Every year, large numbers of women and men are victims of sexual violence. “Sexual violence is any sexual act carried out against someone's will. It can be carried out by any person, regardless of their relationship with the victim, in any environment” (1). On average, it takes six months for victims to tell a loved one about sexual violence and often a year has already passed before they seek professional help (2). By that time, they may have already developed mental health problems, such as psychotraumatic stress disorder (PTSD) or depression (3).

Sexual violence can happen to anyone. Certain groups have an increased risk of experiencing this. Young women between the ages of 18 and 25 and adolescents between the ages of 12 and 18 are at the highest risk of sexual violence (4). Within this group, women with low self-esteem, low self-confidence, no circle of friends, school absenteeism and a cognitive or physical disability are more likely to experience sexual violence.

Victims of human trafficking and refugees also often face sexual violence. In the case of human trafficking, a person is forced to work in circumstances where personal freedom is often severely restricted. Refugees are often a particularly vulnerable group due to their social position with little power. Knowledge of these target groups can contribute to faster identification of mothers with a child born of sexual violence.

Sometimes a woman gets pregnant after sexual assault. The exact prevalence of children born of sexual violence is unknown (5). Abortion is not always possible. Sometimes for practical reasons: women do not have access to care because they are refugees fleeing their country, and the care is simply not accessible. Cultural or religious reasons can play a role: abortion is a taboo. Finally, the pregnancy is sometimes discovered or recognised late. The period within which abortion should have taken place has already expired.

If mothers connect their traumatic experience with the child, this can cause problems in the mother-child relationship. After all, the child is a reminder of the sexual violence (6).

The identity of the child becomes so connected with that of the father, even when the mother and child never see the father again (6). This can lead to negative feelings of the mother towards the child. These feelings can alternate with positive feelings for the child, where the mother can also be aware of the innocence of the child.

Having a child born of sexual violence and talking about it is still a taboo. Because of this socially imposed silence, many mothers choose to live with their secret. In many cultures, mothers and children are stigmatised, discriminated against and often socially isolated, often means a life of long-term stress (5.6). This stress can undermine parenthood and the parent-child relationship.

Some mothers abandon their child or give it up for adoption (5). However, this is not always the case. Other mothers are positive about having a child, even though it was conceived in this way. For them, the child can also mean being rescued from an undesirable situation, or be the start of a new family. Many continue to look for ways to build a good relationship with their child, despite their psychological problems and the social stigma.

In many cases, mothers with a child resulting from sexual violence have more difficulty raising their child because they often suffer from trauma-related or depression-related symptoms, stigma and the resulting stress. These problems can make them less sensitive, less responsive and less emotionally available (6,8,9,10). Ambivalence in the mother-child relationship can lead to the formation of an unsafe attachment relationship (5,12). According to research, traumatised mothers have a greater risk of a less than optimal relationship with their child (12,13,14,15).

An unsafe attachment relationship poses a risk to the functioning of the child later in life (16). Children with an unsecure attachment are more often confronted with anxiety, depression, and behavioural problems and have more difficulty with social contact (17, 18). Adequate and early assistance can support the development of a secure attachment relationship.

Here we can see at a glance what the threats are when building a securely attached relationship with the mother. You can also read about it on the page about points of action in the treatment.

Some mothers seek help for their trauma-related or depression-related complaints because of the problematic behaviour of the child they experience and/or because they experience parenting as stressful. Some of them realise that they are not as good at parenting as they would like because of their own problems or their ambivalent attitude towards the child. Some mothers do want help, but do not get it or the help they do get is inadequate, because the cause of their problems remains undiscussed. Other mothers manage to shape the relationship with their child on their own. How large this group is and what makes them succeed is unknown.

What are the indications that a mother may have experienced sexual violence and has become pregnant as a result? Interviews with professionals who work with this target group said that they pay attention to the following signals (20):

• an unsafe attachment relationship between mother and child;
• hostile communication between father and mother (when the father is in the picture);
• the mother's body language (e.g. dislike of one's own body or child);
• negative thoughts of the mother about the (unborn) child;
• no or minimal initiative to make preparations for the child during pregnancy (Note: in some cultures, it is a matter of course not to make preparations, please consider this);
• avoiding talking about the child.

Asking the standard question about sexual violence, even if there are no direct signals indicating it, can help lead to adequate help earlier. Click here to read more about the different ways in which this can be requested.

For the same reasons, it is also good to ask women of childbearing age who apply for PTSD or depression treatment whether they may be pregnant.