Abstract
BackgroundSexual 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.MethodsA 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.ResultsA 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.ConclusionFindings 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.
Highlights
Sexual violence is prevalent in conflict-affected settings and may result in sexual violence-related pregnancies (SVRPs)
The qualitative findings from this study reveal complex decision-making processes related to SVRPs and highlight a myriad of factors that influenced decision-making among a sample of women with SVRPs in conflict-affected eastern Democratic Republic of the Congo (DRC)
Women considered the circumstances of sexual violence and the biologic, ethnic and social identities of the fetus and/or future child in relation to the perpetrator when making decisions related to SVRPs
Summary
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. There is increasing focus on addressing the unmet needs of women with SVRPs and children born from SVRPs, [1, 4, 5]; there are limited data on how to support women during their pregnancies, especially as they make important decisions about whether to continue or to terminate SVRPs. Numerous factors influence decision-making regarding pregnancy continuation and pregnancy termination. Numerous factors influence decision-making regarding pregnancy continuation and pregnancy termination Women consider their own needs, the potential child, existing children, their partner and other significant relations, and financial matters when making decisions about pregnancy termination [6]. Women contemplate pregnancy termination when the possibility of continuing the pregnancy is perceived to have adverse effects on their lives or on the lives of significant others [10]
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