A mixed-methods assessment of sexual and gender-based violence in eastern Democratic Republic of Congo to inform national and international strategy implementation

Context: National and international strategies were implemented in eastern Democratic Republic of Congo (DRC) to address sexual and gender-based violence (SGBV). Objectives: The objective was to assess community attitudes of SGBV and health facility capacity to address SGBV in eastern DRC. Design and setting: The design and setting are as follows: a cross-sectional, population-based cluster survey of 998 adults in eastern DRC territories, a convenience sample of 27 adults using semi-structured directed interviews, qualitative data from 37 focus groups conducted in three health zones, assessment of 64 health facilities and a comparative analysis of SGBV strategies. Main outcome measures: The main outcome measures opinions regarding SGBV prevention and justice and health facility capacity to address SGBV. Results: The majority of respondents favored the legal system over community mediation to obtain justice for SGBV. However, 61.1% (95% CI, 51.8-70.5%) of SGBV survivors reported being forced to accept community mediation. Among SGBV survivors, 81.2% (95% CI, 74.5-87.8%) reported no available mental health care. Less than half of all respondents reported access to a hospital, clinic or pharmacy. The analyses and facility assessment reinforce the need to improve SGBV care. Conclusions: Mixed methodologies point to the complexities of addressing SGBV, assess key elements of SGBV prevention, justice and response, and may ultimately inform national and international strategies.