The Prevalence of Violence and Abuse Among Internally Displaced Haitian Women and Adolescents

1. The Prevalence of Violence and Abuse Among Internally Displaced Haitian Women and Adolescents Gloria Callwood, Ph.D., PI and Director Caribbean Exploratory Research Center & Noreen Michael, Ph.D. University of the Virgin Islands

2. Background: The Earthquake • 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

3. Destruction

4. Destruction

5. Damage to Government Palace

6. Damage to Government Palace

7. Internally Displaced Habitat 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.

8. Tent City for Displaced Persons

9. Tent City for Displaced Persons

10. Facilities

11. Human Suffering

12. CERC Involvement

13. Why 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

14. 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

15. CERC wrote a proposal for a supplement to Center grant to fund Haiti Project Awarded two years funding

16. The Study

17. Purpose/Aims • 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.

18. Methodology • 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

19. Challenges • 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

20. Project Activity to Date • 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

21. Preliminary Results

22. Demographic Information

23. 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

24. 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%

25. A Look at Abuse in the Haitian Community

26. Prevalence of Physical Abuse Pre and Post Earthquake • Physical or Emotional Abuse after Earthquake • Physical or Emotional Abuse before Earthquake Haiti Survey – Adolescent Questionnaire Results

27. Prevalence of Physical Abuse Pre and Post Earthquake • Physical or Emotional Abuse after Earthquake • Physical or Emotional Abuse before Earthquake Haiti Survey – Adult Questionnaire Results

28. Prevalence of Physical Hurt Pre and Post Earthquake • Physical hurt by someone after Earthquake • Physical Hurt by someone before Earthquake Haiti Survey – Adolescent Questionnaire Results

29. Prevalence of Physical Hurt Pre and Post Earthquake • Physical hurt by someone after Earthquake • Physical Hurt by someone before Earthquake Haiti Survey – Adult Questionnaire Results

30. Prevalence of Sexual Abuse Pre and Post Earthquake • Sexual Abuse after Earthquake • Sexual Abuse before Earthquake Haiti Survey – Adolescent Questionnaire Results

31. Prevalence of Sexual Abuse Pre and Post Earthquake • Sexual Abuse after Earthquake • Sexual Abuse before Earthquake Haiti Survey – Adult Questionnaire Results

32. Perpetrator of Physical or Emotional Abuse • Haiti Survey – Adolescent Questionnaire Results

33. Perpetrator of Physical or Emotional Abuse • Haiti Survey – Adult Questionnaire Results

34. Perpetrator of Physical Hurt • Haiti Survey – Adolescent Questionnaire Results

35. Perpetrator of Physical Hurt • Haiti Survey – Adult Questionnaire Results

36. Perpetrator of Sexual Abuse • Haiti Survey – Adolescent Questionnaire Results

37. Perpetrator of Sexual Abuse • Haiti Survey – Adult Questionnaire Results

38. Evidence of Victimization Sexual Victimization Physical Victimization Psychological/Emotional Victimization

39. Sexual Experiences Victimization • Haiti Survey – Adolescent Questionnaire Results

40. Rape Victimization • Haiti Survey – Adolescent Questionnaire Results

41. Physical Victimization Mean = 45.11 SD = 19.4 Reliability = r = .957 N = 131 • Haiti Survey – Adult Questionnaire Results

42. Psychological/Emotional Battering • Haiti Survey – Adult Questionnaire Results

43. Use of Resources

44. Use of Resources by Adolescents • *Helpfulness – Resource rated as “Good, Very Good or Excellent” Note: Care should be taken in interpreting results. Number of respondents ranged from a low of 5 to a high of 29.

45. Use of Resources by Women • *Helpfulness – Resource rated as “Good, Very Good or Excellent”

46. Implications and Next Steps

47. Implications • 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

48. Next Steps • 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

49. References • Michelle J. Hindin; SunitaKishor; 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

50. Acknowledgements 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