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International Journal of Mental Health Systems
Published in: International Journal of Mental Health Systems 1/2017

Open Access 01-12-2017 | Research

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

Authors: Jennifer Scott, Colleen Mullen, Shada Rouhani, Philipp Kuwert, Ashley Greiner, Katherine Albutt, Gillian Burkhardt, Monica Onyango, Michael VanRooyen, Susan Bartels

Published in: International Journal of Mental Health Systems | Issue 1/2017

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Abstract

Background

Sexual 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.

Methods

A 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.

Results

In 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.

Conclusions

The 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.
Literature
1.
Linden JA. Clinical practice. Care of the adult patient after sexual assault. NEng J Med. 2011;365(9):834–41.CrossRef
2.
Watts C, Hossain M, Zimmerman C. War and sexual violence–mental health care for survivors. NEng J Med. 2013;368(23):2152–4.CrossRef
3.
Johnson K, Scott J, Rughita B, Kisielewski M, Asher J, Ong R, et al. Association of sexual violence and human rights violations with physical and mental health in territories of the Eastern Democratic Republic of the Congo. JAMA. 2010;304(5):553–62.CrossRefPubMed
4.
Bartels SA, Scott JA, Leaning J, Kelly JT, Joyce NR, Mukwege D, et al. Psychosocial consequences of sexual violence in South Kivu Province, Democratic Republic of Congo. J Res Peace Gender Dev Studies. 2011;1(2):48–52.
5.
Bartels S, Scott J, Leaning J, Mukwege D, Lipton R, VanRooyen M. Surviving sexual violence in eastern Democratic Republic of Congo. J Int Women’s Studies. 2010;11(4):37–49.
6.
Kelly JT, Betancourt TS, Mukwege D, Lipton R, Vanrooyen MJ. Experiences of female survivors of sexual violence in eastern Democratic Republic of the Congo: a mixed-methods study. Conflict Health. 2011;5:25.CrossRefPubMedPubMedCentral
7.
Kelly J, Kabanga J, Cragin W, Alcayna-Stevens L, Haider S, Vanrooyen MJ. ‘If your husband doesn’t humiliate you, other people won’t’: gendered attitudes towards sexual violence in eastern Democratic Republic of Congo. Global Public Health. 2012;7(3):285–98.CrossRefPubMed
8.
Kelly J, Kabanga J, Albutt K, Maclin B, Im S, Kissenkoetter M, et al. A patient heart: stigma, acceptance and rejection around conflict-related sexual violence in the Democratic Republic of Congo. Cambridge: Harvard Humanitarian Initiative; 2011.
9.
Liebling H, Slegh H. Bearing children through rape in Eastern Congo: community and state responses. Coventry: Coventry University; 2012.
10.
Steiner B, Benner MT, Sondorp E, Schmitz KP, Mesmer U, Rosenberger S. Sexual violence in the protracted conflict of DRC programming for rape survivors in South Kivu. Conflict Health. 2009;3:3.CrossRefPubMedPubMedCentral
11.
Dossa NI, Zunzunegui MV, Hatem M, Fraser WD. Mental health disorders among women victims of conflict-related sexual violence in the Democratic Republic of Congo. J Interpers Violence. 2015;30(13):2199–220.CrossRefPubMed
12.
Bass JK, Annan J, McIvor Murray S, Kaysen D, Griffiths S, Cetinoglu T, et al. Controlled trial of psychotherapy for Congolese survivors of sexual violence. NEng J Med. 2013;368(23):2182–91.CrossRef
13.
Albutt K, Kelly J, Kabanga J, VanRooyen M. Stigmatisation and rejection of survivors of sexual violence in eastern Democratic Republic of the Congo. Disasters. 2017;41(2):211–27.CrossRefPubMed
14.
Verelst A, De Schryver M, Broekaert E, Derluyn I. Mental health of victims of sexual violence in eastern Congo: associations with daily stressors, stigma, and labeling. BMC Women’s Health. 2014;14:106.CrossRefPubMedPubMedCentral
15.
Verelst A, De Schryver M, De Haene L, Broekaert E, Derluyn I. The mediating role of stigmatization in the mental health of adolescent victims of sexual violence in Eastern Congo. Child Abuse Neglect. 2014;38:1139–46.CrossRefPubMed
16.
Abrahams N, Jewkes R, Mathews S. Depressive symptoms after a sexual assault among women: understanding victim-perpetrator relationships and the role of social perceptions. Afr J Psychiatry. 2013;16(4):288–93.
17.
Littleton HL. The impact of social support and negative disclosure reactions on sexual assault victims: a cross-sectional and longitudinal investigation. J Trauma Dissociation. 2010;11(2):210–27.CrossRefPubMed
18.
19.
