‘Even peacekeepers expect something in return’: A qualitative analysis of sexual interactions between UN peacekeepers and female Haitians

'At the end of their relationship, that man offered her a house': Qualitatively exploring Congolese women's agency in navigating sexual relations with UN peacekeepers within the context of a patriarchal setting in eastern DRC

The UN's Zero Tolerance Policy, which bans all relationships between UN staff and locals, portrays all relationships as exploitative, fails to account for nuances in these relationships and does not acknowledge the agency of local women or communities. This study uses community-based qualitative data from eastern DRC that shares narratives on a wide variety of consensual relationships between peacekeepers and local women. Our paper uses a data-driven approach, including a post-colonial feminist lens, and ideas of structural agency to provide an expanded definition of agency that invites readers to re-examine their views of women in conflict settings. Finally, we provide clear recommendations for the UN and other international non-governmental agencies on policies related to sexual exploitation and abuse.

Promoting condom negotiation self-efficacy among young women in China: the effects of traditional sexual values and descriptive norms

This study attempts to design effective messages to promote condom negotiation self-efficacy and safer sex intent among young women in China. An online experiment with 2 (descriptive norm: present versus absent) × 2 (traditional sexual value: high versus low) between-subjects factorial design was conducted on a purposive sample of 241 female Chinese college students. The results demonstrated that culturally tailored messages incorporating descriptive norms information on the popularity of condom negotiation can increase participants' self-efficacy (F(1,237) = 9.01, partial η2 = 0.04, P = 0.003) but not safer sex intent (F(1,237) = 2.80, partial η2 = 0.01, P = 0.096). Participants with a lower level of traditional sexual values had similar levels of condom negotiation self-efficacy as those with a higher level of values: F(1,237) = 2.85, partial η2 = 0.01, P = 0.09. There were no significant interaction effects of traditional sexual value and descriptive norm on condom negotiation self-efficacy and safer sex intent. The findings contribute to the cultural sensitivity perspective in health education in an Eastern context and have implications for public health practitioners and policymakers.

"It's because We are 'Loose Girls' That's why We had Children with MINUSTAH Soldiers": A Qualitative Analysis of Stigma Experienced by Peacekeeper-Fathered Children and Their Mothers in Haiti

Sexual abuse and exploitation (SEA) perpetrated by UN peacekeepers while on mission is a violation of human rights and undermines the goal of upholding human rights in countries that host peacekeeping missions. In addition to survivors, children fathered by peacekeepers are also victims of SEA that need protection. Stigma poses negative life course consequences for SEA survivors and their peacekeeper-fathered children. However, there is a considerable lack of empirical research concerning the stigma experiences of SEA survivors and their children in post-colonial contexts. The present study addresses this knowledge gap by drawing on The United Nations Stabilization Mission in Haiti as a case study to examine the lived experiences of stigma among SEA survivors and their resultant children. Using 18 qualitative semi-structured interviews conducted in 2017 with Haitian women raising peacekeeper-fathered children, we organized qualitative codes according to Link and Phelan's conceptual model of stigma. The stigmatization process was explored through the themes of labeling, stereotyping, separation, and status loss and discrimination, as described by Link and Phelan. In addition, we nuanced the lived experiences of stigma by discussing the buffering roles of familial acceptance, skin phenotype, and the Haitian context. The findings have implications for the UN. We advocate that stigma be recognized and acted upon as a fundamental protection concern for SEA survivors and their children. Accordingly, the UN has an obligation to provide stigma-related supports for victims and complainants as well as to facilitate long-term child support for the children left behind by peacekeepers.

Development of an Index to Measure the Exposure Level of UN Peacekeeper-Perpetrated Sexual Exploitation/Abuse in Women/Girls in the Democratic Republic of Congo

Sexual exploitation and abuse (SEA) of women and girls by United Nations (UN) peacekeepers is an international concern. However, the typical binary measurement of SEA (indicating that it occurred, or it did not) disregards varying exposure levels and the complex circumstances surrounding the interaction. To address this gap, we constructed an index to quantify the degree to which local women and girls were exposed to UN-peacekeeper perpetrated SEA. Using survey data (n = 2867) from the Democratic Republic of Congo (DRC), eight indicators were identified using a combination of qualitative (thematic analysis of narrative data) and quantitative variables. With further development, this index may offer a more comprehensive and nuanced perspective of peacekeeper-perpetrated SEA that can better inform SEA prevention and intervention efforts.

