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

Male and Female Perceptions and Experiences of Sexual and Gender-based Violence in South Kivu, Eastern DRC

Conflict settings are often the context of some of the highest rates of sexual and gender-based violence (SGBV). Although women are disproportionately the victims of SGBV, they are not the only victims. Indirect impacts of SGBV also impact men, families, and communities. Examining SGBV as only a woman's concern reinforces the hegemonic gender-binary view that SGBV somehow does not include men, who can be direct victims of SGBV, family members of female victims of SGBV, and/or perpetrators of SGBV. This qualitative study seeks to fill a gap by exploring the impact of SGBV on individuals, families, and communities, and potential options to ameliorate those issues. Data were collected in 2019 from community-based discussions in South Kivu, Democratic Republic of Congo. Women described being direct victims of SGBV, as well as the burden of being at constant alert to the possible threat of violence. Men talked more about SGBV being perpetrated against women, and the indirect effect on men's perception of their social husband and/or father role to protect and provide for their family. Taken together, women and men describe three types of violence: sexual violence by an unknown assailant who is often associated the rebel groups or the military; sexual violence from a known assailant within one's community; and sexual or physical violence within intimate partnerships (i.e., intimate partner violence). Women focused more on community-based solutions to reduce their exposure to violence, while men discussed the government's responsibility to end the long-standing conflict that has severely disrupted lives. Practically, these findings support the need to specify different types of SGBV, and the opportunity to tailor interventions by type.

Measuring sexual violence stigma in humanitarian contexts: assessment of scale psychometric properties and validity with female sexual violence survivors from Somalia and Syria

BACKGROUND

Valid measures of sexual violence stigma that can be readily incorporated into program monitoring and evaluation systems are needed to strengthen gender-based violence (GBV) services in humanitarian emergencies. This study sought to assess the psychometric properties, construct validity, and measurement invariance of sexual violence stigma scales among female Somali GBV survivors in Kenya and Syrian GBV survivors in Jordan to identify an abbreviated scale that could be used across humanitarian contexts.

METHODS

We administered measures of sexual violence stigma to 209 female survivors of sexual violence aged 15 and older in Kenya and Jordan. Exploratory factor analysis was used to assess the underlying latent structure, and Item Response Theory was used to estimate item difficulty and discrimination parameters to guide efforts to shorten the scales. Differential item functioning (DIF) by site was assessed using Multiple Indicators, Multiple Causes models. Construct validity of the sexual violence stigma scales was assessed by estimating correlations with functional impairment, depression, and disability.

RESULTS

The sexual violence stigma measure exhibited distinct factor structures among Somali and Syrian GBV survivors. Among Somali survivors, a two-factor model with separate felt (10 items) and enacted (4 items) stigma constructs was identified, with scales for both domains exhibiting good internal consistency (Cronbach's alpha = 0.93 and 0.88, respectively). In Jordan, a single factor solution was uncovered for a 15-item stigma scale with good internal consistency (alpha = 0.86). The shortened core sexual stigma scale consisting of the 4 items that did not exhibit DIF had a Cronbach's alpha of 0.82 in Kenya and 0.81 in Jordan. The felt stigma scale in Kenya, the full stigma scale in Jordan, and abbreviated core stigma scales in both countries were meaningfully correlated with depression, while correlations with functional impairment were weaker and inconsistent across scales.

CONCLUSIONS

An abbreviated core set of invariant perceived and internalized sexual violence stigma items demonstrated evidence of construct validity in two diverse settings. The ability of this measure to be efficiently administered as a part of routine program monitoring and evaluation activities, with the potential addition of items from a measurement bank to improve contextual relevance, can facilitate improvements in the delivery and quality of gender-based violence programs in humanitarian emergencies.

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

INTRODUCTION

Eastern Congo has been affected by armed conflict for decades while the rampant use of sexual violence has left many women and girls dealing with a wide range of consequences of sexual violence. For adolescent victims the psychosocial impact of sexual violence is devastating. However, the role of avoidant/disengagement coping and family support on the mental health impact of sexual violence remains unclear.

METHODS

The study design was a cross-sectional, population-based survey in which 1,305 school-going adolescent girls aged 11 to 23 participated. Mental health symptoms (IES-R and HSCL-37A), family support (MSPSS), avoidant/disengagement (Kidcope), war-related traumatic events (ACEES), experiences of sexual violence, daily stressors, and stigmatization (ACEDSS) were administered through self-report measures. Hierarchical multiple regression analysis was carried out with mental health outcomes as dependent variables for different types of sexual violence. Finally, several ANCOVA models were defined to explore possible interaction effects of avoidant/disengagement coping and family support with stigmatization, daily stressors and war-related traumatic exposure.

