Abstract
The Democratic Republic of the Congo (DRC) has experienced nearly two decades of civil conflict in the Eastern regions of North and South Kivu. This conflict has been notorious for the use of sexual violence as a weapon of war, leading in many cases to pregnancy after rape. The objectives of this analysis were: 1) to describe patterns of sexual violence-related pregnancy (SVRP) disclosure; 2) to consider why survivors chose to disclose to particular individuals; and 3) to examine the dialogue around SVRPs between women with SVRPs and their confidants. In South Kivu Province, Democratic Republic of Congo, two sub-groups of sexual violence survivors completed qualitative interviews, those currently raising a child from an SVRP (parenting group, N = 38) and those who had terminated an SVRP (termination group, N = 17). The findings show that a majority of SVRPs were conceived when participants were held in sexual captivity for prolonged periods of time. The SVRPs were disclosed to friends, family members, other sexual violence survivors, community members, spouses, health care providers, or perpetrators. The confidants were most often chosen because they were perceived by the participants as being discreet, trusted, and supportive. The confidants often provided advice about continuing or terminating the SVRP. Trust and discretion are the most important factors determining to whom women with SVRPs disclose their pregnancies. The vital role of confidants in giving support after disclosure cannot be overlooked. Providing opportunities for survivors to safely disclose their SVRPs, including to health care providers, is a necessary first step in allowing them to access safe and comprehensive post-assault care and services.
Highlights
The nature of these sexual assaults increases the risk of unintended pregnancies and up to 17% of sexual violence survivors in eastern Democratic Republic of Congo (DRC) are estimated to have a resultant sexual violencerelated pregnancy (SVRP).[4]
To help address the existing knowledge gap, this paper presents qualitative data from a larger mixed methods study that examined outcomes of SVRPs in South Kivu Province, DRC. [26, 29, 30] The objectives of this analysis were: 1) to describe patterns of SVRP disclosure; 2) to consider why survivors chose to disclose to particular individuals; and 3) to examine the dialogue around SVRPs between women with SVRPs and their confidants
Qualitative questionnaires designed for each study group were comprised of semi-structured questions on pregnancy history, sexual violence and experiences related to the SVRP, disclosure of the SVRP, and decision-making process regarding continuing or terminating the SVRP [S1–S4 Files.] The guiding questions included examples of probes to be used by interviewers as follow up to specific questions
Summary
Sexual violence has been prevalent during two decades of armed conflict in eastern Democratic Republic of Congo (DRC). [1] Sexual violence in eastern DRC is frequently characterized by multiple perpetrators and repeated assaults on victims while being held in captivity.[2,3] The nature of these sexual assaults increases the risk of unintended pregnancies and up to 17% of sexual violence survivors in eastern DRC are estimated to have a resultant sexual violencerelated pregnancy (SVRP).[4]. Stigma may prevent survivors from disclosing that the pregnancy was conceived from sexual violence and influence who is informed of the pregnancy, resulting in delayed disclosure and/or failure to seek pregnancy-related care, and may influence women’s decisions to continue or to terminate the pregnancy [16]. Termination of pregnancy in DRC is highly restricted, permissible only to save the life of a woman,[17,18] and access to skilled providers for termination services is limited [19], which may further impact disclosure of SVRPs, especially among survivors considering pregnancy termination
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