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Amar Wiem B, Hela S, Jihen J, Hatem K, Narjes K, Malek Z, ElKoury Houcine L, Samir M, Zouhir H. Sexual violence against women in southern Tunisia: Epidemiology and risk factors. Leg Med (Tokyo) 2023; 64:102272. [PMID: 37247464 DOI: 10.1016/j.legalmed.2023.102272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/26/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Sexual violence (SV) against women represents a public health problem. Despite, the promulgation of the new Act of 2017-58, SV remains frequent in Tunisia. In this paper, we propose to determine the socio-demographic characteristics of women victims of SV and to identify risk factors related to serious SV. MATERIAL AND METHODS This is a retrospective, descriptive and analytical study including all women victims of SV, examined at the Forensic Department of Sfax Hospital, between 1st March 2018 and February 29th, 2020. We defined serious SV as any sexual violence associated with genital or anal lesions. RESULTS We collected 269 cases of women victims of SV. This sexual violence was associated with extra-genital physical violence in 18.86 % of the cases. The average age of the victims was 21.23 years (+/-10.67 years). The consultation delay was relatively long. Only 11.52 % of victims consulted within 24 h. It was mainly an extra-family abuse. Vaginal examination revealed recent defloration in 9.29 % of the cases. The proctological examination was normal in most cases (61.63 %).Seven victims were pregnant. In the analytical study, we studied the risk factors of serious SV against women. A total of 150 cases were considered serious (55.8 %). Serious SV was statistically related to the age (over 18),the profession (housewives),the origin (urban),and the relationship with the aggressor (friend, neighbor, or family member).The risk of serious SV was greater when the victim didn't have any traumatic extra-genital injury. CONCLUSION Sexual violence is a serious problem worldwide and in Tunisia. The Tunisian legislation repressing SV has been strengthened by the promulgation of the 2017-58 Act. However, much effort remains to be deployed to fight against this form of violence.
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Affiliation(s)
- Ben Amar Wiem
- Forensic Department of Habib Bourguiba Hospital, Tunisia; Faculty of Medicine of Sfax, University of Sfax, Tunisia.
| | - Siala Hela
- Forensic Department of Habib Bourguiba Hospital, Tunisia; Faculty of Medicine of Sfax, University of Sfax, Tunisia.
| | - Jedidi Jihen
- Faculty of Medicine of Sfax, University of Sfax, Tunisia; Preventive and Community Medicine Department of Hedi Chaker Hospital, Tunisia.
| | - Kallel Hatem
- Intensive Care Unit, Cayenne General Hospital, French Guiana, France; Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, French Guiana, France
| | - Karray Narjes
- Forensic Department of Habib Bourguiba Hospital, Tunisia; Faculty of Medicine of Sfax, University of Sfax, Tunisia.
| | - Zribi Malek
- Forensic Department of Habib Bourguiba Hospital, Tunisia; Faculty of Medicine of Sfax, University of Sfax, Tunisia.
| | - Lebkem ElKoury Houcine
- Forensic Department of Habib Bourguiba Hospital, Tunisia; Faculty of Medicine of Sfax, University of Sfax, Tunisia.
| | - Maatoug Samir
- Forensic Department of Habib Bourguiba Hospital, Tunisia; Faculty of Medicine of Sfax, University of Sfax, Tunisia.
| | - Hammami Zouhir
- Forensic Department of Habib Bourguiba Hospital, Tunisia; Faculty of Medicine of Sfax, University of Sfax, Tunisia.
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Rouhani SA, Scott J, Burkhardt G, Onyango MA, Haider S, Greiner A, Albutt K, VanRooyen M, Bartels SA. A quantitative assessment of termination of sexual violence-related pregnancies in eastern Democratic Republic of Congo. Confl Health 2016; 10:9. [PMID: 27053946 PMCID: PMC4822240 DOI: 10.1186/s13031-016-0073-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/19/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sexual violence is prevalent in eastern Democratic Republic of Congo (DRC), and has resulted in sexual violence-related pregnancies (SVRPs). Despite restrictive laws, women may seek to terminate SVRPs; however, there are limited data on termination of SVRPs. METHODS A mixed methods study was conducted in 2012 in Bukavu, DRC. Adult women who self-reported an SVRP and termination of that SVRP were recruited using respondent-driven sampling (RDS). Trained female interviewers verbally administered a quantitative survey to all participants and a semi-structured qualitative survey to a subset. Quantitative data on characteristics and complications of pregnancy termination, including mental health outcomes, were analyzed using SAS. RESULTS In total, 86 women completed quantitative surveys. Most SVRPs (93 %) involved two or more assailants; 73 % occurred while in captivity. Most women (82 %) terminated the SVRPs at 3 months gestation or earlier; 79 % reported one attempt at pregnancy termination and 21 % more than one attempt. The most common methods of termination were an oral medicine (55 %) or herb (35 %); cimpokolo (31 %) and quinine (18 %) were most frequently reported. These methods were accessed through friends (37 %), healthcare providers (18 %), family (16 %), or self-obtained (12 %). Following the termination, 79 % of women reported subsequent physical symptoms, including abdominal pain (74 %), bleeding (47 %), vaginal discharge (35 %) and fever (18 %); 44 % sought medical care for their symptoms. Varied emotional responses to the termination were reported and included relief (34 %), anxiety (21 %), anger (19 %), guilt (19 %), and regret (10 %). At the time of the study, many women met symptom criteria for post-traumatic stress disorder (57 %), depression (50 %), and generalized anxiety disorder (33 %). CONCLUSION Most women terminated SVRPs using medications or herbs not recognized as evidence-based methods of pregnancy termination and sought these methods outside of the formal healthcare sector. These data suggest that access to safe abortion methods is needed for women with SVRPs in DRC. Physical symptoms and emotional reactions related to the termination varied. While it is not possible to differentiate the impacts of sexual violence, SVRP, and pregnancy termination on mental health outcomes, the findings highlight the complex needs of women with SVRPs and opportunities for integrative health services.
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Affiliation(s)
- Shada A. Rouhani
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA USA
- />Harvard Medical School, Boston, MA USA
| | - Jennifer Scott
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Harvard Medical School, Boston, MA USA
- />Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA USA
- />Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA USA
| | - Gillian Burkhardt
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA USA
| | - Monica A. Onyango
- />Department of Global Health, Boston University School of Public Health, Boston, MA USA
| | - Sadia Haider
- />Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, USA
| | - Ashley Greiner
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Harvard Medical School, Boston, MA USA
- />Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Katherine Albutt
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Harvard Medical School, Boston, MA USA
- />Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Michael VanRooyen
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA USA
- />Harvard Medical School, Boston, MA USA
- />Harvard School of Public Health, Boston, MA USA
| | - Susan A. Bartels
- />Harvard Humanitarian Initiative, Cambridge, MA USA
- />Harvard Medical School, Boston, MA USA
- />Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
- />Department of Emergency Medicine, Queen’s University, Kingston, Canada
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