INTRODUCTION:This study examines women's pathways to medication abortion (MA) and post-MA contraception, including how they source information on the services, their choices and preferences regarding these services and their experiences obtaining the services from community pharmacies in two counties of Kenya. METHODS:Data are from the baseline of a mixed-methods prospective intervention study conducted in two counties of Kenya (Nakuru and Kericho) between May 2024 and June 2025. We recruited women from 43 community pharmacies (27 in Nakuru and 16 in Kericho county). Data collection involved a quantitative survey and in-depth interviews with women. RESULTS:A total of 524 women aged 17-48 years completed the quantitative survey while another 42 women aged 19-40 years (not in the quantitative survey) completed in-depth interviews at baseline (3-7 days following MA purchase). Most women relied on social networks (63% in Nakuru, 85% in Kericho) or pharmacies (35% in Nakuru, 56% in Kericho) for information on MA services. However, women themselves made the final decision to obtain MA. Women valued privacy, confidentiality and trust in pharmacy staff, with 94% of those in Nakuru and 88% of those in Kericho preferring the same pharmacy for post-MA contraceptive methods. Women generally preferred obtaining MA and post-MA contraceptive services separately to allow for the abortion process to be complete and to avoid potential adverse reactions from MA and contraception. They were also generally satisfied with the services they received from the pharmacy, mainly because of privacy, friendliness of the provider, quality of information provided, effectiveness of the medications provided and follow-up conducted by pharmacy staff. CONCLUSION:Community pharmacies are critical points of care for MA and post-MA contraception, providing privacy and convenience to underserved populations. Capacity-strengthening for pharmacists should focus on rights-based, comprehensive counselling to improve sexual and reproductive health outcomes.

BackgroundReproductive 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.MethodsWe 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.ResultsWe 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.ConclusionThis 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.

Reproductive coercion (RC) and intimate partner violence (IPV) threaten women's health and reproductive agency globally. The Addressing Reproductive Coercion in Health Settings (ARCHES) intervention integrates screening for RC and IPV, covert contraceptive options, IPV referrals, and an educational booklet into family planning (FP) services. This study examines client and provider perspectives on ARCHES in Nairobi, Kenya. A qualitative study was conducted in the three private clinics implementing ARCHES. Data were collected through 35 in-depth client interviews and 12 provider interviews three months post-intervention. Participants were purposively sampled based on age and RC/IPV experience. Thematic content analysis was used. Clients reported greater reproductive autonomy through increased knowledge of covert contraception, IPV services, and reproductive rights. Providers reported gaining confidence to address RC and IPV and building stronger relationships with clients. Barriers included stigma around IPV referrals and limited counselling time. Screening for RC/IPV was widely accepted, with some clients recognising abuse for the first time. The compact educational booklet improved knowledge retention and community outreach. Perspectives on male partner engagement were mixed due to concerns about safety and confidentiality. ARCHES was well-received by clients and providers, enhancing FP care and addressing critical gaps in RC and IPV support. Future adaptations should address barriers to IPV referral uptake and provider first-line IPV support, and carefully track implementation to ensure continued client-centred counselling. These findings support ARCHES as a scalable model for integrating FP and violence prevention interventions in Kenya and similar contexts.

