A quantitative assessment of termination of sexual violence-related pregnancies in eastern Democratic Republic of Congo

Abstract

BackgroundSexual violence is prevalent in eastern Democratic Republic of Congo (DRC), and has resulted in sexual violence-related pregnancies (SVRPs). Despite restrictive laws, women may seek to terminate SVRPs; however, there are limited data on termination of SVRPs.MethodsA mixed methods study was conducted in 2012 in Bukavu, DRC. Adult women who self-reported an SVRP and termination of that SVRP were recruited using respondent-driven sampling (RDS). Trained female interviewers verbally administered a quantitative survey to all participants and a semi-structured qualitative survey to a subset. Quantitative data on characteristics and complications of pregnancy termination, including mental health outcomes, were analyzed using SAS.ResultsIn total, 86 women completed quantitative surveys. Most SVRPs (93 %) involved two or more assailants; 73 % occurred while in captivity. Most women (82 %) terminated the SVRPs at 3 months gestation or earlier; 79 % reported one attempt at pregnancy termination and 21 % more than one attempt. The most common methods of termination were an oral medicine (55 %) or herb (35 %); cimpokolo (31 %) and quinine (18 %) were most frequently reported. These methods were accessed through friends (37 %), healthcare providers (18 %), family (16 %), or self-obtained (12 %). Following the termination, 79 % of women reported subsequent physical symptoms, including abdominal pain (74 %), bleeding (47 %), vaginal discharge (35 %) and fever (18 %); 44 % sought medical care for their symptoms. Varied emotional responses to the termination were reported and included relief (34 %), anxiety (21 %), anger (19 %), guilt (19 %), and regret (10 %). At the time of the study, many women met symptom criteria for post-traumatic stress disorder (57 %), depression (50 %), and generalized anxiety disorder (33 %).ConclusionMost women terminated SVRPs using medications or herbs not recognized as evidence-based methods of pregnancy termination and sought these methods outside of the formal healthcare sector. These data suggest that access to safe abortion methods is needed for women with SVRPs in DRC. Physical symptoms and emotional reactions related to the termination varied. While it is not possible to differentiate the impacts of sexual violence, SVRP, and pregnancy termination on mental health outcomes, the findings highlight the complex needs of women with SVRPs and opportunities for integrative health services.

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

“…The majority of women in this study who terminated the pregnancy used non-evidence based methods, most commonly a traditional herb known as Cimpokolo , known by the scientific name Phytolacca dodecandra L’Hérit [27, 28]. The qualitative finding reflect the data from the larger quantitative RDS sample, in which 31 % (26/86) of women cited Cimpokolo as the most common oral medication or herb used to induce abortion [22]. There is minimal evidence on the mechanism or efficacy of this traditional herb, although other herbal and plant-based abortifacients have been described in the literature [29].…”

“…A total of 852 participants (764 in the parenting group, 83 in the termination group, and 3 who met criteria for both study groups) completed quantitative interviews. Quantitative data from the parenting and the termination group have been published elsewhere [20–22]. …”

Grossesses non planifiées et avortements à Kinshasa (République Démocratique du Congo) : Défis et progrès

“…La recherche antérieure a montré que les Congolaises peuvent tenter de provoquer un avortement selon les méthodes traditionnelles, à l'aide par exemple de « cimpokolo » et d'autres herbes, de quinine ou d'autres médicaments oraux obtenus auprès d'amies, de membres de la famille ou de praticiens traditionnels 39,40 . On sait aussi que les prestataires et les femmes enceintes interrompent clandestinement les grossesses au moyen de misoprostol 41 .…”

Caring for victims of sexual violence, part III: pregnancy after rape – integrative review

“…Pensar ou olhar a criança pode ser muito doloroso, pelas lembranças do perpetrador e de si própria enquanto vítima, o que constrói projeções negativas quanto ao bebê, visto como quem a pune ou "emissário do demônio" 22 . Várias dificuldades da VVS e dos serviços podem promover atrasos na busca e no atendimento, chegando mesmo a inviabilizar a realização do procedimento.…”

“…Em 50% dos países onde o aborto não é criminalizado, existe o rastreio de roti na de VS como causa de gestação não desejada, devido à sua alta prevalência, e isso amplia o foco dos cuidados após a IG 21 . Serviços prestadores de IG legal devem oferecer suporte multi profi ssional, integrando as necessidades e pontos de vista das mulheres atendidas, inclusive sobre o melhor momento para o uso das fontes de apoio, cuidados clínicos e psicossociais [22][23][24] . Algumas mulheres que demandam IG apresentam elevados níveis de angústi a psíquica antes do procedimento e níveis signifi cati vamente reduzidos após o mesmo 19,21 .…”