RESULTS

For girls who did not report sexual violence, avoidant/disengagement coping has a direct negative effect on all psychological symptoms. For victims of sexual violence, when high levels of stigma were reported, avoidant/disengagement coping possibly served as a protective factor, as shown by the interaction effect between avoidance/disengagement coping and stigmatization on mental health outcomes. In victims of sexual violence however, high levels of daily stressors combined with avoidant/disengagement strategies showed a strong increase in posttraumatic stress symptoms. Interestingly, the mental health impact of sexual violence was not mitigated by support by family members. For girls who reported a nonconsensual sexual experience without labelling it as rape and at the same time testified to have a lot of family support, there was a positive association between stressors (daily stressors, stigma, and war-related trauma) and posttraumatic stress symptoms.

CONCLUSIONS

These results of this study underwrite to the importance of looking beyond the straightforward negative impact of avoidant/disengagement coping strategies on mental health in adolescent victims of sexual violence. While avoidant/disengagement coping can have a negative impact on psychosocial well-being on adolescent victims of sexual violence, in case of high levels of stigmatization it can as well protect them from posttraumatic stress or anxiety. Furthermore these findings speak to the importance of exploring the diversified relationship between risk and protective factors, such as avoidant/disengagement coping strategies and family support, that shape the mental health impact of sexual violence in adolescent victims.

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

The worst rates of preventable mortality and morbidity among women and children occur in humanitarian settings. Reliable, easy-to-use, standardized, and efficient tools for data collection are needed to enable different organizations to plan and act in the most effective way. In 2015, the World Health Organization (WHO) commissioned a review of tools for data collection on the health of women and children in humanitarian emergencies. An update of this review was conducted to investigate whether the recommendations made were taken forward and to identify newly developed tools. Fifty-three studies and 5 new tools were identified. Only 1 study used 1 of the tools identified in our search. Little has been done in terms of the previous recommendations. Authors may not be aware of the availability of such tools and of the importance of documenting their data using the same methods as other researchers. Currently used tools may not be suitable for use in humanitarian settings or may not include the domains of the authors' interests. The development of standardized instruments should be done with all key workers in the area and could be coordinated by the WHO.

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

Mothers with children born of sexual violence often have complex needs that are seldom adequately addressed in social care settings. The authors' objective was to investigate the current care provisions for these mothers and children, and how these might be enhanced in the future. Twenty-one experts were asked about their current approaches and difficulties in treating this population and to suggest recommendations for improving care. The same group was asked to comment on the relevance and feasibility of implementing suggested options. The authors suggest that a holistic and community embedded approach that can be applied across settings will be most beneficial.

A qualitative analysis of decision-making among women with sexual violence-related pregnancies in conflict-affected eastern Democratic Republic of the Congo

BACKGROUND

Sexual violence is prevalent in conflict-affected settings and may result in sexual violence-related pregnancies (SVRPs). There are limited data on how women with SVRPs make decisions about pregnancy continuation or termination, especially in contexts with limited or restricted access to comprehensive reproductive health services.

METHODS

A qualitative study was conducted in Bukavu, Democratic Republic of the Congo (DRC) as part of a larger mixed methods study in 2012. Utilizing respondent-driven sampling (RDS), adult women who self-reported sexual violence and a resultant SVRP were enrolled into two study subgroups: 1) women currently raising a child from an SVRP (parenting group) and 2) women who terminated an SVRP (termination group). Trained female research assistants conducted semi-structured interviews with a subset of women in a private setting and responses were manually recorded. Interview notes were translated and uploaded to a qualitative software program, coded, and thematic content analysis was conducted.

RESULTS

A total of 55 women were interviewed: 38 in the parenting group and 17 in the termination group. There were a myriad of expressed attitudes, beliefs, and emotional responses toward SVRPs and the termination of SVRPs with three predominant influences on decision-making, including: 1) the biologic, ethnic, and social identities of the fetus and/or future child; 2) social reactions, including fear of social stigmatization and/or rejection; and 3) the power of religious beliefs and moral considerations on women's autonomy in the decision-making process.

CONCLUSION

Findings from women who continued and women who terminated SVRPs reveal the complexities of decision-making related to SVRPs, including the emotional reasoning and responses, and the social, moral, and religious dimensions of the decision-making processes. It is important to consider these multi-faceted influences on decision-making for women with SVRPs in conflict-affected settings in order to improve provision of health services and to offer useful insights for subsequent programmatic and policy decisions.