Deitz MF, Williams SL, Rife SC, Cantrell P. Examining cultural, social, and self-related aspects of stigma in relation to sexual assault and trauma symptoms. Violence Against Women. 2015;21(5):598–615.CrossRefPubMed
20.
Verelst A, De Schryver M, De Haene L, Broekaert E, Derluyn I. The mediating role of stigmatization in the mental health of adolescent victims of sexual violence in Eastern Congo. Child Abuse Negl. 2014;38(7):1139–46.CrossRefPubMed
21.
Quinn DM, Williams MK, Quintana F, Gaskins JL, Overstreet NM, Pishori A, et al. Examining effects of anticipated stigma, centrality, salience, internalization, and outness on psychological distress for people with concealable stigmatized identities. PLoS ONE. 2014;9(5):e96977.CrossRefPubMedPubMedCentral
22.
Kohrt BA, Rasmussen A, Kaiser BN, Haroz EE, Maharjan SM, Mutamba BB, et al. Cultural concepts of distress and psychiatric disorders: literature review and research recommendations for global mental health epidemiology. Int J Epidemiol. 2014;43(2):365–406.CrossRefPubMed
23.
Kohrt BA, Jordans MJ, Tol WA, Luitel NP, Maharjan SM, Upadhaya N. Validation of cross-cultural child mental health and psychosocial research instruments: adapting the depression self-rating scale and child PTSD symptom scale in Nepal. BMC Psychiatry. 2011;11(1):127.CrossRefPubMedPubMedCentral
24.
Tol WA, Stavrou V, Greene MC, Mergenthaler C, van Ommeren M, Garcia Moreno C. Sexual and gender-based violence in areas of armed conflict: a systematic review of mental health and psychosocial support interventions. Conflict Health. 2013;7(1):16.CrossRefPubMedPubMedCentral
25.
Dossa NI, Hatem M. Cognitive-behavioral therapy versus other PTSD psychotherapies as treatment for women victims of war-related violence: a systematic review. Sci World J. 2012;2012:181847.CrossRef
26.
Hall BJ, Bolton PA, Annan J, Kaysen D, Robinette K, Cetinoglu T, et al. The effect of cognitive therapy on structural social capital: results from a randomized controlled trial among sexual violence survivors in the Democratic Republic of the Congo. Am J Public Health. 2014;104(9):1680–6.CrossRefPubMedPubMedCentral
27.
Kalonda JC. Sexual violence in Congo–Kinshasa: necessity of decriminalizing abortion. Rev Med Brux. 2012;33(5):482–6.PubMed
28.
Carpenter RC. Born of war: protecting children of sexual violence survivors in conflict zones. United States: Kumarian Press, Inc.; 2007.
29.
Greiner AL, Albutt K, Rouhani SA, Scott J, Dombrowski K, VanRooyen MJ, et al. Respondent-driven sampling to assess outcomes of sexual violence: a methodological assessment. Am J Epidemiol. 2014;180(5):536–44.CrossRefPubMed
30.
Scott J, Rouhani S, Greiner A, Albutt K, Kuwert P, Hacker MR, et al. Respondent-driven sampling to assess mental health outcomes, stigma and acceptance among women raising children born from sexual violence-related pregnancies in eastern Democratic Republic of Congo. BMJ Open. 2015;5(4):e007057.CrossRefPubMedPubMedCentral
31.
Rouhani SA, Scott J, Burkhardt G, Onyango MA, Haider S, Greiner A, et al. A quantitative assessment of termination of sexual violence-related pregnancies in eastern Democratic Republic of Congo. Conflict Health. 2016;10:9.CrossRefPubMedPubMedCentral
32.
Burkhardt G, Scott J, Onyango MA, Rouhani S, Haider S, Greiner A, et al. Sexual violence-related pregnancies in eastern Democratic Republic of Congo: a qualitative analysis of access to pregnancy termination services. Conflict Health. 2016;10:30.CrossRefPubMedPubMedCentral
33.
Heckathorn D. Respondent-driven sampling: a new approach to the study of hidden populations. Social Problems. 1997;44(2):174–99.CrossRef
34.
Ellsberg M, Heise L. Researching violence against women: a practical guide for researchers and activists. Geneva: World Health Organization and program for appropriate technology in health (PATH); 2005.
35.
Priest H, Roberts P, Woods L. An overview of three different approaches to the interpretation of qualitative data. Part 1: theoretical issues. Nurse Res. 2002;10(1):30–42.CrossRefPubMed
36.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRefPubMed
37.
Miles MB, Huberman M, Saidana J. Quaitative data analysis: a methods sourcebook. 3rd ed. Thousand Oaks: Sage Pub; 2013.
38.
Rouhani SA, Scott J, Greiner A, Albutt K, Hacker MR, Kuwert P, et al. Stigma and parenting children conceived from sexual violence. Pediatrics. 2015;136(5):e1195–203.CrossRefPubMedPubMedCentral
39.