Reproductive coercion (RC) and intimate partner violence (IPV) are prevalent in Kenya and undermine women's reproductive agency; community-based women's groups may offer an opportunity to address these issues. We quantitatively examined women's participation in women-only self-help groups, described discussions of RC within these groups, and assessed differences based on prior experiences of RC and IPV among a clinic-based sample of Kenyan women seeking family planning services to inform future programming. Data were collected from 659 women of reproductive age seeking family planning services at six private clinics in Nairobi as part of the baseline for an intervention to address RC and IPV within family planning counseling. We used descriptive statistics, bivariate hypothesis testing, and adjusted mixed-effect logistic regression models to examine the relationship between self-help group participation and lifetime experience of RC and IPV. Using the same methods, we analyzed group discussions about RC in relation to lifetime experiences of abuse among women who had recently participated in groups. Additionally, we explored associations between RC discussions and the type of self-help group (e.g., economic, charitable) using bivariate tests. Over half of women reported prior participation in women-only self-help groups, with most participating in economic groups (63%). More than one in two women reported prior IPV and one in three reported prior RC. Self-help group participation was not significantly associated with prior experiences of RC or IPV. However, women who had ever experienced RC were more likely to report discussions about RC within groups (AOR 1.82 95% CI 1.06-3.14). Discussions of RC were less common in economic groups. Women-only self-help group participation is common and acceptable among Kenyan women, including those experiencing violence. However, economic groups-though widespread-discuss RC less often, indicating a key opportunity to integrate RC/IPV programming into these settings to strengthen community-based support.

Despite evidence showing the feasibility and acceptability of implementing the World Health Organization's guidelines on managing possible serious bacterial infection (PSBI) in Kenya, the initial implementation revealed sub-optimal community-facility referrals and follow-up of PSBI cases. This study explores facilitators and barriers of community-facility linkages in implementing PSBI guidelines in Busia and Migori counties, Kenya. We used an exploratory qualitative study design drawing on endline evaluation data from the 'COVID-19: Mitigating Neonatal Mortality' project collected between June and July 2022. Data include case narratives with caregivers of sick young infants (0-59 days old) (18), focus group discussions with community health volunteers (CHVs) (6), and in-depth interviews with facility-based providers (18). Data were analysed using an inductive thematic analysis framework. Between August 2021 and July 2022, CHVs assessed 10 187 newborns, with 1176 (12%) identified with PSBI danger signs and referred to the nearest facility, of which 820 (70%) accepted referral. Analysis revealed several factors facilitating community-facility linkage for PSBI treatment, including CHVs' relationship with community members and facilities, availability of a CHV desk and tools, use of mobile app, training and supportive supervision. However, challenges such as health system-related factors (inadequate providers, stockout of essential commodities and supplies, and lack of transport/ambulance) and individual-related factors (caregivers' refusal to take referrals) hindered community-facility linkage. Addressing common barriers and fostering positive relationships between community health workers and facilities can enhance acceptance and access to PSBI services at the community level. Combining community health workers' efforts with a mobile digital strategy can improve the efficiency of the identification, referral and tracking of PSBI cases in the community and facilitate linkage with primary healthcare facilities.

BackgroundBoth unintended pregnancy and unsafe abortion are major public health problems in Kenya. The World Health Organization recommends the use of medication abortion to stop unwanted pregnancies. However, the extent of provision and uptake of medication abortion through private pharmacies in Kenya is not well known. This study assessed the feasibility and acceptability of utilizing pharmacy outlets and community health volunteers to increase women's and girls' access to information, medication abortion and other sexual and reproductive health services and rights.MethodsThe study utilized a single arm (intervention only) pre-test and post-test design that involved implementing a set of interventions and comparing the baseline and endline indicators using simple frequencies considering the number of respondents involved in the study. The study, referred to as Tembe Mkononi project, was conducted from 1st February 2021 to 31st December 2022, in Homa Bay County. Data collection involved baseline and endline interviews with 10 pharmacy staff (drawn from 9 pharmacy outlets) and 20 community health volunteers while program data was extracted from pharmacy sales records.ResultsA total of 527 clients obtained medication abortion drugs from the 9 participating pharmacy outlets between April and December 2022. There was a steady increase in the number of clients served from 15 clients in April 2022 to 112 clients in December 2022. Out of the 527 clients, 523 of them obtained family planning methods. All the pharmacy staff and community health volunteers expressed satisfaction and positive attitude towards the services provided to clients.ConclusionResults of the study show that the provision of medication abortion and other sexual and reproductive health services such as contraceptives to women and girls through private pharmacy outlets was feasible and acceptable. Building the capacity of community health volunteers to create awareness, strengthen referral and follow-up activities increased demand and uptake of sexual and reproductive health services including medication abortion over the project period. Overall, the interventions implemented in a rural county in Western Kenya have potential in addressing the problem of unsafe abortion which is one of the leading causes of maternal morbidity and mortality in Kenya and other developing countries.

