Desire for contraception and birth spacing among women with fistula is significant. Basic group contraception counseling and access are feasible and lead to increased contraceptive knowledge and use.

BackgroundThe epidemic of gender-based violence in the Democratic Republic of the Congo (DRC) has garnered popular media attention, but is incompletely described in the medical literature to date. In particular, the relative importance of militarized compared to civilian rape and the impact on vulnerable populations merits further study. We describe a retrospective case series of sexual abuse among children and youth in eastern DRC.MethodsMedical records of patients treated for sexual assault at HEAL Africa Hospital, Goma, DRC between 2006 and 2008 were reviewed. Information extracted from the chart record was summarized using descriptive statistics, with comparative statistics to examine differences between pediatric (≤18 yrs) and adult patients.Findings440 pediatric and 54 adult sexual abuse cases were identified. Children and youth were more often assaulted by someone known to the family (74% vs 30%, OR 6.7 [95%CI 3.6–12], p<0.001), and less frequently by military personnel (13% vs 48%, OR 0.14 [95%CI 0.075–0.26], p<0.001). Delayed presentation for medical care (>72 hours after the assault) was more common in pediatric patients (53% vs 33%, OR 2.2 [95%CI 1.2–4.0], p = 0.007). Physical signs of sexual abuse, including lesions of the posterior fourchette, hymeneal tears, and anal lesions, were more commonly observed in children and youth (84% vs 69%, OR 2.3 [95%CI 1.3–4.4], p = 0.006). Nine (2.9%) pediatrics patients were HIV-positive at presentation, compared to 5.3% of adults (p = 0.34).InterpretationWorld media attention has focused on violent rape as a weapon of war in the DRC. Our data highlight some neglected but important and distinct aspects of the ongoing epidemic of sexual violence: sexual abuse of children and youth.

Contraceptive knowledge among female camp residents was moderate, actual usage was low, and a considerable proportion reported a history of induced abortion. Efforts must be made to improve access to contraception to prevent unintended pregnancy, and to provide safe abortions and postabortion care.

In the eastern DRC, efforts to enable transport to a healthcare facility and to encourage attended births must be accompanied by improvements in the capacity of existing facilities and in the training of staff to enable the timely diagnosis of labor abnormalities and appropriate intervention.

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