Cholera in the Time of MINUSTAH: Experiences of Community Members Affected by Cholera in Haiti

In 2010, Haiti experienced one of the deadliest cholera outbreaks of the 21st century. United Nations (UN) peacekeepers are widely believed to have introduced cholera, and the UN has formally apologized to Haitians and accepted responsibility. The current analysis examines how Haitian community members experienced the epidemic and documents their attitudes around accountability. Using SenseMaker, Haitian research assistants collected micronarratives surrounding 10 UN bases in Haiti. Seventy-seven cholera-focused micronarratives were selected for a qualitative thematic analysis. The five following major themes were identified: (1) Cholera cases and deaths; (2) Accessing care and services; (3) Protests and riots against the UN; (4) Compensation; and (5) Anti-colonialism. Findings highlight fear, frustration, anger, and the devastating impact that cholera had on families and communities, which was sometimes compounded by an inability to access life-saving medical care. Most participants believed that the UN should compensate cholera victims through direct financial assistance but there was significant misinformation about the UN’s response. In conclusion, Haiti’s cholera victims and their families deserve transparent communication and appropriate remedies from the UN. To rebuild trust in the UN and foreign aid, adequate remedies must be provided in consultation with victims.

Gender-based violence and infectious disease in humanitarian settings: lessons learned from Ebola, Zika, and COVID-19 to inform syndemic policy making

BACKGROUND

The impacts of infectious disease outbreaks, epidemics, and pandemics are not gender neutral. Instead, infectious diseases and gender-based violence (GBV) mutually reinforce each other. Women and girls in humanitarian settings are disproportionately impacted as crises exacerbate gender inequality, violence, and community transmission. A syndemic model of infectious disease and GBV draws attention to their critical linkage, enabling more effective approaches to address both infectious disease transmission and GBV prevalence.

MAIN BODY

Implementation of infectious disease control measures have been consistently absent of critical gender considerations in humanitarian settings. We drew learnings from Ebola, Zika, and COVID-19 to highlight how women and girls living in humanitarian settings have faced bi-directional syndemic vulnerabilities between GBV and infectious disease. Our findings indicate that Ebola, Zika, and COVID-19 exacerbated GBV risk and experience of GBV increased community transmission of these infectious diseases. Moreover, we identified a failure of existing policies to address this mutually deleterious linkage. Thus, we advocate for policymakers to ask three foundational questions: (i) What are the gendered bi-directional risk pathways between infectious disease and GBV?; (ii) How can we act on the gendered risk pathways?; and, (iii) Who should be involved in designing, implementing, and evaluating gender-sensitive policies?

CONCLUSION

Our syndemic policy framework challenges existing thinking on a neglected issue that disproportionally impacts women and girls. By offering foundational guidance to address and thwart the syndemic of infectious disease and GBV in humanitarian settings, we endeavor to proactively and holistically address the reinforcing linkage between GBV and current or emergent infectious diseases.

"It was with my consent since he was providing me with money": a mixed methods study of adolescent perspectives on peacekeeper-perpetrated sexual exploitation and abuse in the Democratic Republic of Congo

Background

The United Nations Organization Stabilization Mission in the Democratic Republic of Congo (MONUSCO) has been marred by widespread allegations of sexual exploitation and abuse (SEA) of women and girls by UN peacekeepers. There is minimal research conducted on the perceptions of communities most affected by the SEA themselves, and even less about those below the age of 18.

Methods

Using mixed-methods data, we examined the perceptions of adolescents aged 13–17 on how the lives of women and girls have been affected by the presence of UN peacekeepers within the DRC. SenseMaker, a mixed-methods narrative capture tool, was used to survey participants around six United Nations bases across eastern DRC. Each participant shared a story about the experiences of Congolese women and girls in relation to MONUSCO personnel and interpreted their own stories by answering a series of questions. Patterns of adolescent perspectives (aged 13–17) were analyzed in comparison to all other age groups and emerging qualitative themes were mapped onto quantitative variables.

Results

Quantitative data showed that adolescents were more likely, in comparison to all other age groups, to perceive interactions between peacekeepers and women/girls as being initiated by the woman/girl, that the MONUSCO personnel was perceived to be able to offer protection, and that the interactions between local women/girls and peacekeepers were sexual in nature. Three qualitative themes emerged: poverty bringing peacekeepers and women/girls together, material/financial gain through transactional sex and sex work, and support-seeking actions of affected women/girls.

