Domestic Violence Against Women on Yap, Federated States of Micronesia

Abstract

Anecdotally there are high rates of domestic violence in the small Micronesian State of Yap, Federated States of Micronesia (FSM), but there have been no studies to quantify the prevalence or characteristics of domestic violence in Yap or in any other state of the FSM. A survey was administered to women at the Yap hospital and community health centers from February through June 2011. Survey data were on domestic violence, which was supplemented by a focus group to explore the issues involved in greater detail. A high prevalence of domestic violence was documented by the survey; perceptions about this were explored in the focus group. On the questionnaire, 148 of 194 (76%) women reported at least one form of abuse. Given the small number of adult women in Yap, these findings suggest that domestic violence is a serious, pervasive problem that Yap needs urgently to address. The issue clearly needs to be investigated throughout the other states of the FSM and addressed at the national policy level as well as at the state level.

Background

Yap, the western-most state of the Federated States of Micronesia (FSM) is located in the western Caroline Islands midway between Guam and Palau. Yap has a total population of approximately 11,200.¹ A majority, 65%, of the population resides on Wa'ab (Yap Proper): four islands connected by roads, waterways and channels, which includes the town of Colonia, Yap's capital, whose population is about 1000. The population density is 243 per square mile (190 for Wa'ab and 550 for the Outer Islands, comparable to the state of Hawai‘i's population density of 216.8 inhabitants per square mile²) and the median age is 20.9.³ According to the 2000 census (still the most recent data available in 2013, with preliminary data from the 2010 census suggesting little change⁴), there were a total of 2,030 households in Yap, with a median of 5.4 persons per household. Some cash income was reported by 1,578 households (77.7%), with a mean household income of $8,300. Yap's literacy rate is 92%. Life expectancy at birth is 66.5 for males, 67.6 for females. In 2004, per capita expenditure on health was US$180, an increase from US$116 in 2002.⁵ By 2008 this had increased to US$470 per capita⁶ (the World Bank reports the annual per capita health expenditure for the United States, 2008–2012, as $8,362; and for Yap's nearest neighbor, Palau, as $930).⁷

Domestic violence is defined as violence against women, men or children by someone in their family.⁸ It is also known as domestic abuse, spousal abuse or intimate partner violence (IPV). For adults, IPV has been defined as control by one or both partners in an intimate relationship such as marriage, dating, or cohabitation. Domestic violence has many forms, including physical aggression (hitting, kicking, biting), verbal/emotional abuse (yelling, threats, blame), sexual abuse, and economic coercion.

It has been difficult to determine precisely the prevalence of domestic violence in Yap since (1) most abuse goes unreported; (2) there is no organization on Yap that keeps records on the number of reports or calls; and (3) data cannot be found in hospital or clinic records. Stories told by health care professionals in Yap suggest anecdotally there are high rates of domestic violence yet there have been no surveys to quantify the prevalence and characteristics of domestic violence in Yap, or anywhere else in the FSM. An Outer Island Health Assessment concluded: “Domestic violence is not often publicly discussed among the Micronesian community.”⁹

Domestic violence occurs throughout the world's cultures and Yap is unfortunately no exception. Many men as well as women have experienced at least one type of abuse, however, this paper focuses on women, who are typically more often victimized, while men are more often the perpetrator.¹⁰ Regular substance use has been shown to be a contributing factor to domestic violence.¹¹ Quingley and Leonard (1999) state that “across a number of recent studies, the drinking pattern of the husband has emerged as one of the most consistent correlates of marital violence,”¹² a pattern found to be true of Micronesians,^13,14 although a recent study suggests that, at least among teenagers in Hawai‘i, drug use may be more closely associated to IPV than alcohol.¹⁵ Additionally, “IPV by both genders is associated with negative consequences that result in injuries, fear, depression, post-traumatic stress disorder, suicide, and homicide, although male-perpetrated IPV has more detrimental effects.”¹⁶ Increased health problems, including injury, chronic pain, gastrointestinal health problems, sexually-transmitted diseases, depression, and post-traumatic stress disorder are well documented by research on abused women in various settings.^17,18

This study focuses on the extent to which domestic violence exists on Yap, compares past and current IPV and child abuse in the family, and examines whether substance use was present at the time of the abuse.

