The Prevalence of Violence and Abuse Among Internally

Displaced Haitian Women and Adolescents

Gloria Callwood, Ph.D., PI and DirectorCaribbean Exploratory Research Center

&Noreen Michael, Ph.D.

University of the Virgin Islands

January 12, 2010, Haiti experienced a 7.0 magnitude earthquake

Epicenter approximately 10 miles SW from the capital, Port-au-Prince

Estimated 316,000 lives lost 245,000 ruined or hopelessly damaged structures

estimated produced 200 million cubic yards of rubble

>1.5 million homeless Hundreds of thousands became “internally

displaced persons” Most governmental buildings and 20 % of Haiti’s

civil servants lost

Background: The Earthquake

Destruction

Destruction

Damage to Government Palace

Damage to Government Palace

Internally DisplacedHabitat International Coalition 10-8-2012 report Only 13,198 houses have been repaired and

4,843 permanent homes built. Of 1.5 Million, 369,000 people still living in

displacement camps 80 % of displaced have nowhere to return to

because they were renters. Data from International Organization for

Migration, current shortages will leave more than 300,000 without housing.

When evicted from camps, no option but to inhabit substandard housing units.

Tent City for Displaced Persons

Tent City for Displaced Persons

Facilities

Human Suffering

CERC Involvement

There is evidence of: Increased Intimate Partner Violence (IVP) after

major disasters High prevalence of sexual assault, IPV and

marital stress around the world where there are displaced populations from natural or human caused disasters

Increased danger to women of rape in refugee situations globally, often necessitating both community safety strategies and increased rape interventions

Why CERC Involvement

2008 intimate partner violence (IPV) data from the population based Demographic and Health Survey (DHS) from 10 countries included Haiti Data

• Report supports that violence against women was a serious problem in Haiti before the 2010 earthquake.

The U S Virgin Islands are in close proximity to Haiti and has a substantial Haitian immigrant population

• Proximity & existing relationships/links to the Caribbean Diaspora make CERC uniquely situated & relevant to addressing violence against displaced women and girls survivors of the earthquake

• CERC major research is focused on violence against women

Why CERC Involvement

CERC wrote a proposal for a supplement to Center grant to fund Haiti Project

Awarded two years funding

The Study

1) Design and develop collaborative approaches and measures to protect internally displaced women and adolescent girl survivors of the Haitian Earthquake from violence and abuse.

2) Describe the prevalence of violence and abuse among internally displaced Haitian women and adolescent girls following the Haitian Earthquake.

3) Evaluate the outcomes of a collaborative project designed to protect internally displaced women and adolescent girls from violence and abuse following the Haitian Earthquake.

Purpose/Aims

Participants:Displaced women and girls 12-44 years old living in Port au Prince

and surrounding areas Process, Instruments and Data collection:

Focus groups representing women, men, health professionals to assure cultural appropriateness and sensitivity

Haitian staff PI, Coordinator, data Collectors

Culturally appropriate measures reviewed and translated into Haitian and French Creole by Haitians

Audio Computer Assisted Self Interview (ACASI) system used to collect data

Methodology

Project delays related to:• Cholera outbreak• Political unrest• Carnival Change of head of state and key players

resulted in need to identify and make contact with new governmental appointees who can positively impact improvement of Haitian women’s status

Challenges

Met with: ◦ Key players in Government ◦ NGOs working on Gender Based Violence ◦ Focus groups

Obtained project approval from Haitian Ethics Committee Entered into subcontract with Universite´ Jean Price Mars

◦ Hired Haitian research staff◦ Provided training to staff◦ Pilot tested use of ACASI system with participants◦ Tested electronic upload of data◦ Completed initial survey interviews

Shared information about project with Haitian community at INUFOCAD graduation

Project Activity to Date

Preliminary Results

DEMOGRAPHIC INFORMATION

The Adolescent Sample◦ Number of Adolescents in Sample: 78◦ Age

Mean Age = 14.2 Median Age = 14

◦ Education 90% attended school before the earthquake 86% were enrolled in school after the earthquake

◦ Education 42.3% reported a 5th grade education or below 37.2% reported being in grade 6th, 7th or 8th 16.7% reported being at the high school level

