An mHealth-enabled intervention to prevent partner violence and pregnancy among adolescents and young women

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ABSTRACT The objective of the proposed study is to assess the feasibility, acceptability, fidelity of implementation, and preliminary efficacy of Jenga Dada (“women’s empowerment” in Kiswahili), an intervention to improve reproductive health (including contraceptive use and control), reduce gender- based violence (GBV) and promote economic self-sufficiency to prevent unintended pregnancy among adolescent females (ages 15-24 years) in urban Kenya. Nearly half of all pregnancies in Kenya are unintended. GBV, specifically intimate partner violence (IPV) and reproductive coercion (RC; i.e. male partner behaviors that block women’s contraceptive use or pregnancy decisions), contributes to unintended pregnancy by reducing girls’ and women’s control over sexual and reproductive decisions. Our recent research in both the U.S. and Kenya indicates that a clinic-based program to assist women and girls with IPV and RC (ARCHES – Addressing Reproductive Coercion in Health Settings) empowers woman and girls to leave abusive partners and reduces incident pregnancy. However, we also found that women and girls frequently discuss experiences of IPV and RC in the context of women’s pooled savings and microloan groups (a.k.a., village savings and loan associations [VSLAs]). VSLAs aim to promote economic self-sufficiency and are an increasingly prevalent structure throughout Kenya and in most low and middle-income countries. Notably, economic self-sufficiency has also been identified as important in reducing adolescent and unintended pregnancy by decreasing financial reliance on male partners, which also reduces risk for IPV. Thus, development and testing of interventions to address IPV and RC in the context of VSLAs may be a promising approach to reduce unintended pregnancy. Another line of our recent research with adolescent girls in the U.S. and Nigeria has led to development of Girls Invest, an mobile health application (mHealth app) designed to increase financial literacy and economic self- sufficiency, demonstrated to be feasible and acceptable in both countries. We have created Jenga Dada (“women’s empowerment” in Kiswahili), by integrating ARCHES components related to RC and IPV within the Girls Invest mHealth intervention, and adapting this to be delivered within the VSLA structure for adolescent and young women in Kenya. This integrated approach enables community-level social support for adolescents as they move towards economic self-sufficiency, reproductive autonomy, and violence-free relationships. The aims of the current proposal are 1) to refine and pilot Jenga Dada among adolescent girls (ages 15-24 years) participating in VSLA groups in the Kibera community of Nairobi, Kenya; and 2) to evaluate the effects of Jenga Dada on intermediate reproductive health, GBV, and economic outcomes via cluster randomized controlled trial (RCT) with random assignment of 12 existing VSLA groups to receive either Jenga Dada or standard VSLA programming. Baseline and 6-month follow-up survey data will be collected (N=144 participants). We will also collect and analyze process data and post-program qualitative data among participants and implementers. Findings will inform a future full-scale evaluation of Jenga Dada on long-term outcomes (e.g., IPV, unintended pregnancy, economic self-sufficiency).