Methods

This study used a mixed methods design. Quantitative data was collected via a written survey, while qualitative data was collected via a focus group. The study protocol was approved by the directors of the hospital and the community health centers acting as Yap's Institutional Review Board.

1. Survey

Data Collection Procedures:

No previous surveys have been conducted in Micronesia, so no culturally appropriate validated survey instrument exists. A survey was developed on domestic violence with input from members of the Yap Department of Health Services Division of Public Health and the Wa'ab Community Health Center (WCHC). It was piloted and revised twice before being implemented. The survey on domestic violence was conducted on Yap from February 2011 through June 2011. All women of Yap were invited to participate by completing the survey at one of the four WCHC sites or the Yap Hospital Outpatient Department. The anonymous written survey was offered to all women, aged 18 years and over. Some health care providers also offered the survey in several villages throughout Wa'ab.

Most women completed the survey without assistance from anyone. For women who requested translation services, health professionals from the WCHC or Yap Department of Health Services assisted in completing the survey. The survey, reproduced in Appendix 1 (see Appendix 1: <http://hjmph.org/HJMPH_Sep13(Dugwen_Appendix).pdf>), was offered to women residing in Yap regardless of whether or not they were originally from Yap.

Survey Analysis

An Access database was created to enter survey responses, which were then exported to Excel for tabulation and analysis by the authors. Data was used from all 199 completed surveys, and since there are less than 2000 adult women on Wa'ab (the total number of all-age females in 2000 was 3695 with 50% of the total under the age of 18), the survey represents approximately a 10% sampling of Yap's adult female population. For partially completed surveys, the denominator was adjusted for categories that were unanswered. Surveys had no personal identification on them, so it is impossible to determine whether women took the survey more than once; however, women were instructed to submit only one survey, and results were examined to be certain no exactly duplicate responses were submitted.

2. Focus Group

Data Collection Procedures

A single focus group was conducted to discuss the issues involved in IPV in greater detail. Eight Yapese women volunteered to participate in the four-hour session. All women were from two villages in the same municipality. The focus group was held in a community house in one of their villages. No incentives were offered. The discussion was conducted in Yapese, facilitated by this paper's first author who is fluent in Yapese. The following six questions were asked in the focus group:

1. Is domestic violence part of our culture?

2. What do you think causes a husband or partner to become violent?

3. Why do women still stay in the marriage?

4. Do you think the violence that children witness affects them and in what ways?

5. Why do women not talk to someone in the community or family member about it?

6. How and/or what can we do to address domestic violence particularly in Yap?

Women were not selected because they were abused, only because they volunteered to participate.

Focus Group Analysis

The focus group was recorded and transcribed into English. Data were analyzed using classic triangulation analysis,¹⁹ with key passages selected by the authors.

Results

1. Survey Results

A total of 199 women participated in the anonymous survey, with 76% (n=148) of respondents reporting experiencing at least one type of abuse; 93% of those reported having experienced verbal abuse, 41% physical abuse, 9% reported sexual abuse with an intimate partner (demographics are reported in Table 1, and key findings are summarized in Table 2).

Table 1.

Demographics of the survey participants.

Income n=177
$1,000 or Less	86	49%
$1,000 – $3,999	32	18%
$4,000 – $6,999	31	18%
$7,000 – $10,999	13	7%
$11,000 and more	15	8%
Education Level n= 197
College	75	38%
Elementary	34	17%
High School	88	45%
Current Relationship Type n=172
Married in court	9	5%
Married in church	26	15%
Cultural marriage	107	62%
Live-in	20	12%
Live apart	10	6%
In a Current Relationship n=194
Yes	160	82%
No	34	18%
Have Children n=157
Yes	119	76%
No	38	24%
Median Age	37
Range	18–70

Table 2.