Conclusions

Our mixed methods data illustrate the problematic finding that adolescents facing poverty may perceive SEA as protective through the monetary and material support gained. These findings contribute to the growing body of literature on peacekeeping economies and have implications for the prevention of, and response to, peacekeeper-perpetrated SEA.

Participant and narrative characteristics associated with host community members sharing experiences of peacekeeper-perpetrated sexual exploitation and abuse in the Democratic Republic of Congo

Introduction

Peacekeeper-perpetrated sexual exploitation and abuse (SEA) in the Democratic Republic of Congo (DRC) account for 36% of the global reports of formal SEA allegations to the UN between 2007 and 2021. However, formally reported SEA represents only a fraction of that which occurs, and community experiences of peacekeeper-perpetrated SEA are likely different than those reflected in official UN documents.

Methods

Using mixed-methods, cross-sectional data collected in the DRC in 2018, we used descriptive analysis and multivariate Poisson regression with robust error estimates to examine the participant and narrative characteristics associated with sharing an experience about peacekeeper-perpetrated SEA.

Results

Participants in Bukavu (adjusted relative risk (aRR) 0.85, 95% CI 0.79 to 0.91) and Kalemie (aRR 0.75, 95% CI 0.69 to 0.81) were less likely to share narratives about sexual interactions, while civilian UN personnel (aRR 1.16, 95% CI 1.00 to 1.34) were slightly more likely to be implicated in narratives about sexual interactions. Narratives in which the outcome was deemed fair to the woman/girl were more likely to be about sexual interactions (aRR 1.07, 95% CI 1.02 to 1.12). Both the regression analysis and the participants’ interpretation of the shared narratives illustrated the significant role poverty played in SEA, suggesting that the outcomes of sexual interactions may have been deemed fair since affected women/girls were perceived to have benefited financially/materially.

Conclusion

There is significant variation between host communities in the likelihood of sharing narratives about SEA, which could prove useful for informing more targeted SEA prevention initiatives. Narratives about sexual interactions with UN personnel were more often deemed to have fair outcomes for the affected women/girls, likely related to ongoing poverty in host communities and perceived financial/material gain. These findings highlight how extreme poverty may impact perceptions around informed consent as well as fairness and require further study. Perceptions around fair outcomes would disincentivise formal reporting, which needs to be considered when devising community-based complaint networks.

"When It's a Girl, They Have a Chance to Have Sex With Them. When It's a Boy…They Have Been Known to Rape Them": Perceptions of United Nations Peacekeeper-Perpetrated Sexual Exploitation and Abuse Against Women/Girls Versus Men/Boys in Haiti

Peacekeeping missions have been marred by reports of sexual exploitation and abuse (SEA) against local community members. However, there is limited research on how SEA against women/girls versus men/boys is perceived in peacekeeping host societies. In 2017 we collected micro-narratives in Haiti and then conducted a thematic analysis to understand how peacekeeper-perpetrated SEA was perceived by local community members comparing SEA against women/girls versus SEA against men/boys. Both male and female participants used language which suggested the normalization, in Haitian society, of both transactional sex with and rape of women/girls by UN personnel. In contrast, peacekeeper-perpetrated SEA against men/boys was viewed as unacceptable and was associated with homosexuality and related stigmatization. Overall, our results suggest that in Haiti, inequitable gender norms, the commodification of female sexuality, and homophobia result in SEA against males being recognized as a wrong that elicits outrage, while SEA against women/girls has been normalized. It is important to address the normalization of SEA against women/girls to prevent future violence and to recognize that SEA is also perpetrated against men/boys. Survivor-centered programs, sensitive to the needs of both male and female survivors, are required.