Perry R, Murphy M, Haider S, Harwood B. “One Problem Became Another”: disclosure of rape-related pregnancy in the abortion care setting. Women’s Health Issues. 2015;25(5):470–5.CrossRefPubMed
40.
Ba I, Bhopal RS. Physical, mental and social consequences in civilians who have experienced war-related sexual violence: a systematic review (1981–2014). Public Health. 2017;142:121–35.CrossRefPubMed
41.
Ullman SE, Filipas HH, Townsend SM, Starzynski LL. Psychosocial correlates of PTSD symptom severity in sexual assault survivors. J Trauma Stress. 2007;20(5):821–31.CrossRefPubMed
42.
Rieder H, Elbert T. Rwanda—lasting imprints of a genocide: trauma, mental health and psychosocial conditions in survivors, former prisoners and their children. Conflict Health. 2013;7(1):6.CrossRefPubMedPubMedCentral
43.
Babalola SO. Dimensions and correlates of negative attitudes toward female survivors of sexual violence in Eastern DRC. J Interpers Violence. 2014;29(9):1679–97.CrossRefPubMed
44.
Wright EM, Pinchevsky GM, Benson ML, Radatz DL. Intimate partner violence and subsequent depression: examining the roles of neighborhood supportive mechanisms. Am J Commun Psychol. 2015;56(3–4):342–56. doi:10.​1007/​s10464-015-9753-8.CrossRef
45.
Cleeve A, Faxelid E, Nalwadda G, Klingberg-Allvin M. Abortion as agentive action: reproductive agency among young women seeking post-abortion care in Uganda. Cult Health Sex. 2017;19(11):1–15.CrossRef
46.
Miller KE, Rasmussen A. War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Soc Sci Med. 2010;70(1):7–16.CrossRefPubMed
47.
Bolton D, Hill J, O’Ryan D, Udwin O, Boyle S, Yule W. Long-term effects of psychological trauma on psychosocial functioning. J Child Psychol Psychiatry. 2004;45(5):1007–14.CrossRefPubMed
48.
Reifels L, Pietrantoni L, Prati G, Kim Y, Kilpatrick DG, Dyb G, et al. Lessons learned about psychosocial responses to disaster and mass trauma: an international perspective. Eur J Psychotraumatol. 2013;4:22897.CrossRef
49.
50.
Kohli A, Makambo MT, Ramazani P, Zahiga I, Mbika B, Safari O, et al. A Congolese community-based health program for survivors of sexual violence. Conflict Health. 2012;6(1):6.CrossRefPubMedPubMedCentral
51.
Njogu K, Orchardson-Mazrui D. Gender inequality and women’s rights in the Great Lakes: can culture contribute to women’s empowerment. New York: UNICEF; 2013.
52.
Arieff A. Sexual violence in African conflicts. Human Rights Watch: Human Rights Watch World Report; 2015.
53.
McCleary-Sills J, Namy S, Nyoni J, Rweyemamu D, Salvatory A, Steven E. Stigma, shame and women’s limited agency in help-seeking for intimate partner violence. Global Public Health. 2015;11(1–12):224–35.PubMed
54.
Simmons CA, Lindsey L, Delaney MJ, Whalley A, Beck JG. Real-world barriers to assessing and treating mental health problems with IPV survivors: a qualitative study. J Interpers Violence. 2015;30(12):2067–86.CrossRefPubMed
55.
Chapleau KM, Oswald DL. A system justification view of sexual violence: legitimizing gender inequality and reduced moral outrage are connected to greater rape myth acceptance. J Trauma Dissociation. 2014;15(2):204–18.CrossRefPubMed
56.
Abeid M, Muganyizi P, Massawe S, Mpembeni R, Darj E, Axemo P. Knowledge and attitude towards rape and child sexual abuse–a community-based cross-sectional study in rural Tanzania. BMC Public Health. 2015;15:428.CrossRefPubMedPubMedCentral
57.
Tedeschi R, Calhoun L. Posttraumatic growth: conceptual foundations and empirical evidence. Psychol Inq. 2004;15(1):1–8.CrossRef
58.
Badri A, Crutzen R, Eltayeb S, Van den Borne H. Promoting Darfuri women’s psychosocial health: developing a war trauma counsellor training programme tailored to the person. PMA J. 2013;4(1):10.
59.
Iacoviello BM, Charney DS. Psychosocial facets of resilience: implications for preventing posttrauma psychopathology, treating trauma survivors, and enhancing community resilience. Eur J Psychotraumatol. 2014;5:23970.CrossRef
Metadata
Title
A qualitative analysis of psychosocial outcomes among women with sexual violence-related pregnancies in eastern Democratic Republic of Congo
Authors
Jennifer Scott
Colleen Mullen
Shada Rouhani
Philipp Kuwert
Ashley Greiner
Katherine Albutt
Gillian Burkhardt
Monica Onyango
Michael VanRooyen
Susan Bartels
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal of Mental Health Systems / Issue 1/2017
Electronic ISSN: 1752-4458
DOI
https://doi.org/10.1186/s13033-017-0171-1

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