Background Since 2013, the World Health Organization has recommended that reproductive coercion (RC) and intimate partner violence (IPV) be addressed within reproductive health services and, in 2018, the Lancet Commission on Sexual and Reproductive Health and Rights found that RC and IPV were significant contributors to unmet need for family planning (FP) and unintended pregnancy. In Kenya, the Ministry of Health (MOH) has made reduction of unintended pregnancy and gender-based violence a primary objective. Despite this need and guidance, no clinic-based intervention models outside of the U.S. (apart from the one described here) have demonstrated efficacy to improve FP use and reduce IPV or RC thereby reducing unintended pregnancy. ARCHES (Addressing Reproductive Coercion in Health Settings) is a brief, clinic-based intervention delivered by existing FP providers aiming to: (1) Increase women’s ability to use FP without interference, (2) Provide a safe and supportive environment for IPV disclosure and referral to support services, and (3) Improve quality of FP counseling, including addressing RC and IPV. The objective of this study is to generate evidence on scaling integrated FP services (including FP, RC, and IPV) in public sector health facilities in Uasin Gishu county, Kenya via adaptation and implementation of ARCHES in partnership with the Kenya MOH. Methods A cluster-randomized controlled trial paired with concurrent implementation science assessments will test effectiveness of the ARCHES model, adapted for scale by the Kenya MOH, in reducing unintended pregnancy. Female FP clients aged 15–49 years at selected sites will complete baseline surveys (immediately prior to receiving care), immediately post-visit exit surveys, and 6-month follow-up surveys. Provider surveys will assess changes in gender-equitable attitudes and self-efficacy to address violence reported by their clients. Costs associated with scaling ARCHES will be tracked and utilized in combination with results of the effectiveness trial to assess costs and cost-effectiveness relative to the standard of care. Discussion This study will provide evidence of the effectiveness of a facility-based intervention to address RC and IPV within public sector FP services at scale, as adapted and implemented in Uasin Gishu county, Kenya. Trial registration Trial registered on 28 September 2023 with clinicaltrials.gov NCT06059196.

BackgroundReducing the burden of neonatal sepsis requires timely identification and initiation of suitable antibiotic treatment in primary health care (PHC) settings. Countries are encouraged to adopt simplified antibiotic regimens at the PHC level for treating sick young infants (SYI) with signs of possible serious bacterial infection (PSBI). As countries implement PSBI guidelines, more lessons on effective implementation strategies and outcome measurements are needed. We document pragmatic approaches used to design, measure and report implementation strategies and outcomes while adopting PSBI guidelines in Kenya.MethodsWe designed implementation research using longitudinal mixed methods embedded in a continuous regular systematic learning and adoption of evidence in the PHC context. We synthesized formative data to co-create with stakeholders, implementation strategies to incorporate PSBI guidelines into routine service delivery for SYIs. This was followed by quarterly monitoring for learning and feedback on the effect of implementation strategies, documented lessons learned and tracked implementation outcomes. We collected endline data to measure the overall effect on service level outcomes.ResultsOur findings show that characterizing implementation strategies and linking them with implementation outcomes, helps illustrate the pathway between the implementation process and outcomes. Although we have demonstrated that it is feasible to implement PSBI in PHC, effective investment in continuous capacity strengthening of providers through blended approaches, efficient use of available human resources, and improving the efficiency of service areas for managing SYIs optimizes timely identification and management of SYI. Sustained provision of commodities for management of SYI facilitates increased uptake of services. Strengthening facility-community linkages supports adherence to scheduled visits. Enhancing the caregiver's preparedness during postnatal contacts in the community or facility will facilitate the effective completion of treatment.ConclusionCareful design, and definition of terms related to the measurement of implementation outcomes and strategies enable ease of interpretation of findings. Using the taxonomy of implementation outcomes help frame the measurement process and provides empirical evidence in a structured way to demonstrate causal relationships between implementation strategies and outcomes. Using this approach, we have illustrated that the implementation of simplified antibiotic regimens for treating SYIs with PSBI in PHC settings is feasible in Kenya.

