Care-seeking patterns and timely access to care among survivors of sexual violence in North Kivu, the Democratic Republic of the Congo: a retrospective file-based study

ABSTRACT

Background

Sexual violence is widespread in war-torn North Kivu province in the Democratic Republic of the Congo (DRC). Timely access to care is crucial for the healing and wellbeing of survivors of sexual violence, but is problematic due to a variety of barriers. Through a better understanding of care-seeking behaviours and factors influencing timely access to care, programmes can be adapted to overcome some of the barriers faced by survivors of sexual violence.

Objective

The aim of this study was to describe demographics, care-seeking patterns and factors influencing timely care-seeking by survivors of sexual violence.

Methods

Retrospective file-based data analysis of sexual violence survivors accessing care within two Médecins Sans Frontières (MSF) programmes supporting the Ministry of Health, in North Kivu, DRC, 2014–2018.

Results

Most survivors (66%) sought care at specialised sexual violence clinics and a majority of the survivors were self-referred (51%). Most survivors seeking care (70%) did so within 3 days. Male survivors accessing care were significantly more likely to seek care within 3 days compared to females. All age groups under 50 years old were more likely to seek care within 3 days compared to those aged 50 years and older. Being referred by the community, a family member, mobile clinic or authorities was significantly associated with less probability of seeking care within 3 days compared to being self-referred.

Conclusion

Access to timely health care for survivors of sexual violence in North Kivu, DRC, is challenging and varies between different groups of survivors. Providers responding to survivors of sexual violence need to adapt models of care and awareness raising strategies to ensure that programmes are developed to enable timely access to care for all survivors. More research is needed to further understand the barriers and enablers to access timely care for different groups of survivors.

Paper Context

• Main findings: Timely access to care for survivors of sexual violence is crucial yet challenging in many places, including in North Kivu, the Democratic Republic of the Congo. This study shows that a majority of survivors access care through specialised clinics, that access is limited for male and child survivors, and highlights factors influencing timely access to care for survivors of sexual violence.

• Added knowledge: This study shows that age, sex, and different referral pathways impact timely care seeking among survivors of sexual violence accessing care.

• Global health impact for policy and action: A better understanding of care-seeking patterns and which factors influence timely care seeking is useful when designing and implementing programmes responding to survivors of sexual violence.

KEYWORDS:

• Gender-based violence
• sexual abuse
• Sexual assault
• rape
• help-seeking behaviour
• Democratic Republic of the Congo

Responsible Editor Julia Schröders

Responsible Editor Julia Schröders

Acknowledgments

We are grateful to all the Ministry of Health and MSF staff working within the MSF programmes in Walikale and Mweso who contributed to this study in different ways. We acknowledge the support in the statistical analysis provided by Elisabeth Wilhelm, Linköping University.

Author contributions

All authors reviewed and agreed upon the final manuscript. HR contributed to study conceptualisation and design, data collection, analysis, interpretation and writing of the original draft. JB contributed to the study design, interpretation of data and revision of manuscript. HF contributed to the study conceptualisation and design, analysis and interpretation of findings and revision of final manuscript. MV contributed to the study conceptualisation and design and interpretation of data. AA contributed with interpretation of data and revision of final manuscript.

Disclosure statement

The fee for ethical approval by the ethics committee in Goma was paid by the MSF North Kivu country programme, Operational Centre Amsterdam. However, MSF had no influence on the analysis or the interpretations done in this study.

Ethics and consent

Ethical approval has been granted from the Ethics Review Board instituted by Médecins Sans Frontières and by the Comité Ethique de l’Université Libre des Pays des Grands Lacs, Goma, DRC.

Paper context

Timely access to care for survivors of sexual violence is crucial yet challenging in many places, including in North Kivu, DRC. This study shows that a majority of survivors access care through specialised clinics, that access is limited for male and child survivors and highlights factors influencing timely access to care for survivors of sexual violence. This information can be used to adapt programmes and improve access to timely care for survivors of sexual violence.

Additional information

Funding

Authors HR, MV and JB were employed by MSF during the time of the study.