In the last decade, scholars and humanitarians have rightly drawn attention to the high rates of gender-based violence in the eastern Democratic Republic of Congo (DRC), which are associated with the high levels of conflict in the country since 1996. However, this focus detracts from the general health problems that stem from the deterioration of the health sector, which began long before the outbreak of war. This article analyses local perceptions of the determinants of maternal health and illness in eastern DRC, and identifies ways in which women cope with barriers to health care that derive from an inadequate and/or absent health-care system. The article demonstrates that in both urban and rural locations in all four provinces of eastern DRC, women have organised to address their own vulnerabilities, which, according to them, amount to more than exposure to gender-based violence. The existence of these informal systems demonstrates the need to reassess the image of Congolese women as primarily passive victims and/or targets of violence. The article suggests that these culturally rooted indigenous solutions be evaluated as worthy recipients of development funding, which is often exclusively offered to international organisations.[« Vous dites viol, je dis hôpitaux. Mais qui parle le plus fort ? » : La santé, l'aide et la prise de décision dans la République Démocratique du Congo]. Durant la dernière décennie, les érudits et les humanitaires ont correctement attiré l'attention sur les taux élevés de violence sur la seule base du genre dans l'est de la République Démocratique du Congo (RDC), qui sont en lien avec les hauts niveaux de conflit dans le pays depuis 1996. Pourtant, cette attention sur les violences sexuelles détourne l'attention qui devrait être portée aux problèmes sanitaires généraux qui sont dus à la détérioration du secteur de la santé, qui a commencé longtemps avant l'émergence de la guerre. Cet article examine les perceptions locales des déterminants de la santé maternelle et de la maladie dans l'est de la RDC et identifie les manières avec lesquelles les femmes s'adaptent aux difficultés d'accès aux soins de santé qui résultent d'un système de santé publique insuffisant et/ou absent. L'article montre que dans les zones tant urbaines que rurales et dans les quatre provinces de l'est de la RDC, les femmes se sont organisées pour faire face à leurs propres vulnérabilités, qui, selon elles, représentent un problème plus important que l'exposition à la violence fondée sur le genre. L'existence de ces systèmes informels démontre le besoin de reconsidérer l'image des femmes congolaises comme étant en premier lieu des victimes passives et/ou des objets de violences. L'article suggère que ces solutions culturellement enracinées dans le modèle local pourraient être évaluées

Prenatal maternal stress has a negative impact on child health but the mechanisms through which maternal stress affects child health are unclear. Epigenetic variation, such as DNA methylation, is a likely mechanistic candidate as DNA methylation is sensitive to environmental insults and can regulate long-term changes in gene expression. We recruited 155 mother-newborn dyads in the Democratic Republic of Congo to investigate the effects of maternal stress on DNA methylation in mothers and newborns. We used four measures of maternal stress to capture a range of stressful experiences: general trauma, sexual trauma, war trauma, and chronic stress. We identified differentially methylated positions (DMPs) associated with general trauma, sexual trauma, and war trauma in both mothers and newborns. No DMPs were associated with chronic stress. Sexual trauma was positively associated with epigenetic age acceleration across several epigenetic clocks in mothers. General trauma and war trauma were positively associated with newborn epigenetic age acceleration using the extrinsic epigenetic age clock. We tested the top DMPs for enrichment of DNase I hypersensitive sites (DHS) and found no enrichment in mothers. In newborns, top DMPs associated with war trauma were enriched for DHS in embryonic and foetal cell types. Finally, one of the top DMPs associated with war trauma in newborns also predicted birthweight, completing the cycle from maternal stress to DNA methylation to newborn health outcome. Our results indicate that maternal stress is associated with site-specific changes in DNAm and epigenetic age acceleration in both mothers and newborns.

Background and objectives The Developmental Origins of Health and Disease (DOHaD) hypothesis posits that early life adversity is associated with poor adult health outcomes. Epidemiological evidence has supported this framework by linking low birthweight with adult health and mortality, but the mechanisms remain unclear. Accelerated epigenetic aging may be a pathway to connect early life experiences with adult health outcomes, based on associations of accelerated epigenetic aging with increased morbidity and mortality. Methodology Sixty-seven mother-infant dyads were recruited in the eastern Democratic Republic of Congo. Birthweight data were collected at birth, and blood samples were collected at birth and follow-up visits up to age three. DNA methylation data were generated with the Illumina MethylationEPIC array and used to estimate epigenetic age. A multilevel model was used to test for associations between birthweight and epigenetic age acceleration. Results Chronological age was highly correlated with epigenetic age from birth to age three (r = 0.95, p < 2.2 x 10 -16). Variation in epigenetic age acceleration increased over time. Birthweight, dichotomized around 2500 grams, predicted epigenetic age acceleration over the first three years of life (b = -0.39, p = 0.005). Conclusions and implications Our longitudinal analysis provides the first evidence for accelerated epigenetic aging that emerges between birth and age three and associates with low birthweight. These results suggest that early life experiences, such as low birthweight, may shape the trajectory of epigenetic aging in early childhood. Furthermore, accelerated epigenetic aging may be a pathway that links low birthweight and poor adult health outcomes.

This study aims to understand men and masculinities in the eastern Democratic Republic of Congo where violence, armed conflicts, and the inability of the state to meet the basic needs of its population have justified the presence of heavy humanitarian aid interventions and probably shaped men’s behaviors. Through this study, I seek to place men first in their local socio-cultural context in order to analyze their behavior and the roles men are called to play within their community. I put my particular attention on the global health agenda and guidelines interrogating how they materialize at the local level, taking the example of the push to increase so-called men’s involvement in prenatal care service. The following questions helped me to explore issues regarding masculinities in Goma and Kanyarutshinya. Who do we call a man? How does one become or un-become a man in the context of Goma and Kanyarutshinya, two specific locations where I conducted my research. Using ethnographic participant observation, I also collected my data using in-depth interviews, key informant interviews, focus group discussion, life histories, and archival data. My analysis of the data collected has shown that war and armed conflict have deteriorated the status of men in the region and consequently, they felt deprived of their masculinity. Men living in a rural setting were attached to the local traditional values defining masculinity and these motivated their behaviors. In urban areas, on the contrary, men were more exposed to intercultural practices and had easy access to media and modern communication channels and were less concerned with local values of masculinities. Everywhere, the precariousness of masculinity was observed; men, despite their efforts to avoid losing their masculinity used the so-called well-known concept of 'debrouillez-vous', failed despite everything. Finally, I found that the call for ‘men’s involvement’ regarding pregnancy and childbirth in Goma and Kanyarutshinya using the international guidelines was almost irrelevant because men were already involved using the local standards. However, the biomedical prenatal care for men in Goma called CPN Papa failed to meet men’s expectations and rejected them, thereby undermining the program’s goals.