Introduction Management of possible severe bacterial infections in young infants (0-59 days) requires timely identification of danger signs and prompt administration of efficacious antibiotic treatment. The Possible Severe Bacterial Infection guidelines underscore the importance of close follow up in an outpatient basis to ensure treatment adherence and early detection of illness-related complications. The purpose of this study was to strengthen the follow up and referral of sick young infants on day 4 and 8 by introducing community-led interventions that facilitated community health volunteers to identify sick young infants, conduct community reviews, link data with responsive facilities, and refer appropriately. Methods Six health facilities were included a a longitudinal, descriptive, mixed methods approach weaved around an initial formative context assessment and three-monthly assessments. Quantitative data was extracted from facility registers to identify gaps in follow up and referral feasibility. Qualitative data was through focus group discussions with community health volunteers and key informant interviews with frontline providers. Results Qualitative data provided insights into key barriers and facilitators of community follow up and referral. Barriers include community socio-cultural practices, competing tasks, dysfunctional community referral pathway, drivers of common infections, and unavailability of essential commodities. Key facilitators entail indication of competency in identification of danger signs in sick young infants, presence of older women, men, and community resource persons that can leveraged on in community engagement and sensitization, and mothers are the primary decision makers in care seeking. There was increased utilization of decision support tools and an increase in the number of sick young infants managed in dispensaries. The COVID-19 pandemic however negatively impacted community follow up and referral of sick young infants. Conclusion This study seeks to contribute evidence on strengthening PSBI community management by enhancing day 4 and day 8 follow up, review and community referral of sick young infants in Turkana, Kenya. The feasibility, adoption, and fidelity of strengthening community facility linkage through integrated communication strategies was documented, indicative of a successful community-facility linkage in dispensaries and health centers despite the effects of the COVID-19 pandemic.

Abstract This study was undertaken to evaluate the effect of a reproductive empowerment contraceptive counselling intervention (ARCHES) adapted to private clinics in Nairobi, Kenya on proximal outcomes of contraceptive use and covert use, self-efficacy, awareness and use of intimate partner violence (IPV) survivor services, and attitudes justifying reproductive coercion (RC) and IPV. We conducted a cluster-controlled trial among female family planning patients (N = 659) in six private clinics non-randomly assigned to ARCHES or control in and around Nairobi, Kenya. Patients completed interviews immediately before (baseline) and after (exit) treatment and at three- and six-month follow-up. We use inverse probability by treatment weighting (IPTW) applied to difference-in-differences marginal structural models to estimate the treatment effect using a modified intent-to-treat approach. After IPTW, women receiving ARCHES contraceptive counselling, relative to controls, were more likely to receive a contraceptive method at exit (86% vs. 75%, p < 0.001) and had a significantly greater relative increase in awareness of IPV services at from baseline to three- (beta 0.84, 95% CI 0.13, 1.55) and six-month follow-up (beta 0.92, 95% CI 0, 1.84) and a relative decrease in attitudes justifying RC from baseline to six-month follow-up (beta −0.34, 95% CI −0.65, −0.04). In the first evaluation of a clinic-based approach to address both RC and IPV in a low- or middle-income country (LMIC) context, we found evidence that ARCHES contraceptive counselling improved proximal outcomes related to contraceptive use and coping with RC and IPV. We recommend further study and refinement of this approach in Kenya and other LMICs. Plain Language Summary Reproductive coercion (RC) and intimate partner violence (IPV) are two forms of gender-based violence that are known to harm women’s reproductive health. While one intervention, ARCHES – Addressing Reproductive Coercion in Health Settings, has shown promise to improve contraceptive use and help women cope with RC and IPV in the United States, no approach has been proven effective in a low- or middle-income country (LMIC) context. In the first evaluation of a reproductive empowerment contraceptive counselling intervention in an LMIC setting, we found that ARCHES contraceptive counselling, relative to standard contraceptive counselling, improved proximal outcomes on contraceptive uptake, covert contraceptive use, awareness of local violence survives, and reduced attitudes justifying RC among women seeking contraceptive services in Nairobi, Kenya. Distal outcomes will be reported separately. Findings from this study support the promise of addressing RC and IPV within routine contraceptive counselling in Kenya on women’s proximal outcomes related to contraceptive use and coping with violence and coercion and should be used to inform the further study of this approach in Kenya and other LMICs.

