title: A quantitative assessment of termination of sexual violence-related pregnancies in eastern Democratic Republic of Congo.
abstract: BACKGROUND
  Sexual 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  In 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 %).
  
  
  CONCLUSIONS
  Most 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.
authors.affiliation: Harvard Humanitarian Initiative, Cambridge, MA USA ; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA USA ; Harvard Medical School, Boston, MA USA.
authors.forename: Shada A
authors.initials: SA
authors.lastname: Rouhani
authors.affiliation: Harvard Humanitarian Initiative, Cambridge, MA USA ; Harvard Medical School, Boston, MA USA ; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA USA ; Division of Women's Health, Brigham and Women's Hospital, Boston, MA USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Scott
authors.affiliation: Harvard Humanitarian Initiative, Cambridge, MA USA ; Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA USA.
authors.forename: Gillian
authors.initials: G
authors.lastname: Burkhardt
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston, MA USA.
authors.forename: Monica A
authors.initials: MA
authors.lastname: Onyango
authors.affiliation: Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, USA.
authors.forename: Sadia
authors.initials: S
authors.lastname: Haider
authors.affiliation: Harvard Humanitarian Initiative, Cambridge, MA USA ; Harvard Medical School, Boston, MA USA ; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Greiner
authors.affiliation: Harvard Humanitarian Initiative, Cambridge, MA USA ; Harvard Medical School, Boston, MA USA ; Department of Surgery, Massachusetts General Hospital, Boston, MA USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Albutt
authors.affiliation: Harvard Humanitarian Initiative, Cambridge, MA USA ; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA USA ; Harvard Medical School, Boston, MA USA ; Harvard School of Public Health, Boston, MA USA.
authors.forename: Michael
authors.initials: M
authors.lastname: VanRooyen
authors.affiliation: Harvard Humanitarian Initiative, Cambridge, MA USA ; Harvard Medical School, Boston, MA USA ; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA ; Department of Emergency Medicine, Queen's University, Kingston, Canada.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Bartels
keywords: Democratic Republic of Congo; Gender based violence; Pregnancy; Sexual violence; Termination