Author: Jasmyn J. Tang, MPH
September 19, 2023
Part 4: The Democratic Republic of Congo’s Reality with Sexual and Reproductive Health
The Democratic Republic of Congo (DRC) is the largest country in Sub-Saharan Africa (SSA) endowed with an abundance of natural resources; however, 62% of Congolese live on less than $2.15 USD per day, making it one of the five poorest nations in the world[10]. For decades, the DRC was riddled with conflict, civil war, and political instability. Despite having gained independence 62 years prior and having endured two Congo wars, the DRC finally experienced a peaceful transition of power in January 2019 with the inauguration of President Félix Antoine Tshisekedi Tshilombo[2][10].
Before delving into matters of sexual and reproductive health (SRH), it's crucial to address a pressing endemic issue: sexual violence. The DRC is plagued with sexual violence, especially in the east, with tens of thousands of women, girls, men, and boys having been raped or sexually abused[6]. Research suggests that practices of sexual violence have already been embedded within cultural and gender norms entrenched within traditional perceptions of masculinity[1]. Interestingly, 75% of women believe that partner violence and wife beating are justified even though 50% of women have at least one experience of physical or sexual violence in their lifetime[13]. Reflecting this sentiment, no laws or policies criminalize marital rape or domestic violence; but, the effectiveness of these policies raise doubts[12].
Armed groups and even members of Congolese security forces are perpetrators of violence, using rape as a weapon of war and targeting girls as young as two and as old as 80 years of age[6]. A Congolese survivor of rape was documented by the United Nations as she recounted a heart-wrenching experience in which during a walk home, she and her companions found themselves surrounded by a group of five men who continuously raped them, resulting in a five-month hospitalization. In the aftermath, she was quoted saying,
“The men broke my body into many pieces and shattered my soul.”
- United Nations
According to Human Rights Watch, perpetrators of these types of attacks can be arrested, but they are usually released after only a few days due to corruption among judicial and prison staff, coupled with poor investigations[4][6]. Even though rape is officially seen as “against the law,” the justice system is riddled with corruption and political interference with a long-standing policy to reward armed leaders and war criminals with senior positions, thus continuing the cycle of violence. Even with some so-called justice, the victims of these crimes often lack support and endure stigmatization by family and psychosocial trauma, leading to social exclusion, abandonment, and ridicule[4].
As seen, cultural norms and attitudes in the country play a big role in forming morals and values. The DRC has the 3rd highest fertility rate in the world with women on average giving birth to 6-7 children; and with 52% of the population under 15, SRH education is imperative[7]. While most of the country consists of young adults, viewpoints of sex education are largely fueled by a lack of information and misinformation. A study done on 224 young adults in the DRC, aged 15-19 in urban areas and 18-24 in rural areas, presented an analysis of perceptions relating to various sexual and reproductive health issues. One major issue was barriers to modern contraceptive use. Both male and female adolescents had some knowledge about contraceptive methods like condoms or pills, however many cited products like antimalarial or deworming medications, as well as more traditional methods like drinking lots of water or tracking their “fertile” period, to prevent pregnancy. In addition, there’s shame and disapproval associated with using these methods, leading to beliefs of prostitution or disease.
In both urban and rural communities, young adults have similar views that they are responsible when it comes to these decisions which can lead to pregnancy or premarital sex. However, one major commonality is that there is a lack of support from health professionals when it comes to educating youths about SRH topics. Both boys and girls felt that health providers had negative attitudes towards their contraception use or presented an unwillingness to provide modern contraception at all, evidenced by the fact that 74% of all women 15-29 have unmet contraceptive needs[5]. In urban areas, doctors and nurses were seen as more knowledgeable and open to discussing SRH; but, according to the World Health Organization (WHO), there are only 0.9 doctors, 11.1 nurses/midwives, and 0/05 pharmacists per 10,000 individuals within the DRC[12]. This, along with societal narratives, inhibits the process for young adults to receive proper SRH care.
