A qualitative analysis of psychosocial outcomes among women with sexual violence-related pregnancies in eastern Democratic Republic of Congo

Abstract

BackgroundSexual violence is prevalent in eastern Democratic Republic of Congo (DRC) and has potentially devastating psychosocial consequences. Previous studies have reported on sexual violence and its impact on the mental health of survivors, but there are few studies conducted among women with sexual violence-related pregnancies (SVRPs). Women with SVRPs may be at greater risk of complex psychosocial outcomes, including social stigmatization. This study aimed to describe psychosocial outcomes among this subgroup of sexual violence survivors in order to inform future interventions.MethodsA mixed methods study was conducted in Bukavu, DRC in 2012 among adult women who self-reported an SVRP and either (1) were currently raising a child from an SVRP (parenting group) or (2) had terminated an SVRP (termination group). This manuscript presents qualitative findings from the mixed methods study. Participants were recruited using respondent-driven sampling and a proportion engaged in semi-structured qualitative interviews conducted by trained female interviewers. Thematic content analysis was conducted and key themes were identified.ResultsIn total, 55 women were interviewed, of whom 38 were in the parenting group and 17 in the termination group. Women with SVRPs experienced a myriad of emotional responses as they navigated their social environments following the SVRPs. Negative reactions, including social stigmatization and/or social rejection, toward women with SVRPs and toward children born from SVRPs were important influences on psychological well-being. Women expressed both internalized emotionality intertwined with externalized experiences in the social environment. Many women demonstrated resilience, or what could be termed post-traumatic growth, identifying avenues of agency to advance the social conditions for women.ConclusionsThe findings from the qualitative study, and in particular, the respondents’ needs and suggested strategies, may be useful to inform future research, programs, and policies for women with SVRPs in eastern DRC. Future research could move beyond cross-sectional assessments to utilize innovative research methodologies to assess processes of psychological adaptation among women with SVRPs. Multi-dimensional psychosocial programs for women with SVRPs should consider basic needs such as shelter, food, and health care within the broader framework of trauma-informed care. Participatory programming, guided by beneficiaries, could provide further avenues for agency to advance social conditions for women with SVRPs in eastern DRC.

Mothers with children born of sexual violence: Perceptions of global experts regarding support in social care settings

“…Overall, experts rated difficulties with relationships as the overriding concern for this population; including with family, a husband or spouse, with children or with the wider community. This finding reflects current literature for these mother-child dyads (Dossa, Hatem, Zunzunegui, & Fraser, 2014), including feelings of isolation and fewer possibilities for integration (Scott et al, 2017). Despite a large proportion of high income countries represented in this study, several experts currently work in conflict settings or low and middle income countries (LAMIC) -or have done in the past -and report the unavailability of adequate support in these areas as similarly problematic.…”

“…They can be feared as links to armed combatants, and accused of infidelity and acting shamefully within their culture (Albutt, Kelly, Kabanga, & VanRooyen, 2016). They can also be at risk of self-induced or enforced isolation (Scott et al, 2017).…”

“…In a reciprocal process, mothers may become fearful with the reminder of their traumatic experience when looking at their child, but when displaying symptoms relating to posttraumatic stress disorder or depression they may become frightening themselves (Van Ee, Kleber, & Mooren, 2012). In addition, mothers may become emotionally dysregulated following their own trauma, and thus unable to provide optimal care to their children (Scott et al, 2017;Van Ee & Kleber, 2013). As a result, outcomes for mother-child dyads often include attachment difficulties; parental symptoms of PTSD are directly related to children's insecure and disorganised attachment styles (van Ee, Kleber, Jongmans, Mooren, & Out, 2016).…”

Data Collection Tools for Maternal and Child Health in Humanitarian Emergencies: An Updated Systematic Review

“…Operative indication, procedure performed, perioperative death, injury, disease, surgery performed, epidemiology, and impact of injuries in children No description of specific tools used Miscellaneous 4,10,11,16,18,19,[36][37][38]44,48,[50][51][52][53][54][55][56][57][58][59][60][61] Immunization coverage for diphtheria, pertussis, tetanus, measles, hepatitis B, neonatal tetanus protection, skilled attendant at delivery, child mental health symptoms, infant mortality, child mortality, access to health services, psychosocial situation, appropriate treatment setting for mental health care, posttraumatic stress symptoms, abuse and resilience, and receipt of essential public health services Surveys were conducted using standardized monitoring and assessment of relief and transitions (SMART) methodology; United Nations Children's Fund's (UNICEF) Multiple Indicator Cluster Survey 4 (MICS4) questionnaire were adapted for assessment ANC = antenatal care; TT = tetanus toxoid.…”

The Impact of Avoidant/Disengagement Coping and Social Support on the Mental Health of Adolescent Victims of Sexual Violence in Eastern Congo

“…Risk factors of other war-related traumatic events, daily stressors, and (widely reported) negative social reactions have been identified as contributing to mental health outcomes of sexual violence in war settings (20,22,23). Recent studies point in particular to how the various ways victims of sexual violence are stigmatized, rejected, and excluded has a detrimental effect on their mental health (20,21,(24)(25)(26).…”