KENYA

ARCHES in Kenya

Problem: The 2022 Demographic and Health Survey in Kenya found, 2 in 5 women report lifetime experience of intimate partner violence (IPV) and 1 in 10 report prior experience of pregnancy coercion. Other ARCHES studies have found rates of reproductive coercion (RC) to be even higher among women seeking family planning, up to 42% in our latest study in Uasin Gishu, Kenya. Approximately 1 in 3 women have reported a mistimed or unwanted pregnancy. Additionally, women in Kenya, like those worldwide, also struggle with issues of economic violence.

Overview: ARCHES has been adapted in Kenya in several projects. The first project, beginning in 2016, included adapting ARCHES within family planning counseling delivered in private clinics in Nairobi with IPPF and Family Health  Options of Kenya (FHOK). Based on positive findings, in 2019 the Kenya Ministry of Health expressed interest in scaling the program, leading to the next project to adapt ARCHES within family planning counseling delivered in public facilities in one county, Uasin Gishu. Most recently, ARCHES content is also currently being adapted and tested in women’s economic empowerment groups in Uasin Gishu County. Learn more about each project below.

  • Purpose: Based on positive findings from the Nairobi evaluation, to adapt ARCHES to public facilities in one county in Kenya to prepare for nation-wide scale-up in a county-by-county approach.
  • Timeline and current status: 2020-2024, active – analysis and dissemination ongoing 
  • Context: Routine family planning counseling in 24 public facilities in Uasin Gishu county, Kenya. 
  • Primary goals: To adapt ARCHES in a way that is feasible, acceptable and effective and can be scaled nationally.
  • Evaluation design: Randomized cluster-controlled trial with 3,735 women of reproductive age seeking family planning services. Data collection included baseline, immediate post treatment (exit) and six month follow-up surveys from women. Providers completed pre-, post-,  and six-month follow-up training surveys. Providers and clients were sampled for qualitative post-implementation interviews. 
  • Adaptation: Adaptation was based on formative research with women, government stakeholders, and provider and facility assessments. Adaptation was primarily organized top-down with the Ministry of Health making decisions regarding the adaptation. Adaptation also included development of a provider-facing mobile app to help providers deliver the content. The ARCHES strategies were integrated into the Balanced Counseling Strategy Plus (BCS+) tools including the algorithm. The ARCHES training was integrated into the standard FP Module 1 training for all government employed family planning providers.
  • Primary findings: Almost 1 in 2 participants reported receiving the full intervention (i.e. information on methods that can be used discretely, RC screening, IPV screening, provision of IPV referral information). Among female clients, ARCHES decreased all forms of intimate partner violence and increased awareness of IPV support services, quality of person-centered family planning care, and confidence to use a FP method in the face of opposition. When implemented with full fidelity, ARCHES also increased FP uptake. Among providers, ARCHES increased provider self-efficacy to provide comprehensive FP counseling.
  • Lessons Learned: The mobile app vastly improved person-centered quality of family planning counseling and fidelity of ARCHES implementation in a highly scalable design. Providers still required intensive mentorship post-training to achieve faithful implementation, which may be resource intensive to scale. Otherwise, ARCHES was deemed as highly feasible and acceptable by providers and clients. On average, offering ARCHES only took 90 seconds of extra provider time at a cost of 6 cents USD per client.
  • Partners and funding: GEH-UCSD, the Kenya Ministry of Health, and Population Council – Kenya, Funded by the Gates Foundation. 
  • Resources:
  • Purpose: To jointly improve reproductive and economic empowerment among women in Uasin Gishu County, Kenya by adapting two evidence-based interventions, ARCHES and Girls Invest, to be delivered via an educational program in women’s economic empowerment groups. 
  • Timeline and status: 2022 – 2025, active – data collection ongoing
  • Context: Women’s table banking and village savings and loan association (VSLA) groups in Uasin Gishu County, Kenya.
  • Primary goals: To adapt ARCHES and Girls Invest strategies and educational content to women’s economic empowerment groups in a way that is feasible, acceptable, and improves intermediate outcomes on self-efficacy to use family planning, including in the face of opposition, self-efficacy to control economic assets, and self-efficacy to seek support for violence experiences. 
  • Evaluation design: A cluster-randomized controlled pilot trial in 18 women’s economic empowerment groups. Data collection includes baseline and four-month follow-up and qualitative follow-up with participating women’s groups.
  • Adaptation: Adaptation was based on formative research with women participating in women’s economic empowerment groups and group leaders, community health workers, and ARCHES trained providers and led in a participatory approach through a community-advisory board composed of representatives from three women’s groups. ARCHES and Girls Invest strategies were integrated into a structured educational and small group discussion program, delivered by a local community-based organization focused on women’s empowerment, delivered over eight 60-90 minute sessions. 
  • Partners and funding: GEH-UCSD, Rural Women’s Peace Link (RWPL), Women’s Empowerment Link (WEL), Population Council – Kenya, San Diego State University (SDSU)Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).
  • Resources: 

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