title: Fistula and other adverse reproductive health outcomes among women victims of conflict-related sexual violence: a population-based cross-sectional study.
abstract: BACKGROUND
  Sexual violence (SV) is being used widely as a weapon of war. However, few studies have investigated its health effects. The objective of the present study is to investigate the relationship between sexual violence and several serious reproductive health conditions including fistula.
  
  
  METHODS
  We conducted a cross-sectional study among 320 women living in Goma, the Democratic Republic of Congo. We assessed the association of four outcomes: fistula, chronic pelvic pain, desire for sex, and desire for children, with SV in two contexts: conflict-related and nonconflict-related. Two groups of women: those who experienced conflict-related sexual violence (CRSV) and those who experienced nonconflict-related sexual violence (NCRSV), were compared with women who had not experienced SV. Data were collected by trained interviewers using a standard questionnaire.
  
  
  RESULTS
  Compared with women who did not experience SV, after adjustment for potential confounders, women who experienced CRSV were significantly more likely to have fistula (OR = 11.1, 95% CI [3.1-39.3]), chronic pelvic pain (OR = 5.1, 95% CI [2.4-10.9]), and absence of desire for sex (OR = 3.5, 95% CI [1.7-6.9]) and children (OR = 3.5, 95% CI [1.6-7.8]). Women who experienced NCRSV were more likely to report absence of desire for children (OR = 2.7, 95% CI [1.1-6.5]), and seemed more likely to report chronic pelvic pain (OR = 2.3, 95% CI [0.95-5.8]), although the difference was not statistically significant. Women who experienced NCRSV did not have higher odds for fistula and absence of sexual desire.
  
  
  CONCLUSIONS
  Conflict-related sexual violence can contribute to women's adverse reproductive health outcomes. Its impact is more devastating than that of NCRSV.
authors.affiliation: Département de médecine sociale et préventive, École de Santé Publique de l'Université de Montréal, Montreal, QC, Canada.
authors.forename: Nissou Ines
authors.initials: NI
authors.lastname: Dossa
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Zunzunegui
authors.forename: Marie
authors.initials: M
authors.lastname: Hatem
authors.forename: William
authors.initials: W
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo; D005260:Female; D006801:Humans; D007989:Libido; D008875:Middle Aged; D017699:Pelvic Pain / Q000453:epidemiology*; D011902:Rape / Q000523:psychology / Q000706:statistics & numerical data*; D043762:Reproductive Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012742:Sex Offenses / Q000523:psychology / Q000706:statistics & numerical data; D014624:Vaginal Fistula / Q000453:epidemiology*; D014858:War Crimes / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: armed conflict; chronic pelvic pain; fistula; reproductive health; sexual violence