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BMC Pregnancy Childbirth. 2018 Aug 8;18(1):322. doi: 10.1186/s12884-018-1942-7.

A qualitative analysis of decision-making among women with sexual violence-related pregnancies in conflict-affected eastern Democratic Republic of the Congo.

Scott J1,2,3,4, Onyango MA5, Burkhardt G6,7,8, Mullen C9, Rouhani S10,6,11, Haider S12, Albutt K10,6,13, Greiner A10,6,14, VanRooyen M10,6,11,15, Bartels S10,6,14,15,16.

Author information

Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 3rd Floor, Boston, MA, 02215, USA.
Division of Women's Health, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA, 02138, USA.
Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
Harvard Humanitarian Initiative, 14 Story Street, Cambridge, MA, 02138, USA.
Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Boston, MA, 02115, USA.
Department of Obstetrics and Gynecology, University of New Mexico, MSC 10 5582, Albuquerque, NM, 87131, USA.
Department of Psychiatry, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA.
Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Department of Obstetrics & Gynecology, University of Chicago, 5837 S. Maryland Avenue, Chicago, IL, 60615, USA.
Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA, 02215, USA.
Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
Department of Emergency Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.



Sexual violence is prevalent in conflict-affected settings and may result in sexual violence-related pregnancies (SVRPs). There are limited data on how women with SVRPs make decisions about pregnancy continuation or termination, especially in contexts with limited or restricted access to comprehensive reproductive health services.


A qualitative study was conducted in Bukavu, Democratic Republic of the Congo (DRC) as part of a larger mixed methods study in 2012. Utilizing respondent-driven sampling (RDS), adult women who self-reported sexual violence and a resultant SVRP were enrolled into two study subgroups: 1) women currently raising a child from an SVRP (parenting group) and 2) women who terminated an SVRP (termination group). Trained female research assistants conducted semi-structured interviews with a subset of women in a private setting and responses were manually recorded. Interview notes were translated and uploaded to a qualitative software program, coded, and thematic content analysis was conducted.


A total of 55 women were interviewed: 38 in the parenting group and 17 in the termination group. There were a myriad of expressed attitudes, beliefs, and emotional responses toward SVRPs and the termination of SVRPs with three predominant influences on decision-making, including: 1) the biologic, ethnic, and social identities of the fetus and/or future child; 2) social reactions, including fear of social stigmatization and/or rejection; and 3) the power of religious beliefs and moral considerations on women's autonomy in the decision-making process.


Findings from women who continued and women who terminated SVRPs reveal the complexities of decision-making related to SVRPs, including the emotional reasoning and responses, and the social, moral, and religious dimensions of the decision-making processes. It is important to consider these multi-faceted influences on decision-making for women with SVRPs in conflict-affected settings in order to improve provision of health services and to offer useful insights for subsequent programmatic and policy decisions.


Conflict; Decision-making; Democratic Republic of the Congo; Pregnancy; Reproductive health services; Sexual violence

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