The Distribution and Consequences of Sexual Misconduct Perpetrated by Peacekeepers in Haiti: An Exploratory Cross-Sectional Analysis

During the United Nations Stabilization Mission in Haiti (MINUSTAH), reports of sexual abuse and exploitation and children fathered by peacekeepers were brought forward to the UN. In 2017, a cross-sectional mixed-methods survey was administered by Haitian research assistants using SenseMaker® (Cognitive Edge, Singapore), a rapid data collection tool that allows participants to share a narrative on a topic of interest. In total, 2541 self-interpreted narratives in relation to the experiences of Haitian women and girls vis-à-vis peacekeepers were collected from a convenience sample of Haitian males and females across Haiti. This exploratory secondary data analysis analyzes whether narratives about sexual misconduct perpetrated by MINUSTAH peacekeepers were associated with rural, semi-urban, or urban locations and investigates the relationship between sharing narratives about sexual misconduct and the desire to engage with the UN/MINUSTAH. After adjustment, narratives addressing sexual misconduct were more likely to be shared in rural locations, compared to urban locations (RRrural: 1.19; 95% CI: 1.03, 1.38). Personal experiences of sexual misconduct were more likely (RRsex: 4.52; 95% CI: 3.34, 6.12) to be associated with rejection of the UN/MINUSTAH, compared to personal narratives of positive/neutral experiences. This research is an empirical steppingstone to understanding the distribution and consequences of peacekeeper-perpetrated sexual abuse and exploitation in Haiti.

Gender-Stratified Analysis of Haitian Perceptions Related to Sexual Abuse and Exploitation Perpetrated by UN Peacekeepers during MINUSTAH

Feminist scholarship has analyzed the gendered dynamics of national- and international-level risk factors for peacekeeper-perpetrated sexual exploitation and abuse (SEA); however, the gendered dynamics within the host country have not been adequately considered. Using the United Nations Stabilization Mission in Haiti (MINUSTAH) as a case study, this research analyzes gender differences within community-level perceptions of SEA. Using SenseMaker® as a data collection tool, cross-sectional qualitative and quantitative data were collected by Haitian research assistants over an 8-week period in 2017. Participants first shared a narrative in relation to MINUSTAH and then self-interpreted their narratives by noting their perceptions, attitudes, and beliefs on a variety of questions. The self-coded perceptions were analyzed quantitatively to determine patterns, and this was complemented with a qualitative analysis of the narratives. Women/girls were more likely to perceive the sexual interactions as “relationships” compared to Haitian men/boys. Furthermore, women/girls were more likely to perceive the peacekeeper as “supportive”, whereas men/boys conceptualized the peacekeeper as “authoritative”. SEA-related policies/programs, such as the UN Trust Fund in Support for Victims of SEA, should engage with local Haitian actors and consider such nuanced and gendered perceptions to maximize community trust and program efficacy.

The contested global politics of pleasure and danger: Sexuality, gender, health and human rights

This special issue of Global Public Health brings together papers examining how sexuality, gender, health and human rights have become increasing visible and highly contested within global health. The papers included here question and explore the often contradictory processes through which global equity-seeking populations negotiate pleasure and danger across multiple arenas (including HIV and AIDS, LGBTQ+ health and rights, intersex rights, sex worker rights, realities of refugee and displaced persons, and gender-based violence) and in diverse geographic contexts (Afghanistan, Bangladesh, Canada, Ghana, Haiti, Kenya, Mauritania, Nigeria, Peru, Rwanda, and the USA). These papers examine emerging questions about the gaps and limits in current legal structures that do not legitimize sexual rights as fundamental human rights, the role of agency (and of bounded agency) needed to navigate constrained contexts, ways in which community-based solidarity efforts shape access to sexual rights, and how sexual pleasure and consent are experienced and negotiated in rights-constrained contexts. The interdisciplinary authors included in this collection showcase how the ranging definitions of sexual rights, their enactment, and expressions of pleasure and danger are inextricably entangled with local contexts and cultural systems that underpin not only people's lived experience but simultaneously become central topics for global health research, policy and practice.

'They came with cholera when they were tired of killing us with bullets': Community perceptions of the 2010 origin of Haiti's cholera epidemic

In 2010 following a catastrophic earthquake, Haiti saw the beginning of what would become the world's largest cholera epidemic. Nepalese United Nations peacekeepers were later implicated as the source of cholera. Our research examines Haitian community beliefs and perceptions, six-and-a-half years after the outbreak began, regarding the origin of Haiti's cholera outbreak. A narrative capture tool was used to record micronarratives of Haitian participants surrounding ten United Nations bases across Haiti. Seventy-seven micronarratives focused on cholera were selected for qualitative analysis from a larger dataset. Three themes emerged: who introduced cholera to Haiti, how cholera was introduced to Haiti, and preventative measures against cholera. With varying levels of confidence, the origins of the epidemic were conceptualised as directly resulting from the actions of the United Nations and Nepalese peacekeepers, exhibiting a distrust of foreign intervention in Haiti and frustration with inadequate water and sanitation infrastructure that facilitated widespread transmission of cholera. This study reinforces the need for additional transparent communication from the UN to address ongoing misconceptions surrounding the cholera outbreak, action to clean water and sanitation practices in Haiti, and for the voices of Haitian citizens to be heard and included in reforming foreign aid delivery in the country.