INTRODUCTION:In 2015, the World Health Organization (WHO) developed guidelines for the management of sick young infants (SYIs) with possible serious bacterial infection (PSBI) where referral is not feasible. The Ponya Mtoto project was designed as an implementation research project to demonstrate how to adopt the WHO PSBI guidelines in the Kenyan context.PONYA MTOTO PROJECT DESCRIPTION:Between October 2017 and June 2021, Ponya Mtoto was implemented in 4 Kenyan counties with higher infant and newborn mortality rates than the national mean. A total of 48 health facilities stratified by level of services were selected as study sites.IMPLEMENTATION APPROACH:The following activities were done to institutionalize the management of SYIs with PSBI where referral is not feasible in Kenya's health system: (1) participating in a cocreation workshop and development of a theory of change; (2) revising the national integrated management of newborn and childhood illnesses guidelines to incorporate the management of PSBI where referral is not feasible; (3) improving availability of essential commodities; (4) strengthening provider confidence in the management of SYIs; (5) strengthening awareness about PSBI services for SYIs at the community level; and (6) harmonizing the national integrated management of newborn and childhood illnesses guidelines to address discrepancies in the content on the management of PSBI. In addition, the project focused on strengthening quality of care for SYIs and using implementation research to track progress in achieving project targets and outcomes.CONCLUSION:Using an implementation research approach to introduce new WHO guidelines on PSBI where referral is not feasible into Kenya's health care service was critical to fostering engagement of a diverse range of stakeholders, monitoring provider skills and confidence-building, strengthening provision of key commodities for managing SYIs with PSBI, and sustaining community-facility linkages.

Possible severe bacterial infections (PSBI) is one of the three leading causes of newborn and young infant mortality globally that can be prevented by timely diagnosis and treatment using suitable antibiotics. High impact interventions such as use of out-patient injectable gentamicin and dispersible Amoxicillin with community-based follow up have been shown to reduce mortality in clinical trials. The objective of this study was to assess the health systems' preparedness and organizational gaps that may impact execution in providing care for newborns and sick young infants. This formative research study was embedded within a three-year implementation research project in 4 Counties in Kenya. The indicators were based on facility audits for existing capacity to care for newborns and young infants as well as County organizational capacity assessment. The organizational capacity assessment domains were derived from the World Health Organization's Health Systems Building blocks for health service delivery. The scores were computed by adding average scores in each domain and calculated against the total possible scores to generate a percentage outcome. Statistical analyses were descriptive with adjustment for clustering of data. Overall, the Counties have inadequate organizational capacity for management of sick young infants with Organizational Capacity Index scores of between 61-64%. Among the domains, the highest score was in Health Management Information System and service delivery. The lowest scores were in monitoring and evaluation (M&E). Counties scored relatively low scores in human resources for health and health products and commodities with one scoring poorly for both areas while the rest scored average performance. The four counties revealed varying levels of organizational capacity deficit to effectively manage sick young infants. The key underlying issues for the below par performance include poor coordination, low funding, inadequate supportive supervision, and M&E to enable data utilisation for quality improvement. It was evident that newborn and young infant health services suffer from inadequate infrastructure, equipment, staffing, and coordination. As Kenya, continuously rolls out the guidelines on management of sick young infants, there is need to focus attention to these challenges to enhance sustainable adoption and reduction of young infant morbidity and mortality.