Demographic Information

The Adult Sample◦ Number of Adults in Sample: 208◦ Age

Mean Age = 28 Median Age = 27 [Over 50% in the 20-29 age group]

◦ Education 8th grade or less 38.2% Some High School 42.8%

High school graduate or HS equivalence 3.9% Some trade, community college 1.4% Completed trade, community college 2.4% Never attended high school 11.1%

Demographic Information

A LOOK AT ABUSE IN THE HAITIAN COMMUNITY

Prevalence of Physical Abuse Pre and Post Earthquake

Physical or Emotional Abuse before Earthquake

Response Frequency Percent

No 39 50.0

Yes 39 50.0

Total 78 100.0

Physical or Emotional Abuse after Earthquake

Response Frequency Percent

No 38 48.7

Yes 40 51.3

Total 78 100.0

Haiti Survey – Adolescent Questionnaire Results

Prevalence of Physical Abuse Pre and Post Earthquake

Haiti Survey – Adult Questionnaire Results

Physical or Emotional Abuse before Earthquake

Response Frequency Percent

No 63 30.3

Yes 145 69.7

Total 208 100.0

Physical or Emotional Abuse after Earthquake

Response Frequency Percent

No 58 27.9

Yes 150 72.1

Total 208 100.0

Prevalence of Physical Hurt Pre and Post Earthquake

Physical Hurt by someone before Earthquake

Response Frequency Percent

No 42 53.8

Yes 36 46.2

Total 78 100.0

Physical hurt by someone after Earthquake

Response Frequency Percent

No 43 53.8

Yes 36 46.2

Total 78 100.0

Haiti Survey – Adolescent Questionnaire Results

Prevalence of Physical Hurt Pre and Post Earthquake

Physical Hurt by someone before Earthquake

Response Frequency Percent

No 72 34.6

Yes 136 65.4

Total 208 100.0

Physical hurt by someone after Earthquake

Response Frequency Percent

No 75 36.1

Yes 133 63.9

Total 208 100.0

Haiti Survey – Adult Questionnaire Results

Prevalence of Sexual Abuse Pre and Post Earthquake

Sexual Abuse before Earthquake

Response Frequency Percent

No 61 78.2

Yes 17 21.8

Total 78 100.0

Sexual Abuse after Earthquake

Response Frequency Percent

No 61 78.2

Yes 17 21.8

Total 78 100.0

Haiti Survey – Adolescent Questionnaire Results

Prevalence of Sexual Abuse Pre and Post Earthquake

Sexual Abuse before Earthquake

Response Frequency Percent

No 106 51.0

Yes 102 49.0

Total 208 100.0

Sexual Abuse after Earthquake

Response Frequency Percent

No 103 49.5

Yes 105 50.5

Total 208 100.0

Haiti Survey – Adult Questionnaire Results

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0%

10%

20%

30%

40%

50%

60%

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Before EarthquakeAfter Earthquake

Perpetrator of Physical or Emotional Abuse

Haiti Survey – Adolescent Questionnaire Results

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0%5%

10%15%20%25%30%35%40%45%

Before EarthquakeAfter Earthquake

Perpetrator of Physical or Emotional Abuse

Haiti Survey – Adult Questionnaire Results

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Other

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0%

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Before QuakeAfter Quake

Perpetrator of Physical Hurt

Haiti Survey – Adolescent Questionnaire Results

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Before QuakeAfter Quake

Perpetrator of Physical Hurt

Haiti Survey – Adult Questionnaire Results

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Before QuakeAfter Quake

Perpetrator of Sexual Abuse

Haiti Survey – Adolescent Questionnaire Results

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0%5%

10%15%20%25%30%35%40%

Pre QuakePost Quake

Perpetrator of Sexual Abuse

Haiti Survey – Adult Questionnaire Results

EVIDENCE OF VICTIMIZATION

Sexual VictimizationPhysical VictimizationPsychological/Emotional Victimization

Sexual Experiences Victimization

Haiti Survey – Adolescent Questionnaire Results

Adolescents' Sexual Experiences

Victim of Sexual ContactVictim of Attempted RapeVictim of Sexual CoercionVictim of Rape

