Strengthening Kenya's public health response to reproductive coercion and intimate partner violence in family planning clinics: applying the FRAME + IS approach

TL;DR

Kenya adapted a program to address reproductive coercion and intimate partner violence in family planning clinics, using a new framework to track changes during implementation.

Contribution

The first example of a government systematically adapting and tracking an evidence-based intervention for reproductive coercion and intimate partner violence in public health settings.

Findings

Twelve key adaptations were made to the intervention and implementation strategies in Kenya.

Most adaptations were planned and occurred before implementation, focusing on feasibility and sustainability.

FRAME+IS provided a practical roadmap for institutionalizing interventions in public health systems.

Abstract

Reproductive coercion (RC) and intimate partner violence (IPV) undermine reproductive autonomy and are prevalent among women seeking family planning (FP) services. In response, Kenya's Ministry of Health (MOH) selected ARCHES (Addressing Reproductive Coercion in Health Settings), an evidence-based intervention (EBI) integrating universal education, screening, and support on RC and IPV during routine FP counseling, for national adaptation and scale-up within a hybrid implementation-effectiveness trial. Institutionalizing such interventions within public health systems requires careful adaptation to ensure contextual fit while preserving core functions.

We developed and applied FRAME + IS, a unified adaptation-tracking framework that integrates the FRAME and FRAME-IS tools, to systematically document modifications made to the ARCHES intervention and its implementation strategies. The adaptation process was guided by adaptive management and the ADAPT-ITT framework and included formative research, national and county-level workshops, iterative piloting, and implementation planning, led by the Kenya MOH.

We identified 12 key adaptations: six related to intervention content and six related to implementation strategies. Most were planned (75%) and occurred prior to implementation (83%). Adaptations addressed feasibility, sustainability, and alignment with government systems. Examples include integration into national FP counseling protocols, namely the Balanced Counseling Strategy Plus, a shift from paper-based tools to a mobile app, and a formalized provider mentorship schedule. While the majority of adaptations were consistent with the original ARCHES intervention core strategies (58%), several, including removal of discreet contraceptive use counseling from official provider training materials and job-aids, were not consistent with the original model and reflected necessary trade-offs due to political sensitivities and implementation realities. The Kenya MOH was the final decision-maker on all adaptations, incorporating input from national and county-level staff, providers, and intervention experts.

This is the first published example of a government adopting provider training and guidelines to integrate RC and IPV response within FP services while systematically tracking these adaptations within a public health system. By applying FRAME + IS, this study offers both a practical roadmap for governments seeking to institutionalize IPV and RC interventions at scale and a streamlined framework to document changes to EBIs and implementation strategies during complex integration processes.

Figures