • Raj A.
        • Reed E.
        • Marable D.
        • Silverman J.G.
        Intimate partner violence and health care-seeking patterns among female users of urban adolescent clinics.
        Matern Child Health J. 2010; 14: 910-917
        • Miller E.
        • Goldstein S.
        • McCauley H.L.
        • Jones K.A.
        • Dick R.N.
        • Jetton J.
        • et al.
        A school health center intervention for abusive adolescent relationships: a cluster RCT.
        Pediatrics. 2015; 135: 76-85
        • Rickert V.I.
        • Wiemann C.M.
        • Harrykissoon S.D.
        • Berenson A.B.
        • Kolb E.
        The relationship among demographics, reproductive characteristics, and intimate partner violence.
        Am J Obstet Gynecol. 2002; 187: 1002-1007
        • Coker A.L.
        Does physical intimate partner violence affect sexual health? A systematic review.
        Trauma Violence Abuse. 2007; 8: 149-177
        • Decker M.R.
        • Silverman J.G.
        • Raj A.
        Dating violence and sexually transmitted disease/HIV testing and diagnosis among adolescent females.
        Pediatrics. 2005; 116: e272-e276
        • Gazmararian J.A.
        • Petersen R.
        • Spitz A.M.
        • Goodwin M.M.
        • Saltzman L.E.
        • Marks J.S.
        Violence and reproductive health: current knowledge and future research directions.
        Matern Child Health J. 2000; 4: 79-84
        • World Health Organization
        Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence.
        World Health Organization, Geneva2013
        • Stockl H.
        • Hertlein L.
        • Himsl I.
        • Delius M.
        • Hasbargen U.
        • Friese K.
        • et al.
        Intimate partner violence and its association with pregnancy loss and pregnancy planning.
        Acta Obstet Gynecol Scand. 2012; 91: 128-133
        • Stockman J.K.
        • Lucea M.B.
        • Campbell J.C.
        Forced sexual initiation, sexual intimate partner violence and HIV risk in women: a global review of the literature.
        AIDS Behav. 2013; 17: 832-847
        • American College of Obstetricians Gynecologists
        Reproductive and sexual coercion. Committee Opinion No. 554.
        Obstet Gynecol. 2013; 121: 411-415
        • Clark L.E.
        • Allen R.H.
        • Goyal V.
        • Raker C.
        • Gottlieb A.S.
        Reproductive coercion and co-occurring intimate partner violence in obstetrics and gynecology patients.
        Am J Obstet Gynecol. 2014; 210: 42.e1-42.e8
        • Gee R.E.
        • Mitra N.
        • Wan F.
        • Chavkin D.E.
        • Long J.A.
        Power over parity: intimate partner violence and issues of fertility control.
        Am J Obstet Gynecol. 2009; 201: e1-e7
        • Miller E.
        • McCauley H.L.
        • Tancredi D.J.
        • Decker M.R.
        • Anderson H.
        • Silverman J.G.
        Recent reproductive coercion and unintended pregnancy among female family planning clients.
        Contraception. 2014; 89: 122-128
        • Physicians and domestic violence
        Ethical considerations. Council on Ethical and Judicial Affairs, American Medical Association.
        JAMA. 1992; 267: 3190-3193
        • American College of Obstetricians Gynecologists
        ACOG Committee Opinion No. 518: Intimate partner violence.
        Obstet Gynecol. 2012; 119: 412-417
        • Garcia-Moreno C.
        • Hegarty K.
        • d'Oliveira A.F.
        • Koziol-McLain J.
        • Colombini M.
        • Feder G.
        The health-systems response to violence against women.
        Lancet. 2015; 385: 1567-1579
        • O'Doherty L.J.
        • Taft A.
        • Hegarty K.
        • Ramsay J.
        • Davidson L.L.
        • Feder G.
        Screening women for intimate partner violence in healthcare settings: abridged Cochrane systematic review and meta-analysis.
        BMJ. 2014; 348: g2913
        • Chang J.C.
        • Decker M.R.
        • Moracco K.E.
        • Martin S.L.
        • Petersen R.
        • Frasier P.Y.
        Asking about intimate partner violence: advice from female survivors to health care providers.
        Patient Educ Couns. 2005; 59: 141-147
        • Gerbert B.
        • Johnston K.
        • Caspers N.
        • Bleecker T.
        • Woods A.
        • Rosenbaum A.
        Experiences of battered women in health care settings: a qualitative study.
        Women Health. 1996; 24: 1-17
        • Bair-Merritt M.H.
        • Lewis-O'Connor A.
        • Goel S.
        • Amato P.
        • Ismailji T.
        • Jelley M.
        • et al.
        Primary care-based interventions for intimate partner violence: a systematic review.
        Am J Prev Med. 2014; 46: 188-194
        • McCloskey L.A.
        • Lichter E.
        • Williams C.
        • Gerber M.
        • Wittenberg E.
        • Ganz M.
        Assessing intimate partner violence in health care settings leads to women's receipt of interventions and improved health.
        Public Health Rep. 2006; 121: 435-444
        • Miller E.
        • Decker M.R.
        • McCauley H.L.
        • Tancredi D.J.
        • Levenson R.R.
        • Waldman J.
        • et al.
        A family planning clinic partner violence intervention to reduce risk associated with reproductive coercion.
        Contraception. 2011; 83: 274-280
        • Nelson H.D.
        • Bougatsos C.
        • Blazina I.
        Screening women for intimate partner violence: a systematic review to update the U.S. Preventive Services Task Force recommendation.
        Ann Intern Med. 2012; 156 ([w-279, w-80, w-81, w-82]): 796-808
        • Rhodes K.V.
        • Levinson W.
        Interventions for intimate partner violence against women: clinical applications.
        JAMA. 2003; 289: 601-605
        • World Health Organization
        Health care for women subjected to intimate partner violence or sexual violence: A clinical handbook.
        • Decker M.R.
        • Frattaroli S.
        • McCaw B.
        • Coker A.L.
        • Miller E.
        • Sharps P.
        • et al.
        Transforming the healthcare response to intimate partner violence and taking best practices to scale.
        J Women's Health (Larchmt). 2012; 21: 1222-1229
        • Tancredi D.J.
        • Silverman J.G.
        • Decker M.R.
        • McCauley H.L.
        • Anderson H.
        • Jones K.A.
        • et al.
        Cluster randomized controlled trial protocol: Addressing Reproductive Coercion in Health Settings (ARCHES).
        BMC Womens Health. 2015; 15
        • Santelli J.S.
        • Lindberg L.D.
        • Orr M.G.
        • Finer L.B.
        • Speizer I.
        Toward a multidimensional measure of pregnancy intentions: evidence from the United States.
        Stud Fam Plan. 2009; 40: 87-100
        • McCauley J.
        • Yurk R.
        • Jenckes M.
        • Ford D.
        Inside “Pandora's Box”: abused women's experiences with clinicians and health services.
        J Gen Intern Med. 1998; 13: 549-555
        • McNutt L.-A.
        • Carlson B.
        • Gagen D.
        • Winterbauer N.
        Reproductive violence screening in primary care: perspectives and experiences of patients and battered women.
        J Am Med Womens Assoc. 1999; 54: 85-90
        • Chang J.
        • Decker M.R.
        • Moracco K.
        • Martin S.
        • Petersen R.
        • Frasier P.
        What happens when health care providers ask about intimate partner violence? A description of consequences from the perspectives of female survivors.
        J Am Med Womens Assoc. 2003; 58: 76-81