Background: Food insecurity remains a major concern worldwide. In North and South Kivu provinces, the Democratic Republic of the Congo, repeated wars and gender-based violence exacerbate the situation. However, little is known about the determinants of food insecurity in the region. Objective: This study analyzed the gendered determinants of food insecurity in North and South Kivu in the Democratic Republic of Congo, a region of ongoing civil conflict. Methods: 1754 women were included in a cross-sectional study. Multilevel ordinal logistic regression was used to identify household-level determinants of food insecurity. Results: The poorest households were five times more likely to be food insecure (OR = 5.66, 95% CI 3.74–8.55). Women’s participation in decision-making about resource allocation decreased the risk for household food insecurity (OR = 0.68, 95% CI 0.57–0.87), while higher tolerance to gender-based violence increased the risk of food insecurity (OR = 1.29, 95% CI 1.05–1.54). Conclusion: Involving empowered women in decision-making about resource allocation and actions to reduce gender-based violence could help mitigate food insecurity.

Background: Access to quality healthcare is a global fundamental human right. However, in the Democratic Republic of the Congo, several parameters affect the choices of health service users in fragile, rural contexts (zones). The overarching aim of this study was to identify the first recourse of healthcare-seeking and the determinants of utilization of health centers (primary health care structures) in the rural health zones of Katana and Walungu. Methods: A cross-sectional survey was conducted from June to September 2017. Consenting respondents comprised 1751 adults. Continuous data were summarized using means (standard deviation) and medians (interquartile range). We used Pearson’s chi-square test and Fisher exact test to compare proportions. Logistic regression was run to assess socio-determinants of health center utilization. Results: The morbidity rate of the sample population for the previous month was 86.4% (n = 1501) of which 60% used health centers for their last morbid episode and 20% did not. 5.3% of the respondents patronized prayer rooms and 7.9% resorted to self-medication principally because the cost was low, or the services were fast. Being female (OR: 1.51; p = 0.005) and a higher level of education (OR: 1.79; p = 0.032) were determinants of the use of health centers in Walungu. Only the level of education was associated with the use of health centers in Katana (OR: 2.78; p = 0.045). Conclusion: Our findings suggest that health centers are the first recourse for the majority of the population during an illness. However, a significant percentage of patients are still using traditional healers or prayer rooms because the cost is low. Our results suggest that future interventions to encourage integrated health service use should target those with lower levels of education.

Objective: In the Democratic Republic of the Congo, there is a low adherence of the population to the use of family planning (FP) due to various social barriers. This study aimed to understand the drives from social barriers to the use of FP in women in the Kivu, a region particularly affected by poverty and many years of conflicts. A theory of planned behaviour (TPB) using a generalised structural equation modelling has been applied to understand the complex sociocultural drivers to the intention and the ultimate decision to use FP. Design: Longitudinal study. Setting: A community-based approach was used to investigate FP use in the North and South-Kivu regions. Participants: Overall, 1812 women 15 years and older were enrolled in the baseline study and 1055 were retrieved during the follow-up. Primary and secondary outcomes: FP use and intention to use FP. Results: The mean age was 36±12.9 years, with a minimum of 15 years old and a maximum of 94 years old. Among sexually active participants, more than 40% used a modern contraceptive method at the last sexual intercourse. Education was positively and significantly associated with intention to use FP (β=0.367; p=0.008). Being married was positively and marginally significantly associated with intention to use FP (β=0.524: p=0.050). S ubjective norms were negatively and significantly associated with intention to use FP (β=−0.572; p=0.003) while perceived control was positively associated with intention to use FP (β=0.578; p<0.0001). Education and perceived control were positively and significantly associated with the use of FP (respectively, β=0.422, p=0.017; and β=0.374; p=0.017), while Intention to use FP was positively and marginally significantly associated with the use of FP (β=0.583; p=0.052). Conclusion: TPB helped understand sociocultural barriers to FP use and it can be useful to define adapted strategies in different contexts.

In the Democratic Republic of the Congo, women in (peri-)urban areas are commonly engaged in small trade, which allows them to meet the basic needs of their families. Microsaving approaches are a low-risk option to obtain financing for economic activities. A project combining men’s sensitization on gender equity and women’s empowerment through village savings and loan associations were implemented in North and South Kivu to raise the household economic level. This study assessed how involving men in gender equity affects women’s health and socio-economic outcomes, including food security. A cohort study was conducted with 1812 women at the baseline; out of them 1055 were retrieved at the follow-up. Baseline data collection took place from May to December 2017 and the follow-up from July 2018 to January 2019. To identify socio-economic changes and changes of gender relations, linear and logistic regressions were run. Results showed that the household income improved with intervention (coefficient = 0.327; p = 0.002), while the capacity to pay high bills without contracting debts decreased (coefficient = 0.927; p = 0.001). We did not find enough statistically significant evidence of the influence of the intervention on skilled birth attendance (coefficient = 0.943; p = 0.135), or family planning use (coefficient = 0.216; p = 0.435) nor women’s participation in the decision-making (coefficient = 0.033; p = 0.227) nor on couple’s cohesion (coefficient = 0.024; p = 0.431). Food insecurity levels decreased over time regardless of being in the intervention or control area. Empowering women while sensitizing men on gender aspects improves financial well-being (income). Time, security, and strong politics of government recognizing and framing the approach are still needed to maximize the benefit of such projects on social factors such as women’s participation in decision-making and social cohesion.

The Democratic Republic of the Congo is among the poorest countries in the world with a low gender development index. To help households improve their economic levels and address gender-based violence, the Mawe Tatu programme was created to combine women’s empowerment through village savings and loans associations (VSLA) with engaging men in changing their attitudes and adopting positive masculinities. This study explores the impact of women’s empowerment through VSLA while their husbands participate in a men’s reflection group pursuing a gender equity curriculum. Data were collected over three years through focus group discussions and in-depth interviews with both men and women. Data were analysed using an inductive approach, building themes based on respondents’ narratives. Household welfare was described as ‘improved’ when both partners participated in the intervention. More cash was available in the household, cohesion within the couple increased, and men were more likely to involve their wives in decision-making processes. Men were also more involved in childcare and more concerned about their partner’s health, especially during pregnancy. Combining women's economic empowerment through VSLA while raising awareness of gender equity among their husbands is a promising approach. However, it is necessary to develop positive femininities in parallel to positive masculinities, as women to avoid being judged, may fear changes preserving empirical gender norms. Creating more ‘friendly’ and inclusive spaces in health centers will make it easier for men to accompany their wives for maternal health services.