5e congrès de la Chaire internationale Mukwege

The capability approach, which advocates a concrete universality of emancipation for all women, can be extended to the debate surrounding the practice of female genital mutilation (FGM), a practice recognized as harmful, a form of gender-based violence and a public health problem due to its negative consequences on women's health. Changing attitudes towards this practice is possible by challenging this social norm rooted in the patriarchal system.

The aim of this research is to examine how restorative justice contributes to women's empowerment and thus to their psychological recovery.

Fieldwork based on a qualitative method and narrative interviews was carried out with migrant women who had already undergone this practice, but who questioned the social norm and decided not to apply it to their daughters.

The themes that emerged from the data after analysis were: emotional suppression, loyalty conflict, self-appropriation and choice.

In the process of changing their attitudes to the practice of FGM, women reinvent new gender roles based on what they have previously been taught. They have made choices and preferences for themselves and their daughters.

This project focused on the social reintegration of women victims of sexual violence cared for by the Panzi Foundation in the city of Bukavu. Its aim was to take stock of the constraints encountered by women survivors of sexual violence in carrying out their income-generating activities, with a view to providing strategic guidance. A qualitative approach was adopted for data collection and analysis, specifically interviews and transcriptions. The results show that baking, embroidery and sewing are income-generating activities initiated on behalf of women survivors of sexual violence.

However, the results of the study show that covid-19, the inadequacy of training materials or tools, and the level of expertise of the women survivors' supervisors are all constraints faced by the women survivors throughout their vocational training.

At the Foundation level, there are also a number of constraints, notably operating costs, low intake capacity, low estimates of follow-up costs and low take-up of the project by beneficiaries. In view of the results obtained in this study, it can be seen that the Panzi Foundation's work on the social reintegration of women survivors is a long-term undertaking. Much remains to be done.

Abortion is partially legalized in 48 out of 54 sub-Saharan African (SSA) countries. However, legal frameworks authorizing abortion are generally weakly implemented. Extending abortion rights does not necessarily improve access to abortion.

This analysis examines the problems of implementing abortion laws in SSA, through the prism of reproductive justice (RJ) rooted in neo-feminism (N-F).

RJ is a theory that analyzes the different levels of contextual and societal forces in abortion access. We suggest that implementation problems result from the inadequate transposition of the abortion rights struggle from high-income countries to SSA contexts. Many societal forces, including social, religious and moral imperatives, override the legality of abortion in SSA. We suggest the use of N-F (African feminism rooted in values of negotiation and relationships) to navigate these forces and improve access to abortion. One promising negotiation strategy to emerge in Tanzania was state tolerance of an emerging clandestine market for medical abortion.

RJ allows us to recognize the contextual forces that shape access to abortion, while N-F points to potential avenues for navigating these forces. An interesting use of N-F is tolerance of clandestine medical abortion in restrictive contexts. However, we recognize the limitations of this approach and recommend continuing the fight for legalized abortion using N-F as a complement.

Created in 1997, the Institut Supérieur en Sciences Infirmières, ISSI, is helping to change the image of nurses' contribution to improving the health of the population in the Democratic Republic of Congo (DRC). According to the International Council of Nurses, nursing encompasses health promotion, disease prevention and care for the sick, disabled and dying. ISSI contributes to the development of the nursing profession and the social revaluation of nurses in the DRC.

By 2023, 585 nurses had completed the first cycle. Since 2014, 64 healthcare professionals, including 54 women, have graduated with a Master's degree in Healthcare Program Administration. As part of the midwifery conversion program, 14 nurses have completed the bridging program and 20 others will start in October 2024. Various on-the-job capacity-building projects have enabled over 4,000 nurses to receive training in hospital hygiene, thanks in particular to the Cellule pour la promotion des pratiques d'hygiène set up by ISSI in 2007. Training courses on emergency and resuscitation care, ethics and deontology, basic care, reception, etc. have been organized for over 1,000 nurses throughout the country.

During internships, students learn to carry out community diagnoses and provide quality care. The values imparted at ISSI and lived out afterwards are additional assets for making an impact on the health of the population.

Investing in the education and empowerment of young girls who want to become nurses and midwives is a way of investing in the health of the population in a country like the DRC.

Introduction: Violence against women whether by an intimate partner or of a sexual nature is a global public health issue and a violation of women's rights. In 2016, Belgium became a signatory to the Istanbul Conference, which aims to prevent and combat all forms of violence against women and domestic violence. The approach focused on African migrant women in relation to domestic violence remains little known. A combination of factors: being a migrant woman and of African origin, makes these women even more vulnerable in their living environment.

