Globally, sexual violence against young girls and women during war is recognized as a major public health problem associated with long-term adverse physical, mental, and social consequences [
1‐
7]. From Liberia to the Democratic Republic of Congo (DRC) and from Northern Uganda to the Central African Republic (CAR), sexual violence has been frequently used during war, mostly targeting young girls and women [
2,
4,
5,
7‐
10]. In these wars, incidents of serial rape and torture are reported to be a daily occurrence at individual, family, and community levels for girls and young women [
2,
4,
6‐
9]. In this study the focus was on sexual violence perpetrated against the civilian population in Northern Uganda in the two-decade (1986–2006) violent conflict between the Lord’s Resistance Army (LRA) rebels and government troops. The motivation for carrying out sexual violence against the population in Northern Uganda differed significantly between both warring factions [
11].
Widespread variations exist across conflicts, warring factions, and regions regarding sexual violence during war. For example, in Eastern Democratic Republic of Congo, sexual violence has been rampant and perpetrated with impunity to subjugate, weaken, humiliate, and punish the enemy [
4]. In Northern Uganda, sexual violence was embedded in the ideology of the LRA and operationalized through its structures and norms [
6]. Although many theories have been developed over the years to explain war-time sexual violence [
12], the theories of “
militarized masculinity” [
13] and “
organizational opportunity” [
14] can be used to explain the nature of sexual violence perpetrated in Northern Uganda during the two-decade war (1986–2006). In the “
militarized masculinity” theory, sexual violence is used to show power by feminizing the perceived enemy [
13]. In Northern Uganda, government troops targeted the population, especially the Acholi sub-region, where men were forced to have sex with other men or with inanimate objects such as banana stems, or to rape women in the presence of their husbands or family members [
11]. Therefore, the “
militarized masculinity” theory can be used to explain the type of sexual violence perpetrated by government troops. The LRA, on the other hand, specifically targeted girls and young women for abduction to become “wives” to LRA fighters and commanders and to produce children with them. In rebel captivity, sexual relations and violence were controlled and regulated. The rape of civilians was very rare and sexual activities outside of “marriage” were prohibited in LRA captivity [
5,
15]. Sexual violence was embedded in the ideology of the LRA whose leader, Joseph Kony, claimed that the Holy Spirit had ordered him to create a purer Acholi race untainted by President Museveni [
16]. Consequently, sexual violence perpetrated by LRA fighters aligns with the “
organizational opportunity” theory [
14].
The current study
The current study focuses mainly on reported sexual violence among young women while in LRA captivity who either escaped or were released by their captors. The study aims to assess the roles of stigma and community relations in the association between reported sexual violence and general functioning among formerly abducted girls in Northern Uganda. Such data are crucial for informing the development of interventions that support formerly abducted girls as they return to their communities. In this context,
general functioning is conceptualized as maintaining consistent self-care through attention to hygiene, feeding, safe housing environment, domestic chores, planning for future activities, and developing basic social skills through living in harmony with family members and the community.
Stigma is conceptualised as being labelled and perceived according to negative stereotypes (for example, defiled, tainted, of low value, and unworthy), and suffering resultant discrimination from either family or community members [
17].
Community relations is conceptualised as how the local community treats, perceives, and regards a formerly abducted girl with possibly little or complete lack of respect and consideration (for example, being afraid of, disrespectful to or pretending to be better than her). Finally,
sexual violence is conceptualised as, inter alia, being raped, sexually enslaved, forcefully allocated as a “wife” to a man, and/ or to endure forced pregnancy.
Specifically, the objectives of the current study were to assess reported sexual violence against formerly abducted girls in Northern Uganda and its effects on general functioning, stigma, and community relations; and to quantify the extent to which stigma and poor community relations mediate the associations between reported sexual violence and general functioning. Relating reported sexual violence to general functioning is crucial because it provides insight into how formerly abducted girls contribute to their communities, families, and their own survival in the aftermath of the war. The present study has the potential to add to the existing literature concerning the pathologies of sexual violence among young girls and women in Northern Uganda and the Great Lakes region; shed light on key factors that account for the effects of reported sexual violence on general functioning; and inform interventions aimed at mitigating the impact of the pandemic of sexual violence on formerly abducted girls in the aftermath of the LRA war.
Although incidents of sexual violence have been reported in many theatres of war by international bodies such as the United Nations (UN Resolution 1960 of 2010), research on its long-term adverse physical, mental, and social consequences has lagged behind [
10]. This is notwithstanding the fact that physical health problems associated with reports of sexual violence against young girls and women are suggested to be long-term [
18]. Serious health consequences of sexual violence include traumatic genital injuries that may result in fistulae, problems related to reproduction and sexually transmitted infections including HIV [
3,
4,
8,
19,
20]. The physical health consequences of sexual violence have also been associated with adverse mental health outcomes such as depression, anxiety, low self-esteem, and later promiscuous sexual behavior [
3,
21‐
25]. Similarly, post-war poverty and material deprivation drive many formerly abducted girls and women into trading sex for food and material items. For example, studies on war-affected girls and women in Northern Uganda show that sexual promiscuity was common among girls and women who were raped by rebel or government soldiers and paramilitary forces [
3,
26].
In addition to physical and mental health problems, sexually violated girls and young women report stigmatization and poor community relations as a result of their war experiences. Stigma might be seen to arise due to the lack of approved moral and sexual behaviour in Acholi culture, custom and tradition based upon traditional practices surrounding marriages. Sex and the bearing of children outside this cultural milieu met with disapproval, rejection, and discrimination. Furthermore, the stigma is extended beyond the formerly abducted girls to their children [
27,
28] compounding the mother’s mental health problems and poor general functioning. Studies on stigma among people living with HIV have found that it exacerbates mental health problems such as depression, anxiety, and PTSD, all of which are known to impair normal functioning [
29‐
31]. It is likely that a combination of stigma and poor community relations may partly explain poor functioning among formerly abducted girls who report sexual violence.
Previous research indicates that women who report sexual violence lack a robust social support structure and live under the constant shadow of pain and discomfort that may impair their general functioning [
28]. In addition, formerly abducted girls who report sexual violence may experience rejection from family and society and face discrimination for having been former rebel soldiers’ ‘wives’ or having children fathered by rebel soldiers and/ or commanders alleged to have committed atrocities [
32]. Communities sometimes interpreted the double tragedy of the girls as a sign of weak moral standing. There is a dearth of research assessing the extent to which this negative societal evaluation impacts the long-term general functioning of formerly abducted girls who report sexual violence.