Introduction An ‘on-demand’ contraceptive pill may suit women having infrequent sex. We assessed the feasibility of e-commerce pharmacy provision and acceptability of levonorgestrel (LNG) 1.5 mg for pericoital use in Kenya. Methods A 12-month prospective, single-arm, open-label, interventional study conducted from August 2020 to August 2021. A total of 897 women aged 18–49 years at risk of pregnancy and having infrequent sex (ie, six times or fewer coital frequency/month) were screened and enrolled. We undertook univariate and bivariate analysis on multiple data points: enrolment dataset, bimonthly surveys, extended survey around 6-month follow-up, and e-commerce pharmacy sales log. Results A total of 2291 pericoital LNG 1.5 mg pill doses were dispensed to 300 women over a 12-month period mainly via the USSD (Unstructured Supplementary Service Data) platform. Of the 266 women who obtained the pill and completed the survey, most (83%) were satisfied/very satisfied with e-commerce platform services, citing convenience and ease of use. The pill was also acceptable. Of the 266 women who used it at least once, 94% were satisfied/very satisfied, likely to continue using and would recommend it to others; 86% used it within 24 hours before/after sex as recommended and most of the time they had sex; and 147 (55%) experienced side effects, mainly nausea, headache, changes in menstrual pattern, cramps and dizziness that were mild and tolerable. Conclusions E-commerce pharmacy provision of LNG 1.5 mg for pericoital use is feasible. In addition, a pericoital LNG 1.5 mg pill is acceptable among women having infrequent sex and could potentially address their unmet family planning needs.

Background Kenya has successfully expanded HIV treatment, but HIV-related stigma and discrimination, and unintended pregnancy remain issues for many Kenyan women living with HIV. While HIV-related stigma can influence the health seeking behaviors of those living with HIV, less is known about how reproductive health outcomes influence internalized stigma among women living with HIV. Methods Baseline data only were used in this analysis and came from an implementation science study conducted in Kenya from 2015 to 2017. The analytic sample was limited to 1116 women who are living with HIV, between 18 to 44 years old, and have ever experienced a pregnancy. The outcome variable was constructed from 7 internalized stigma statements and agreement with at least 3 statements was categorized as medium/high levels of internalized stigma. Unintended pregnancy, categorized as unintended if the last pregnancy was mistimed or unwanted, was the key independent variable. Univariate and multivariate logistic regression models were used to assess the association between unintended pregnancy and internalized stigma. Associations between internalized stigma and HIV-related discrimination and violence/abuse were also explored. Results About 48% agreed with at least one internalized stigma statement and 19% agreed with at least three. Over half of women reported that their last pregnancy was unintended (59%). Within the year preceding the survey, 52% reported experiencing discrimination and 41% reported experiencing violence or abuse due to their HIV status. Women whose last pregnancy was unintended were 1.6 times (95% CI 1.2–2.3) more likely to have medium/high levels of internalized stigma compared to those whose pregnancy was wanted at the time, adjusting for respondents’ characteristics, experiences of discrimination, and experiences of violence and abuse. Women who experienced HIV-related discrimination in the past 12 months were 1.8 times (95% CI 1.3–2.6) more likely to have medium/high levels of internalized stigma compared to those who experienced no discrimination. Conclusions Results suggest that unintended pregnancy is associated with internalized stigma. Integrated HIV and FP programs in Kenya should continue to address stigma and discrimination while increasing access to comprehensive voluntary family planning services for women living with HIV.

