Strengthening Kenya's Public Health Response to Reproductive Coercion and Intimate Partner Violence in Family Planning Clinics: Applying the FRAME+IS Approach

Jamie Menzel^1*Jasmine Uysal¹Erin Pearson¹Jane Namwebya²Mary Gathitu³Alice Mwangangi³Clarice Okumu³Betty Chirchir⁴Wilson Liambila²George Odwe²Edward Serem³Chi-Chi Undie²Jay Silverman⁵

• ¹Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, CA, United States
• ²Population Council Kenya, Nairobi, Kenya
• ³Division of Reproductive, Maternal, Newborn, Child and Adolescent Health, Ministry of Health, Nairobi, Kenya
• ⁴Department of Health, Uasin Gishu County, Eldoret, Kenya
• ⁵Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, New Orleans, United States

Background: 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. Methods: 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. Results: 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. Conclusion: 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.