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Scott J, Mullen C, Rouhani S, Kuwert P, Greiner A, Albutt K, Burkhardt G, Onyango M, VanRooyen M, Bartels S. A qualitative analysis of psychosocial outcomes among women with sexual violence-related pregnancies in eastern Democratic Republic of Congo. Int J Ment Health Syst 2017; 11:64. [PMID: 29075319 PMCID: PMC5648419 DOI: 10.1186/s13033-017-0171-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 09/30/2017] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Jennifer Scott
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 3rd Floor, Boston, MA 02215 USA
- Division of Women’s Health, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Colleen Mullen
- Department of Psychiatry, One Boston Medical Center Place, Boston Medical Center, Boston, MA 02118 USA
- Department of Psychiatric Emergency Services for Cambridge/Somerville, Boston Medical Center, Boston, MA USA
| | - Shada Rouhani
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Philipp Kuwert
- Department of Psychiatry and Psychotherapy, and HELIOS-Hansehospital Stralsund, University of Greifswald, Greifswald, Germany
| | - Ashley Greiner
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
| | - Katherine Albutt
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Gillian Burkhardt
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Boston, MA 02115 USA
- Department of Obstetrics and Gynecology, University of New Mexico, MSC 10 5582, Albuquerque, NM 87131 USA
| | - Monica Onyango
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd floor, Boston, MA 02118 USA
| | - Michael VanRooyen
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Susan Bartels
- Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA 02138 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 190 Pilgrim Road, Boston, MA 02215 USA
- Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
- Department of Emergency Medicine, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
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