Background Understanding the perceptions of quality of care given to sick young infants in primary healthcare settings is key for developing strategies for effective uptake and utilisation of possible severe bacterial infection guidelines. The purpose of this study is to assess families and providers’ perceptions of care given to sick young infants at primary healthcare facilities in four diverse counties in Kenya. Methods A cross-sectional qualitative design involving 37 in-depth interviews and 39 focus group discussions with very young (15–18 years), young (19–24 years) and older (25–45 years) caregivers of young infants aged 0–59 days; and key informant interviews with community-based and facility-based front-line health providers (14) in primary healthcare facilities. Qualitative data were captured using audio tapes and field notes, transcribed, translated and exported into QSR NVivo V.12 for analysis. A thematic framework approach was adopted to classify and analyse data. Results Perceived care given to sick young infants was described around six domains of the WHO framework for the quality of maternal and newborn healthcare: evidence-based practices for routine and emergency care; functional referral systems; effective communication; respect and preservation of dignity; availability of competent, motivated human resources; and availability of physical resources. Views of caregivers and providers regarding sick young infant care in primary healthcare settings were similar across the four sites. Main hindrance to sick young infant care includes stockout of essential drugs, limited infrastructure, lack of functional referral system, inadequate providers which led to delays in receiving treatment, inadequate provider skills and poor provider attitudes. Despite these challenges, motivation and teamwork of health providers were key tenets in care provision. Conclusion The findings underscore the need to prioritise improving quality of sick young infant services at primary healthcare settings by building capacity of providers through training, ensuring continuous supply of essential medicines and equipment and improving infrastructure including referral.

The Population Council is an established leader in the development of reproductive health technologies. An estimated 170 million individuals worldwide use a highly effective contraceptive that was developed based on science generated by the Council. This infographic provides the Council’s four-stage product introduction framework that spans the continuum from product development to reaching the end-user. Stage 1 is Innovation, Stage 2 is Investment, Stage 3 is Launch, and Stage 4 is Scale Up. The Council works with stakeholders every step of the way from innovation to scale up into health systems. Advocates identify health areas of critical need; users inform our product design; donors, social entrepreneurs, manufacturers, and other market actors invest in our ideas; policymakers and implementers in the public and private sectors assist in launching the health technology; and health-care providers and consumers provide feedback on how well technologies are addressing needs while product designers and manufacturers continuously improve the technology.

Background Reproductive coercion (RC) and intimate partner violence (IPV) are prevalent forms of gender-based violence (GBV) associated with reduced female control over contraceptive use and subsequent unintended pregnancy. Although the World Health Organization has recommended the identification and support of GBV survivors within health services, few clinic-based models have been shown to reduce IPV or RC, particularly in low or middle-income countries (LMICs). To date, clinic-based GBV interventions have not been shown to reduce RC or unintended pregnancy in LMIC settings. Intervention ARCHES (Addressing Reproductive Coercion in Health Settings) is a single-session, clinic-based model delivered within routine contraceptive counseling that has been demonstrated to reduce RC in the United States. ARCHES was adapted to the Kenyan context via a participatory process to reduce GBV and unintended pregnancy among women and girls seeking contraceptive services in this setting. Core elements of ARCHES include enhanced contraceptive counseling that addresses RC, opportunity for patient disclosure of RC and IPV (and subsequent warm referral to local services), and provision of a palm-sized educational booklet. Methods A matched-pair cluster control trial is being conducted to assess whether the ARCHES intervention (treatment condition), as compared to standard-of-care contraceptive counseling (control condition), reduces RC and IPV, and improves contraceptive outcomes for woman and girls of reproductive age (15 to 49 years) seeking contraceptive services from community-based clinics in Nairobi, Kenya. All six clinics were assigned to intervention-control pairs based on similarities in patient volume and demographics, physical structure and neighborhood context. Survey data will be collected from patients immediately prior to their clinic visit (baseline, T1), immediately after their clinic visit (exit), and at 3- and 6-months post-visit (T2 and T3, respectively). Discussion This study is the first to assess the efficacy of an adaptation of the ARCHES model to reduce GBV and improve reproductive health outside of the U.S., and one of only a small number of controlled trials to assess reductions in GBV associated with a clinic-based program in an LMIC context. Evidence from this trial will inform health system efforts to reduce GBV, and to enhance female contraceptive control and reproductive health in Kenya and globally. Trial registration Registered May 23, 2018 - ClinicalTrials.gov , NCT03534401 . Unique Protocol ID: 170084.