The future seems bleak, but there is progress. The World Bank has invested $100 million in the DRC Gender Based Violence (GBV) Prevention and Response Project to provide preventive intervention and raise awareness to change attitudes and behavior among both women and men around gender equality and violence with nearly 7 million beneficiaries[13]. Furthermore, the Global Partnership for Education granted $135 million to increase education and empowerment for women and girls in order to provide safe and effective school environments to teach and learn[11]. Finally, using technology as a medium, an SRH information system via the Nurse Nisa WhatsApp chatbot was created to decrease misinformation and provide accurate and confidential SRH information directly to young people in order for them to have the opportunity to make their own reproductive choices without being stigmatized8.
Overall, the Democratic Republic of Congo has a long journey ahead to overcome the obstacles surrounding sexual and reproductive health. Data from the UN on the 2030 SDG goals indicate that the DRC of 159/166 on the SDG Index with major challenges remaining in 14/17 goals including good health and well-being, quality education, and gender equality[3]. Though many projects are being created and funded to assist with these issues, only time will tell whether they will have positive, long-lasting, and sustainable impacts.
Download the accompanying infographic below or view it on our website here.
Sources
Alexandre, A. B., & Moke Mutondo, K. (2021). Behind the weapon of war: sexual violence in wartime as a reflection of social attitudes towards women in peacetime. Journal of Sexual Aggression, 28(2), 149–163. https://doi.org/10.1080/13552600.2021.1949500
BBC. (2023, July 31). DR Congo Country Profile. BBC News. https://www.bbc.com/news/world-africa-13283212
Congo, Dem. Rep. Sustainable Development Report. (n.d.). https://dashboards.sdgindex.org/profiles/congo-dem-rep
Doctors Without Borders. (2021, July 15). Confronting the sexual violence epidemic in Democratic Republic of Congo. Doctors Without Borders. https://www.doctorswithoutborders.org/latest/confronting-sexual-violence-epidemic-democratic-republic-congo
Fatusi, A. O., & Lince-Deroche, N. (2021, November 1). Democratic Republic of the Congo. Guttmacher Institute. https://www.guttmacher.org/regions/africa/democratic-republic-congo
Human Rights Watch. (2023, August 2). Democratic Republic of Congo: Ending Impunity for Sexual Violence. Human Rights Watch. https://www.hrw.org/news/2014/06/10/democratic-republic-congo-ending-impunity-sexual-violence
Mbadu Muanda, F., Gahungu, N. P., Wood, F., & Bertrand, J. T. (2018). Attitudes toward sexual and reproductive health among adolescents and young people in urban and rural DR Congo. Reproductive health, 15(1), 74. https://doi.org/10.1186/s12978-018-0517-4
McMahon, E., Fetters, T., Jive, N. L., & Mpoyi, M. (2023). Perils and promise providing information on sexual and reproductive health via the Nurse Nisa WhatsApp chatbot in the Democratic Republic of the Congo. Sexual and Reproductive Health Matters, 31(4). https://doi.org/10.1080/26410397.2023.2235796
United Nations. (2021, May 19). Sexual violence survivors in DR Congo caught in crisis of ‘catastrophic magnitude.’ United Nations. https://news.un.org/en/story/2021/05/1092292
World Bank. (2023, March 29). Democratic Republic of Congo Overview. World Bank. https://www.worldbank.org/en/country/drc/overview
World Bank. (2023, May 18). Empowering Girls and Enhancing Learning in the Democratic Republic of Congo. World Bank. https://www.worldbank.org/en/results/2023/05/18/empowering-girls-and-enhancing-learning-in-the-democratic-republic-of-afe-congo
World Health Organization. (2021). Sexual and reproductive health and rights: Infographic snapshot: Democratic Republic of the Congo 2021. World Health Organization. https://apps.who.int/iris/handle/10665/349426
Zeufack, A. (2022, December 12). Changing social norms and values to end widespread violence against women and girls in DRC. World Bank Blogs. https://blogs.worldbank.org/africacan/changing-social-norms-and-values-end-widespread-violence-against-women-and-girls-drc