Objective: Identify representations of violence among sub-Saharan African women, and knowledge of the services available in Brussels to combat domestic violence.

Methodology: Qualitative interview research with seven women from sub-Saharan Africa.

Results: The following themes were identified: 1) awareness of domestic violence, 2) perception and impact of domestic violence, 3) perception of the facts and knowledge of the support structures available in the Brussels-Capital region, 4) violence suffered but not perceived.

Conclusion: Highlighting the limits of unperceived violence, normal or abnormal attitudes in a couple's relationship in order to assess exposure to a situation of domestic violence, and the lack of knowledge of existing structures active in the fight against domestic violence by African women in the Brussels-Capital region does not contribute to the freeing of the word. It is therefore important to adapt the communication channel to the specific needs of migrant women.

In the form of a literature review, this proposal presents the state of scientific knowledge on the psychological impacts of climate change, having read over sixty articles dating from the last fifteen years.

Starting from a set of distinct definitions, a typology was drawn up in order to understand the different representations of the phenomenon. Measurement instruments assessing the phenomenon according to their conceptualization were then presented, including the “Inventory of Climate Emotions”, the only one to measure eight emotions linked to climate change.

In terms of the supposed consequences of this phenomenon, this review listed several studies correlating with mental health issues. However, it must be acknowledged that the effect sizes remain modest and that no causal link can be demonstrated. We therefore set out to present three theoretical models that shed light on the phenomenon from a psychoeducational perspective, including the process of ecoanxiety and climate mourning.

A look was also taken at the programs or interventions used to support individuals. Because of its novelty, no study evaluating an intervention program exists, and few studies focus on the interventions to be preferred.

This review highlights the importance of producing longitudinal empirical studies and evaluated intervention programs with experimental specifications to help affected individuals, such as women and people with direct experience of climate change.

Médecins du Monde conducted a study in 2023 and 2024 to explore the barriers to safe and fulfilling sexuality among young people aged 15 to 21 in Benin and Burkina Faso, analyzing the impact of the social environment on their sexual well-being.

The presentation will aim to disseminate the results of this study and lead a discussion on the specific challenges to positive sexuality among young people. The results will inform future actions to promote safe and satisfying sexual practices, in line with the Guttmacher-Lancet Commission's recommendations for a comprehensive approach to sexual health.

Based on 180 semi-structured interviews, the data reveal major obstacles such as gender stereotypes, lack of reliable information and social pressure (social networks and entourage). The results underline the need to integrate sex education strategies that respect and value young people's lived experiences, with a particular focus on strengthening relational skills and deconstructing harmful myths and practices.

The Guttmacher-Lancet Commission (2018) points out that sexual health involves general well-being, not just the absence of disease, yet research into young people's sexuality has long focused on risk prevention. This study will help fill a gap in understanding the sexual needs of young people in Sub-Saharan Africa.

Every woman has the right to health. In malaria-endemic countries like Senegal, pregnant women are exposed to an increased risk of perinatal complications and death when infected. The country's National Malaria Control Program (NMCP) recommends at least three doses of intermittent preventive treatment (IPT) during pregnancy. In 2021, only 38% of Senegalese women received doses of IPTp-3+ during their last pregnancy; the NMCP's goal is to achieve 80% coverage by 2025.

Plan International conducted a study in 2022 to investigate husbands' knowledge of malaria. Using cluster sampling proportional to size, quantitative data were collected from 357 husbands (or male partners) in the Kolda and Tambacounda regions of Senegal and analyzed with SPSS 28. 90% of men knew about mosquito nets, but only 18% knew about chemoprophylaxis for pregnant women and children. Religion, tribe, age and disability did not affect IPT knowledge, but those with secondary or higher education had better knowledge of IPT and recommended dosage (X2 (1,N=357) =18.14, p<0.001 and X2 (1,N=180) =7.74, p=0.021, respectively).

Following the study, Plan International set up husbands' clubs in both regions to improve their knowledge of malaria and promote positive masculinities. Investing in gender-transformative strategies such as husbands' clubs, and studying their impact, is essential to achieving MDGs 3 and 5.

