Conflict and Health 2016 DOI 10.1186/s13031-016-0097-2

Sexual violence-related pregnancies in eastern Congo Kinshasa: a qualitative analysis of access to pregnancy termination services

Burkhardt G, Scott J, Onyango MA, Rouhani S, Haider S, Greiner A, Albutt K, VanRooyen M and Bartels S

Abstract

Background: Sexual violence has been prevalent throughout the armed conflict in eastern Congo Kinshasa (RC). Research on sexual violence-related pregnancies (SVRPs) and pregnancy termination in eastern DRC, a context with high prevalence of sexual violence, high maternal mortality, and restrictive abortion laws, is scant but crucial to improving the overall health of women in the RC. Understanding women's perceptions and experiences related to an SVRP, and in particular to pregnancy termination in this context, is critical for developing effective, targeted programming.

Method: Respondent-driven sampling (RDS) was used to recruit two subgroups of women reporting SVRPs, 1) women raising a child from an SVRP (parenting group) and 2) women who had terminated an SVRP (termination group), in Bukavu, RC in 2012. Semi-structured qualitative interviews on pregnancy history and outcomes were conducted with a systematically selected sub-group of women recruited through RDS methodology. Interview responses were translated, transcribed and uploaded to the qualitative data analysis software Dedoose. Thematic content analysis, complemented by the constant comparative technique from grounded theory, was subsequently used as the analytic approach for data analysis.

Results: Fifty-five qualitative interviews (38 parenting group and 17 termination group) were completed. The majority of women in the termination group reported using traditional herbs to terminate the SVRP, which they often obtained on their own or through family, friends and traditional healers; whereas women in the parenting group reported ongoing pregnancies after attempting pregnancy termination with herbal medications. Three women in the termination group reported accessing services in a health center. Almost half of the women in the parenting group cited fear of death from termination as a reason for continuing the pregnancy. Other women in the parenting group contemplated pregnancy termination, but did not know where to access services. Potential legal ramifications and religious beliefs also influenced access to services.

Conclusion: Women in this study had limited access to evidence-based safe abortion care and faced potential consequences from unsafe abortion, including increased morbidity and mortality. Increased access to reproductive health services, particularly safe, evidence-based abortion services, is paramount for women with SVRPs in eastern RC and other conflict-affected regions.

Comment: This paper from Congo Kinshasa shows that in conflict-affected regions it is not only important to do everything to stop the violence, but also that, in the meantime, one must make sure that health services are available. And while service for the wounded is usually high on the agenda of the fighting parties, especially reproductive health services are crucial for women. (HMV)