title: Stigma and Parenting Children Conceived From Sexual Violence.
abstract: OBJECTIVE
  Since armed conflict began in 1996, widespread sexual violence in eastern Democratic Republic of Congo has resulted in many sexual violence-related pregnancies (SVRPs). However, there are limited data on the relationships between mothers and their children from sexual violence. This study aimed to evaluate the nature and determinants of these maternal-child relationships.
  
  
  METHODS
  Using respondent-driven sampling, 757 women raising children from SVRPs in South Kivu Province, Democratic Republic of Congo were interviewed. A parenting index was created from questions assessing the maternal-child relationship. The influences of social stigma, family and community acceptance, and maternal mental health on the parenting index were assessed in univariate and multivariable analyses.
  
  
  RESULTS
  The majority of mothers reported positive attitudes toward their children from SVRPs. Prevalence of perceived family or community stigma toward the women or their children ranged from 31.8% to 42.9%, and prevalence of perceived family or community acceptance ranged from 45.2% to 73.5%. In multivariable analyses, stigma toward the child, as well as maternal anxiety and depression, were associated with lower parenting indexes, whereas acceptance of the mother or child and presence of a spouse were associated with higher parenting indexes (all P ≤ .01).
  
  
  CONCLUSIONS
  In this study with a large sample size, stigma and mental health disorders negatively influenced parenting attitudes, whereas family and community acceptance were associated with adaptive parenting attitudes. Interventions to reduce stigmatization, augment acceptance, and improve maternal mental health may improve the long-term well-being of mothers and children from SVRPs.
authors.affiliation: Harvard Humanitarian Initiative, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; shada.rouhani@gmail.com.
authors.forename: Shada A
authors.initials: SA
authors.lastname: Rouhani
authors.affiliation: Harvard Humanitarian Initiative, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Women's Health and Departments of Obstetrics and Gynecology and.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Scott
authors.affiliation: Harvard Humanitarian Initiative, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts;
authors.forename: Ashley
authors.initials: A
authors.lastname: Greiner
authors.affiliation: Harvard Humanitarian Initiative, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts;
authors.forename: Katherine
authors.initials: K
authors.lastname: Albutt
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Departments of Obstetrics and Gynecology and Harvard School of Public Health, Boston, Massachusetts;
authors.forename: Michele R
authors.initials: MR
authors.lastname: Hacker
authors.affiliation: Department of Psychiatry, HELIOS Hansehospital, University Medicine Greifswald, Stralsund, Germany; and.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kuwert
authors.affiliation: Harvard Humanitarian Initiative, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts;
authors.forename: Michael
authors.initials: M
authors.lastname: VanRooyen
authors.affiliation: Harvard Humanitarian Initiative, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts; Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Emergency Medicine, Queen's University, Ontario, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Bartels
mesh_terms: D000328:Adult; D001290:Attitude; D005260:Female; D006801:Humans; D008297:Male; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology; D015999:Multivariate Analysis; D016487:Parenting / Q000523:psychology; D012742:Sex Offenses / Q000523:psychology; D057545:Social Stigma