Introduction: The problem of SGBV remains of great concern worldwide. In the DRC, the prevalence of SGBV is 16.3% among women aged 15 to 24 (Rapport EDS-RDC II 2013-2014). RENADEF is a platform of NGOs, created on 12/082002 in Goma, North Kivu - DRC, which campaigns for the elimination of all forces of violence against women and girls. RENADEF implemented the HIV/AIDS and SGBV prevention and response program targeting Adolescents and Young Girls (AJF), and women in 14 provinces of the DRC, from 2018 to 2020.

Objectives: Reduce the vulnerability of young girls, women to HIV/AIDS and GBV (Gender-Based Violence), as well as the barriers hindering access to health, HIV/AIDS, and Sexual and Reproductive Health services.

Discussion:Synergy in efforts, activities in community, health, and school settings, experience sharing between the DRC and Uganda on the SASA! approach, educational and informational spaces for youth, unified coordination, and experience sharing among service providers on supporting young girls.

Conclusions:** 500 stakeholders were trained, and 1.2 million people were reached with awareness campaigns. Support was provided to 15 health facilities and 33 legal clinics, including the Panzi Foundation. A total of 7,040 cases of gender-based violence (GBV) were recorded, of which 17% received medical care, 62% received psychological care, and 42% received legal and judicial support. Additionally, 40% of the cases led to court rulings, with 75% of those rulings being executed.

To eradicate GBV, policymakers, technical and financial partners, as well as community members, must work together. Let us call on policymakers to get involved and on partners to mobilize resources to support interventions against GBV.

Since 2011, Malaika has been a primary and secondary school providing education to around 430 students in a village called Kalebuka in the Democratic Republic of Congo. The school also hosts a community center offering sports activities and literacy sessions for the students' families.

In April 2022, the director and teachers of Malaika School expressed the need for in-depth courses on the stages of puberty and sexual health for adolescent girls. With their consent, I created a booklet and interactive lessons covering topics such as the menstrual cycle, physical and hormonal changes, and contraceptive methods, among others. The main goal of this project was to help reduce the risk of early pregnancies by equipping the students to make free and informed decisions. A secondary goal was to contribute to the fight against gender inequalities in access to sexual education information. As a result, around thirty students attended bi-monthly sessions lasting three hours each, from August 2022 to January 2023.

In conclusion, this project taught me the importance of continuous collaboration with the local team to adapt the teaching to the sociocultural context and available resources on the ground. To optimize the learning experience, it is essential to consider the instability of the internet connection in Kalebuka and offer recorded lessons for asynchronous access. Overall, witnessing the determination of the young girls to become leaders in sharing evidence-based information on sexual health is a long-term achievement.

Gender-based violence (GBV) among adolescents is a common phenomenon in Africa with negative emotional, physical, sexual, and economic consequences. Recently, interventions to address this issue have increased. However, few studies have focused on documenting these interventions and their effectiveness in preventing GBV and supporting survivors. A scoping review was therefore conducted to synthesize knowledge on experiences of combating GBV among adolescents in Africa and to identify relevant action levers.

The scoping review followed the approach proposed by Arksey and O'Malley. The databases consulted for scientific articles were PubMed and CINAHL, and the websites of the United Nations, the World Health Organization (WHO), and the World Bank were used for grey literature. The search was limited to the period from 2000 to 2023.

Nineteen articles and documents were included in the review. The interventions could be grouped into four categories: 1) community interventions, 2) economic empowerment interventions, 3) school-based interventions, and 4) multisectoral and comprehensive interventions. While positive effects were generally observed in changing social norms and beliefs, community-based and multisectoral interventions proved to be more effective than others in preventing GBV experiences and supporting survivors.

To counter the harmful effects of GBV on the sexual and reproductive health of adolescent girls in Africa, global, multisectoral, participatory, and context-specific approaches should be prioritized.

Socioeconomic reintegration into the community has been part of the support actions for survivors assisted by the Panzi Foundation since 1999 (Susan et al., 2010). To assess its relevance and effectiveness, this study, based on a mixed-methods approach and guided by theories of social integration and empowerment, determines that socioeconomic reintegration is the culmination of the "One Stop Center Model" (Mukwege and Berg, 2016) through the promotion of social leadership, autonomy, and economic empowerment of survivors within their communities. This support enables survivors to initiate economic activities that are accepted and adapted to the local economic system.