Key Results of the Domestic Violence Survey (different denominators indicate number of women who answered that question)

Description	Count	Percent
Self-reported abuse history Never been abused Experienced at least one type of abuse Current and past abuse by family	38/194 148/194 8/194	20% 76% 4%
			Women who ever experienced physical or sexual abuse	88/194	45%
			Women who are currently in a relationship that is abusive	97/160	61%
Women who are currently in a verbally abusive relationship	90/97	93%
Women who are currently in a physically abusive relationship	40/97	41%
Women who report ever being abused by a male family member as a child	58/153	38%
Women who would see a professional domestic violence counselor if available on Yap	130/187	70%
Women who would use a women's shelter	103/186	55%

Additionally, 62% of women who reported abuse indicated that their male partner was usually under the influence of alcohol during the abuse. Of the women who reported abuse, 38% reported having been abused as a child; 19% reported having been sexually abused, 24% reported having been physically abused, 53% reported having been verbally/emotionally abused and 45% of the total respondents reported that the perpetrator, a family member, was under the influence of alcohol at the time of abuse.

Respondents also indicated how they wanted the problem of domestic violence addressed on Yap. The majority responded that they would see a health professional trained in mental health counseling (70%) and that a shelter for battered women should be built on Yap (55%).

2. Focus Group Results

Four main themes emerged from the focus groups: (1) personal experiences of abuse; (2) reasons for silence on the topic; (3) cultural influences; and (4) suggestions for improving the situation.

All eight focus group participants reported having experienced at least one type of abuse or to know another female victim. They agreed that the consumption of alcoholic beverages and use of marijuana contribute greatly to domestic violence on Yap. When asked if they had thought of going to the police or running to someone for safety, participant responses included one woman who said “it's hard to think of anything at the time of the actual beating.” Another woman said “most of the time we don't see it coming and so we are not prepared and it's hard for us to run off when the kids are scared and crying.” Only a few women admitted being able to escape the violence by running into the bushes and waiting until their husband was asleep before going back to the house, or finding safety in a neighbor's house. “As for the police, it's hard because they either get to the scene and it's finished or when they arrive they are told to go back and mind their business,” one woman added. These women felt that when they were growing up, intimate partner violence was less frequent and less common in their parents' generation.

During the focus group, one woman related a personal experience: “an unfaithful male who is cheating on his partner, would accuse her of cheating on him,” an observation to which the rest of the participants agreed. There are women who reported being physically abused if a man other than their intimate male partner talked to her - at work, shopping or at a social gathering. “It's an excuse to beat us up and no matter what we say or the fact that we're innocent, he's always right.” Many of the beatings are severe, leaving the female partner on the ground crying, pleading, and covered in blood.

As for records at the hospital, focus group participants did not believe that there was much IPV data for Yap because, when they do seek medical care, the description of the incident is changed before the woman reaches the hospital. Victims claim they fell or weren't looking where they were going and walked right into a door or corner of a shelf. Instead of seeking medical care, most women either stay home or go to their family for local medicine to treat the cuts, bruises and broken bones. These women are constantly living in fear and are reminded that if they leave they will never see their children or meet someone else. Though much of the abuse seems barbaric, most of the women on Yap choose to stay in their marriage.

“I only go back to my husband after each fight not because I still love him, but because of the children. Earlier on in the marriage, after the first physical and verbal/emotional abuses, I left and went to my family for security. He came the next day sober and said he will never drink again, yell at us and tell us to leave. It's been more than five years and it's still happening, but I'm only staying for the children.”

One woman commented that in Yapese culture, if the woman dies while married to her husband, their children will have land, which provides them with security and stability. Perhaps, she added, “this is why some brutally abused women stay with the same partner until death from the abuse. But abuse of any type is not a part of the traditional culture of Yap. There was no tradition of using violence to 'discipline' your wife.” Traditionally, at the beginning of the marriage, the wife's family would inform the husband's family that if she misbehaves, to “put her on the road” so she can go back home, but never to beat her up, but this custom is no longer practiced.

When two or more women gather, participants related, they often gossip about a guy in the community who beat up his wife because of the visible bruises on her face and arms, but when she is confronted she lies and comes up with excuses. When asked why some women don't go and ask someone in the community for assistance, the respondents felt that this would be perceived as gossiping about your family and allowing the community to know what one's husband does. Since Yap is small in size and population, women fear that once the word reaches their partner, the next beating will be worse than the last and will come at a time when they least expect it.

