ABSTRACT Intimate partner violence (IPV) during the perinatal period is a pervasive and devastating public health epidemic. IPV also intersects with structural and institutional violence, particularly for Black, Latine, low income, and sexual and gender diverse (SGD) people, who report experiencing systems-level violence during the perinatal period. Healthcare settings offer a unique opportunity to support perinatal IPV survivors and connect them with community-based resources, as they come for regularly scheduled prenatal and postpartum visits. Universal empowerment is a promising healthcare-based IPV intervention, where IPV related education and resources are provided to all perinatal patients, avoiding some of the challenges of the traditional screen and refer approach. Universal empowerment has been tested and shown to be effective and feasible in other settings such as family planning clinics and school-based health centers, but has not been rigorously evaluated during prenatal visits. Universal empowerment may be further optimized by doula-based support for IPV survivors, as doulas have been shown to improve other health outcomes (e.g., preterm birth, access to perinatal visits) although less is known about their effect on reducing IPV. Doulas may be particularly effective in buffering perinatal people from discrimination and bias experienced in healthcare and social services systems, which is critical for IPV survivors with marginalized or multiply marginalized identities who experience both IPV and structural violence. In response to RFA-NR-23-004, the objective of this application is to conduct a 2-arm type 1 hybrid trial with 250 perinatal people (125 per group) to test the effectiveness of an enhanced universal empowerment intervention delivered during 28–32 week prenatal visits (Thrive) compared with universal empowerment plus pairing with an IPV-trained doula (Doula Thrive). In Aim 1, we will assess the effectiveness of both Thrive and Doula Thrive in reducing IPV (primary outcome; defined as a range of coercive and controlling behaviors), as well as perinatal cannabis use, tobacco use, and depression (secondary outcomes). We hypothesize that while both interventions will reduce IPV, we will find a greater effect for Doula Thrive. In Aim 2, we will conduct mediation and moderation analyses to test mechanisms through which the intervention is effective and to elucidate survivor profiles moderating intervention effectiveness. Through interviews, surveys, and tracking data, in Aim 3 we will collect data on implementation factors aligned with the PRISM framework. We have convened a community-academic team with expertise in IPV, perinatal disparities, doula care, community-partnered research, clinical trial design and analysis, and implementation science; IPV survivors will be core partners in this work. Results will inform the design of a future implementation trial to test further implementation, dissemination, and sustainability. This ...