Income contributes to meeting the primary needs of households, financial empowerment, and the improvement of the mother-wife-woman status. On average, 30% of survivors manage to take on leadership roles (president, vice president, treasurer, or counselor) within smaller community groups. However, the effort to (re)accommodate survivors lacks planned and structural support from the community, leading to weakened resilience and less profitable economic reorientation. As a recommendation, it is suggested to extend the follow-up period to 5 years and strengthen the structural capacities of communities.

Introduction: In the Democratic Republic of Congo (DRC), the prevalence of Female Genital Mutilation (FGM) Types I-III was estimated at 5% (WHO, 1997), and the stretching of the labia minora (Type IV) is also practiced.

Objectives: To determine the prevalence and sociocultural profile of women with FGM, as well as the long-term effects on pelvic-perineal and sexual functions.

Methodology: This is a cross-sectional study conducted from 2021 to 2023 among 507 adult women living in 6 provinces of the DRC. Women who provided written consent were included, while pregnant women, women in the postpartum period (≤ 6 months), and those with war-related mutilations were excluded. A questionnaire was used, supplemented by a perineal examination. Various statistical tests were applied, with an α level set at 0.05.

Results: The prevalence of FGM was 15.2% [Types I-II (1.7%); Type IV (13.5%)], with identical clinical characteristics (p > 0.05). Type IV was more common among the Swahili (65.7%) and Luba (27.1%) ethnic groups, with an average age of 13.8 years. Types I-II were practiced among the Bangala (100%) at an unknown age. Women with FGM were more likely to marry before 18 and had a higher parity, experiencing twice as much urinary incontinence, and three times more dyspareunia and lack of sexual satisfaction compared to women without FGM (p < 0.01). The strength and tone of pelvic floor muscles, vulvar elasticity, and other pelvic dysfunctions were similar (p > 0.05).

**Conclusion:** FGM is practiced in certain tribes in the DRC. It is a contributing factor, along with early marriage and high parity, to urinary incontinence, dyspareunia, and lack of sexual satisfaction.

Co-auteur(e)s : Reman T, Feipel V, Abdulcadir J, Maroyi Raha K, Mukwegwe D, Bertuit J

The WHO estimates that 30% of women worldwide have or will experience sexual violence (SV) at least once in their lifetime. This percentage increases in conflict zones where SV is used as a weapon of war, such as in the Kivu region in eastern DRC [1]. These instances of SV lead to health consequences for survivors, particularly in the pelvic area [2-4]. However, no studies have used validated questionnaires to assess these consequences, especially in relation to sexual function. This lack of data is problematic in the implementation of appropriate rehabilitation treatment in centers supporting survivors in Kivu.

The research protocol for a retrospective cohort study was developed with a sample size of 310 women, recruited from the cities of Goma and Bukavu and divided into two groups: a group of survivors of sexual violence (SV) and a control group. The inclusion criteria were: being over 18 years old, living in DRC, speaking French or being translatable, and being a survivor of SV. The exclusion criteria were pregnancy, early postpartum, obstetric fistulas, and early postoperative conditions from pelvic surgeries. In addition to a questionnaire collecting socio-demographic data and information on SV, sexual function was assessed using the FSFI questionnaire, which is validated in French.

Currently, the analyses are ongoing, and preliminary results are presented based on 80% of the calculated sample. Most of the reported sexual assaults were committed by armed groups (47.8%), and the total FSFI score was significantly different between the two groups, with a lower score for the SV group.

The project is supported by regional stakeholders, and the clinical data will enable reference hospitals to establish rehabilitation protocols that align with the local context. At the international level, this data will contribute to better care for migrant survivors.

**Context and Objectives:** Wars expose children to traumatic experiences that disrupt their psychomotor development, leading to harmful consequences for their psyche and body. These traumas cause psychomotor disorganization, affecting the way children interact with their environment and develop emotionally, cognitively, and motorically. The objective of this study is to analyze existing literature to better understand the impact of war trauma on the psychomotor dynamics of children, thereby highlighting the need for tailored interventions to support their development in conflict settings.

Method: A keyword and date-based search (2013-2023) was conducted in the PubMed, African Journal Online, Science Direct, and Cairn databases to identify scientific publications specifically addressing psychomotor development disorders resulting from post-traumatic stress in children who have experienced war.

Results: Twenty-three articles were selected, mainly consisting of case studies and prospective studies. The concepts discussed in these articles highlight the consequences of trauma on psychomotor development. Four disorders were identified: tonic regulation disorders, spatiotemporal organization disorders, body image disorders, and body schema disorders.

