RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, B2, New York, NY, 10032, USA.
CARE USA, 151 Ellis St NE, Atlanta, GA, 30303, USA.
Reprod Health. 2019 Jul 8;16(1):98. doi: 10.1186/s12978-019-0764-z.
Inadequate infrastructure, security threats from ongoing armed conflict, and conservative socio-cultural and gender norms that favour large families and patriarchal power structures contribute to poor sexual and reproductive health (SRH) outcomes in North and South Kivu provinces, Democratic Republic of the Congo (DRC). In order to expand contraceptive and post-abortion care (PAC) access in North and South Kivu, CARE, the International Rescue Committee and Save the Children provided technical support to the Ministry of Health and health facilities in these regions. Partners acknowledged that community leaders, given their power to influence local customs, could play a critical role as agents of change in addressing inequitable gender norms, stigma surrounding SRH service utilization, and topics traditionally considered taboo within Congolese society. As such, partners actively engaged with community leaders through a variety of activities such as community mapping exercises, values clarification and transformation (VCAT) activities, situational analyses, and education.
This manuscript presents findings from 12 key informant interviews (KIIs) with male political and non-political community leaders conducted in six rural health zones of North and South Kivu, DRC. Transcripts were analysed thematically to explore community leaders' perceptions of their role in addressing the issue of unintended pregnancy in their communities.
While community leaders in this study expressed overall positive impressions of contraception and strong support for ensuring access to PAC services following spontaneous and induced abortions, the vast majority held negative beliefs concerning women who had induced abortion. Contrasting with their professed opposition to induced abortion, leaders' commitment to mediating interpersonal conflict arising between community members and women who had abortions was overwhelming.
Results from this study suggest that when thoughtfully engaged by health interventions, community leaders can be empowered to become advocates for SRH. While study participants were strong supporters of contraception and PAC, they expressed negative perceptions of induced abortion. Given the hypothesized link between the presence of induced abortion stigma and care-avoidance behavior, further engagement and values clarification exercises with leaders must be integrated into community mobilization and engagement activities in order to increase PAC utilization.
基础设施不足、持续武装冲突带来的安全威胁，以及支持大家庭和父权制权力结构的保守社会文化和性别规范，是导致刚果民主共和国（DRC）南北基伍省性健康和生殖健康（SRH）状况不佳的原因。为了扩大在南北基伍的避孕和流产后护理（PAC）服务，CARE、国际救援委员会和拯救儿童组织向这些地区的卫生部和卫生机构提供了技术支持。合作伙伴认识到，鉴于他们影响当地习俗的权力，社区领导人可以在解决不平等的性别规范、围绕 SRH 服务利用的耻辱感以及传统上被视为刚果社会禁忌的话题方面，发挥关键的变革推动者作用。因此，合作伙伴通过各种活动积极与社区领导人接触，如社区绘图练习、价值观澄清和转变（VCAT）活动、情况分析和教育。
本文介绍了对来自南北基伍六个农村卫生区的 12 名男性政治和非政治社区领导人进行的 12 次关键人物访谈（KII）的结果。对访谈记录进行了主题分析，以探讨社区领导人对他们在解决社区意外怀孕问题中的作用的看法。
尽管这项研究中的社区领导人对避孕措施总体持积极印象，并强烈支持确保在自发性和诱导性流产后获得 PAC 服务，但绝大多数人对曾进行过人工流产的妇女持有负面看法。与他们对人工流产的公开反对形成鲜明对比的是，领导人对调解社区成员和曾堕胎的妇女之间的人际冲突的承诺是压倒性的。
这项研究的结果表明，当社区领导人受到卫生干预措施的深思熟虑的关注时，他们可以被赋予支持 SRH 的权利。虽然研究参与者是避孕和 PAC 的坚定支持者，但他们对人工流产表示负面看法。鉴于人工流产耻辱感的存在与护理回避行为之间的假设联系，必须将与领导人的进一步接触和价值观澄清练习纳入社区动员和参与活动，以增加 PAC 的使用。