Note: n=34

Victimization

Not Rape VictimRape Victim

Note: n=72

Rape Victimization

Haiti Survey – Adolescent Questionnaire Results

Physical Victimization

Haiti Survey – Adult Questionnaire Results

Mean = 45.11SD = 19.4Reliability = r = .957N = 131

Experience with Battering

Not BatteredBattered

Mean = 31.98SD = 16.85Reliability = r = .94N = 207

Psychological/Emotional Battering

Haiti Survey – Adult Questionnaire Results

USE OF RESOURCES

Use of Resources by Adolescents

*Helpfulness – Resource rated as “Good, Very Good or Excellent”

Resource Usage Helpfulness*

Parent or Guardian 31.9% 73.9%Legal Assistance (P or G) 26.4% 63.2%Teacher or Head Master 26.4% 68.4%Fellow Student or Friend 26.4% 73.7%Mental Health Professional 25.0% 61.1%Church 40.3% 72.4%ER or Clinic 23.6% 64.7%Primary Care MD or Nurse 34.7% 84.0%Internet 6.9% 60.0%

Note: Care should be taken in interpreting results. Number of respondents ranged from a low of 5 to a high of 29.

Use of Resources by WomenRESOURCE USAGE HELPFULNES

S*Workplace, School, Supervisor, Instructor 16.8% 25.0%Co-worker or Co-student 22.6% 34.9%Mental Health professional 20.5% 35.9%Church, Priest, Voodoo Priest 18.9% 41.7%Alcohol/Drug treatment program 10.6% 25.0%Legal Assistance 17.9% 35.3%Restraining Order 14.3% 40.7%ER or Clinic 19.5% 54.1%Primary Care Doctor or Nurse 18.9% 55.6%Community Health Worker 12.1% 60.9%Crisis Hotline 18.9% 47.2%Domestic Violence (DV) Advocate 16.3% 38.7%DV Support Group 14.7% 42.9%DV Shelter 15.3% 41.4%Police 18.4% 42.9%DLS, BS, NGOs 15.3% 69.0%Community Organization or NGO 5.8% 45.5%Internet 12.1% 60.9%

*Helpfulness – Resource rated as “Good, Very Good or Excellent”

IMPLICATIONS AND NEXT STEPS

Health care providers can positively intervene with women and girls at risk for or victims of violence by routinely assessing for violence, and providing appropriate interventions, referrals, and safety messages

Implications

Development of safety training modules to be delivered to percentage of participating women and girls

Collaboration with KOFAVIV (NGO) to deliver training

Resurvey of participants receiving training to evaluate effectiveness of training in keeping participants safe

Next Steps

Michelle J. Hindin; Sunita Kishor; Donna L. Ansara (2008) Intimate Partner Violence among Couples in 10 DHS Countries: Predictors and Health Outcomes. DHS Analytical survey # 18. Calverton, MD, USA. Macro International, Inc.

International Rescue Committee Report (2011) http://www.rescue.org/sites/default/files/resource-file/IRC_Report_HaitiAnniversary.pdf

Habitat International Coalition: reprint of10-8-2012 report Haiti-Housing: Organizations launch “lasting solutions” campaign for displaced people. AlterPresse

References

Haiti Project Team Doris W. Campbell, PhD, ARNP, FAAN1; Desiree Bertrand, MSN, RN1;

Tessa Liburd1, Kimbalee Dawson, MA1; Lorna W Sutton, MPA1; Noreen Michael, PhD₁ Jacquelyn C. Campbell, PhD, RN, FAAN2; Phyllis W Sharps, PhD, RN, FAAN2; Nancy Glass, PhD, RN, FAAN2, Elizabeth Sloand, PhD, RN2; Betty Dennis, PhD, RN3; Cheryl Killion, PhD, RN, FAAN4 ; Faye Gary, PhD, RN, FAAN4 ; Hossein Yarandi, PhD5; Annie Lewis-O’Connor, PhD6

◦ Affiliations 1University of the Virgin Islands; 2 Johns Hopkins University; 3North Carolina Central University; 4Case Western Reserve University; 5Wayne State University; 6 Brigham and Womens Hospital

Haitian Collaborators: Nicole Muller-Cesar, MSW, Project Director; Jean Fanélise, MSA, HSA,

MD, PhD., Project Coordinator

Haitian Nationals and residents of Port au Prince who shared their insights.

Funded by NIH NIMHD to the University of the Virgin Islands School of Nursing Grant # P20 MD002286

Acknowledgements