Discussion and Conclusion: The care of children affected by war must restore harmony between the psyche and the body, both of which have been traumatized, in order to facilitate their adaptation to their environment. Body-based approaches are often more suitable for this age group than therapies focused solely on verbal communication. Therapies centered on emotional regulation, repairing interpersonal bonds, and ensuring emotional safety are essential to support their recovery and optimal development despite the trauma they have experienced.

Sexual assault victims, particularly those subjected to extreme violence, experience both psychological and physical trauma that affects their psychomotor dynamics. The consequences are multifaceted: emotional, sensory, relational, and spatiotemporal disorders. This vignette illustrates the effects of trauma on a patient's psychomotor dynamics. It reflects the disconnection between the body and mind caused by trauma. This body-mind rupture manifests clinically as disorganization in the body, in spatial-temporal references, and in thought. The unspeakable event leaves a trace in the form of raw sensory material that the victim cannot process, which can be seen as the "signature of the trauma" (Nebout-Lenes, 2001). Psychomotor therapy helps the patient reconnect with the "sensory" through the body, offering an opportunity for expression and verbalization (Daudin & Defontaine, 2015). The goal of psychomotor care is to assist in the verbalization of the bodily experience and the accompanying emotions using various media of expression.

Objective - This study aims to identify the prevalence of PTSD and its correlation with body satisfaction among patients consulting at hospitals in Bukavu, a region located in eastern DRC, South Kivu, which is dominated by recurrent wars causing death, desolation, and other traumatic events on a daily basis.

Methodology - The PTSD Checklist (PCL-5, vf) was used to screen for post-traumatic stress disorder (PTSD), and the Bruchon-Schweitzer Questionnaire (QIC) was used to analyze body satisfaction among patients consulting in internal medicine. The pathological threshold for the PCL-5 was >=32, and the threshold for body satisfaction was >=3. The patients consulted were aged between 18 and 65 years. The interview duration varied between 45 and 60 minutes.

Results - A total of 75 patients were recruited for this study. Among them, 26 cases (34.7%) suffer from PTSD (score >32) although they sought consultation for a somatic condition. Their average body satisfaction score was 2.65. Of these 26 PTSD cases, 17 were aware of the existence of a clinical psychologist in the area, but only 7 patients consulted the psychologist.

Conclusion - The results of this study confirm the hypothesis that 10 to 20% of individuals exposed to trauma develop PTSD. These individuals have a negative perception of their bodies, and the majority do not consult the clinical psychologist in Bukavu.

Introduction : Urinary incontinence (UI) is the complaint of any involuntary loss of urine. It is a very common condition worldwide with a prevalence ranging from 15% to 55% of the female population [1]. There is no epidemiological data among community-dwelling adult (≥ 18 years) female in the Democratic Republic of Congo (DRC). The aim is to highlight the prevalence and factors that may contribute to the occurrence of UI.

Methods : It is a community-based cross-sectional study conducted in 2021-2023 among 507 women (≥18 years) in 6 health centers in the provinces (Kongo central, Kasai-Oriental, Equateur, Kinshasa, Nord et Sud-Kivu) of DRC. Sampling was non-probability. Any consenting woman who spoke French or could be translated was included. Pregnant or postpartum women ≤ 6 months and those with vesicovaginal fistulas were excluded. The International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS), in French, was used. Pelvic floor muscles were assessed according to the PERFECT scheme. Student's t-test and binary logistic regression were used with an α threshold of 0.05.

Results The prevalence of UI was 31% (CI95%: 27 - 35.2%) of which 51% were embarrassed. The prevalences of urinary urgency, stress and mixed incontinence were 63.7%, 11.5% and 22.9% respectively. The mean age of incontinent women compared with continents was 36.9±15.1 years versus 32.2±14.2 years (p<0.001). Pelvic floor muscle functionality was low in both groups (p=NS). In univariate analysis, age, occupational status, constipation, parity, episiotomy, perineal tears and loss of vulvar elasticity were risk factors for UI. But in multivariate analysis, only constipation, episiotomy, perineal tears and professional status remained risk factors for UI. No pelvic floor parameters were associated with UI.

Conclusion : This study shows that UI is common among community-dwelling adults female in DRC with a high prevalence (31%) corresponding to range found in developing World literature (2.8 - 57.7%) [2]. This study emphasizes the importance of raising awareness among female and health-cares professionals and of setting up appropriate multidisciplinary care in the DRC.