"If I was with my father such discrimination wouldn't exist, I could be happy like other people": a qualitative analysis of stigma among peacekeeper fathered children in the Democratic Republic of Congo

Background

The United Nations (UN) Organization Stabilization Mission in the Democratic Republic of Congo (MONUSCO) comprises the largest and longest serving peacekeeping operation to date. Since the launch of the mission in 1999, sexual relations between UN peacekeepers and the local population regularly occur; some resulting in children being conceived. Reports have indicated that women and girls bearing children from such relations face difficult socio-economic realities. The present study is the first to explore the situation of peacekeeper fathered children (PKFC) through a qualitative analysis that includes interview material from mothers and child participants.

Methods

The article uses theories from stigma research to illustrate how children conceived through sexual relations with UN peacekeepers integrate into social networks. We conducted a case study of mothers and their PKFC at different sites of UN peacekeeping (UNPK) in eastern Democratic Republic of Congo (DRC). Based on 95 in-depth interviews held in 2018, a thematic qualitative analysis examined experiences of stigma and discrimination. In order to understand the challenges of mothers and children from a transgenerational perspective, we evaluated perceptions of rejection rooted in the mother-child relationship.

Results

Of the mothers and children surveyed, a large majority struggled with stigmatizing behaviour by family and/or community members. PKFC perceived their discrimination to be based upon their mixed ethnicity, fatherlessness, illegitimacy at birth, as well as a lack of resources and opportunity. Mothers most often attributed their stigma to economic deprivation, extra-marital sexual relations, single parenting and being associated with UNPK. Parallels in the experiences of mothers and children suggest a bi-directional transmission of status loss and stigma between generations.

Conclusions

This is the first empirical study to compare the situation of PKFC and their mothers in any country of UNPK deployment. The findings highlight multiple burdens that affect their daily lives and illustrate an interplay between drivers of stigmatization for mothers and children. The overarching needs identified are financial, and these call for action regarding policies and programmes that provide resources to those concerned. The results further demonstrate the need for psychosocial support that considers transgenerational dynamics and both mothers and children as core addressees of assistance.

Hurricane impact associated with transactional sex and moderated, but not mediated, by economic factors in Okay, Haiti

Natural disasters, such as hurricanes, often negatively affect the economic wellbeing of affected individuals. Under such conditions, women may engage in transactional sexual behaviors in order to compensate for lost income and provide for their households. In this study, we evaluated the relationship between hurricane impact and transactional sex and if this relationship was moderated, or mediated, through economic factors. Between December 2017 and February 2018, approximately one year after the area was hit by a category 4 hurricane (Hurricane Matthew), we interviewed a random sample of female microfinance members (n = 304) in Okay, Haiti. We estimated the association between hurricane impact and transactional sex using log-binomial regression. Next, we tested for economic moderation of this relationship by incorporating interaction terms between hurricane impact and food insecurity, poverty, and loss of income generating materials in three separate log-binomial models. Finally, we assessed possible mediation of this relationship by loss of income generating resources and a latent variable, economic stress, using a structural equation model. We found participants who had experienced hurricane impact were 58% more likely to have engaged in transactional sex [prevalence ratio (95% confidence interval): 1.58 (1.19-2.09)]. This relationship was significant and strongly positive among women who were food insecure and had high poverty but not so among women who were food secure and had low poverty, respectively. The final structural equation model (with fit: χ2 = 19.700, degrees of freedom = 15; CFI = 0.958; TLI = 0.941; RMSEA = 0.040) revealed that the relationship was not mediated through economic factors. However, the association between hurricane impact and transactional sex remained significant while controlling for these economic factors. Notably, the findings that the relationship between hurricane impact and transactional sex was moderated, but not mediated, by economic factors implies populations at-risk of experiencing natural disasters should be preemptively targeted with economic interventions to build capacity and resilience before such a disaster hits.