Focus group participants also noted that they are not the only victims of abuse. One of the women said her husband verbally and physically abused their children to make her feel bad. “The abuse happens at home and parties or family gatherings. Every time I tell him not to yell or talk harshly at our kids especially in a crowd, I always get beaten up at home and yelled at that I'm an animal and do nothing for him or his family.”

Some women report feeling ashamed if the community finds out. Some feel they deserved the abuse, and there are women who feel it is a private family matter that should not involve the government, community members, or friends.

Discussion

Both our survey and focus group demonstrate that domestic abuse is definitely a problem in Yap.

The results of this study suggest that Yap may fit into the mid-range of domestic abuse rates throughout the world. A WHO multi-country study found a range between 15% (Japan) to 71% (Ethiopia) of women aged 15–49 years reported physical and/or sexual violence by an intimate partner at some point in their lives.²⁰ High rates of women being victims of physical abuse have been shown for Barbados at 30%, Canada at 29%, Egypt at 34%, New Zealand at 35%, Switzerland at 21%, and United States at 25%. This study shows that Yap at 41% has a higher percentage than any of these.²¹ The problem may well be as severe throughout the FSM, where at least two deaths have been reported as the result of severe wife beating,²² but a culture of silence still surrounds the issue throughout Micronesia.⁸ Nearby, the Republic of Palau faces similar problems of domestic violence, as reported by a 1997 survey,²³ while Samoa has also reported significant cases of domestic violence.²⁴

Domestic violence is not healthy in any relationship, regardless of culture or traditions. Substance use and abuse contributes to the problem; our findings regarding the effects of alcohol support the findings of a study on injuries in Yap that showed that 88% of all injuries were alcohol related.²⁵ Furthermore, hundreds of studies have shown that alcohol abuse is closely associated with violence and offenses,26 but this should not be considered an excuse for domestic violence. Yap's women are especially vulnerable, as this study indicates that they face high rates of domestic violence but lack options for escape, protection or support.

The FSM laws may not have a clear legal position aimed specifically at domestic violence, but domestic violence falls under the definition and description of assault under Yap State Law No. 2-48 Section 209 and severe cases need to prosecuted under this law. The FSM did accede without reservations to the UN treaty that included the Convention on the Elimination of All Forms of Discrimination against Women in September of 2004,²⁷ though it remains unclear whether the FSM regards itself as bound by the provisions of that treaty.

The prevalence of domestic violence throughout the FSM, including the Outer Islands of Yap, should be documented by surveys similar to this one, to inform a national level policy discussion on how to remedy the problem in ways that are culturally sensitive yet effective.

These findings are subject to several limitations. As the study was conducted in the health centers and hospital, the study sample may not be perfectly representative of all Yapese women. However, because health care services are essentially free in Yap and the health centers are distributed around Wa'ab, the survey is likely to be representative of the women of Wa'ab. Clearly the sample is not representative of the women residing in the outer islands. Some responses to the survey were invalid/never completed. Only 7 Outer Island women completed the survey, and therefore the results may not be applicable to Yap's Outer Islands. For a more representative sample, women from the Outer Islands need to be included in future research. The sample suffers from being a convenience sample and therefore is open to bias, since data were gathered from a convenience sample. Women who were either abused themselves or knew of someone may have been more interested in participating, which would result in the over-representation of the prevalence of IPV. However, it may also be argued that women who experienced abuse may be more uncomfortable with participating in a domestic violence survey or focus group, which in turn would result in the under-reporting of IPV.

Conclusions

In 2009, President Mori of the FSM signed a proclamation that on November 25, 2009, the FSM would observe International Domestic Violence Prevention Day. The proclamation urged all residents of the FSM to raise social awareness on the issue of domestic violence against women and its prevention.²⁸ However, as of the writing of this paper in 2012, there has not been another observance on this issue. It would be beneficial if individuals and agencies in the community that have experience, training, and education on violence and substance abuse advocate for the victims and raise community awareness that this problem requires action. These individuals and/or agencies include law enforcers, medical, and legal professionals who come in contact with victims of violence, abuse, or substance abuse. Together these agencies, along with the hospital and community health centers, should participate in discussions on ways that social policies can be improved to address this problem, a discussion this study hopefully facilitates.

Conflict of Interest

None of the authors identify any conflict of interest.