Enabling women living with HIV to use contraception effectively can decrease unintended pregnancies and in turn reduce maternal mortality and vertical transmission of HIV. This brief describes the implementation process and intervention tested under the Evidence Project for delivering integrated FP and HIV services at the community level in Kenya. It outlines the implementation steps, best practices, and lessons learned of an intervention that was tested within the existing community health structure. Community health volunteers were trained to offer FP as part of their routine services to women living with HIV, and community health units were prepared to sustain those services. This brief complements a research report that offers evidence of the feasibility, quality of care, and acceptability, of using community health volunteers to integrate FP into existing HIV/AIDS services for women living with HIV at the community-level in Busia County, Kenya. The report also provides an incremental cost-analysis to estimate the additional health system cost for integrating the provision of pills and condoms into community health volunteers’ existing activities, and the recurrent cost of maintaining these additional services.

Background Reproductive coercion (RC), which includes contraceptive sabotage and pregnancy coercion, may help explain known associations between intimate partner violence (IPV) and poor reproductive health outcomes, such as unintended pregnancy. In Kenya, where 40% of ever-married women report IPV and 35% of ever-pregnant women report unintended pregnancy, these experiences are pervasive and co-occurring, yet little research exists on RC experiences among women and adolescent girls. This study seeks to qualitatively describe women’s and girls’ experiences of RC in Nairobi, Kenya and opportunities for clinical intervention. Methods Qualitative data were collected as part of the formative research for the adaptation of an evidence-based intervention to address reproductive coercion and IPV in clinical family planning counselling and provision in Nairobi, Kenya in April 2017. Focus group discussions ( n = 4, 30 total participants) and in-depth interviews ( n = 10) with family planning clients (ages 15–49) were conducted to identify specific forms of reproductive coercion, other partner-specific barriers to successful contraception use, and perceived opportunities for family planning providers to address RC among women and girls seeking family planning services. Additionally, data were collected via semi-structured interviews with family planning providers ( n = 8) and clinic managers ( n = 3) from family planning clinics. Data were coded according to structural and emergent themes, summarized, and illustrative quotes were identified to demonstrate sub-themes. Kenyan family planning providers and administrators informed interpretation. Results The results of this study identified specific forms of pregnancy coercion and contraceptive sabotage to be common, and often severe, impeding the use of contraceptives among female family planning clients. This study offers important examples of women’s strategies for preventing pregnancy despite experiencing reproductive coercion, as well as opportunities for family planning providers to support clients experiencing reproductive coercion in clinical settings. Conclusions Reproductive coercion is a critical barrier to modern contraceptive use in Kenya. Results from this study highlight opportunities for family planning providers to play a critical role in supporting women and girls in their use of contraception when reproductive coercion is present.

The progesterone vaginal ring (PVR) is a contraceptive designed for use by breastfeeding women in the first year postpartum. This Report presents results of an acceptability study of the PVR in Kenya, Nigeria, and Senegal. Women seeking postpartum family planning services were offered various contraceptive options including the PVR. Of the 174 participating women, 110 (63 percent) used one ring and 94 (54 percent) completed the study by using two rings over a six-month period. Women were interviewed up to three times: at the time they entered the study, at 3 months (the end of the first ring cycle), and at 6 months (the end of the second ring cycle or when they exited if they had discontinued earlier). Many participants found the ring to be acceptable, with over three-quarters reporting that it was easy to insert, remove, and reinsert. While a small proportion of women experienced ring expulsion, the majority did not. These findings suggest that even in countries with little or no use of vaginal health products, contraceptive vaginal rings offer women a new option that they are able and willing to use.