Experience and impact of gender-based violence in Honiara, Solomon Islands: a cross-sectional study recording violence over a 12-month period

Abstract

Objective

This study aims to collect data on the experience and impact of gender-based violence experienced by women attending health clinics in Honiara, Solomon Islands.

Method

Any woman over the age of 18 who attended a local health clinic in Honiara, Solomon Islands during the time of recruitment (ten consecutive weekdays in May 2015) was eligible to participate in an interviewer administered, in-person survey, gathering data on gender-based violence over the past 12 months.

Results

A total of 100 women were recruited into this study. Of these women, 47% of women reported experiencing physical or sexual violence in the past 12 months. The most common perpetrators were the woman’s husband or boyfriend. There are low rates of reporting, particularly through formal avenues such as to police or village leaders. Alcohol was involved in more than half the cases of reported violence.

Conclusion

Women in this study report high rates of gender-based violence. To our knowledge, this is the only study examining women’s personal experience of gender-based violence in the Solomon Islands, with self-reported data on the frequency and nature of the violence, and the impact on women, including physical and mental, utilisation of healthcare services, police and legal involvement. Efforts to reduce gender-based violence should aim to reduce intimate partner violence, increase reporting and address wider social attitudes towards gender equality.

Correspondence to Professor Alexandra LC Martiniuk; [email protected]

STRENGTHS AND LIMITATIONS OF THIS STUDY

• We explored the experience and impact of gender-based violence among woman visiting Honiara health clinics through one-on-one interviews.

• Strengths include interviews were conducted in local languages and translated by local translators, and comprehensive information was gathered on the nature, frequency and impact of violence, including physical injuries, utilisation of healthcare services, police and legal involvement, and mental health impact.

• Limitations include this study having a small sample size (100 women), one-quarter declined study participation, and the study was a single-site, cross-sectional study.

Introduction

Gender-based violence is defined as ‘any act that is perpetrated against a person’s will and is based on gender norms and unequal power relationships and can involve physical, emotional, psychological or sexual harm’.¹ Specifically, violence against women refers to ‘any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life’.² Violence against women is a global public health concern and it is estimated that 35% of women worldwide have experienced physical or sexual violence in their lifetime.^{3 4} Globally, women and girls aged 15–44 are more at risk of rape and gender-based violence than of cancer, motor vehicle crashes, war and malaria.³

Gender-based violence has a negative impact on physical and mental health.^{5 6} Experiencing gender-based violence can lead to mental distress, such as alcohol use, depression, anxiety, post-traumatic stress disorder, suicidal thoughts and attempts, and physical symptoms, such as pain, dizziness, chronic pain and vaginal discharge.^{7 8} Gender-based violence can also result in women being at increased risk of sexually transmitted infections (including HIV), unintended pregnancies, termination of pregnancy, low birthweight babies, premature birth, fetal growth restriction, stillbirth or miscarriage, death from homicide or suicide and disability.^8–11 Women experiencing violence can also face homelessness, loss of income and poverty from unemployment or inability to work due to trauma and safety fears.^{12 13} Seventy per cent of men and women in the Solomon Islands believe that violence against women is justifiable in some circumstances,¹⁴ thus normalising gender-based violence.

The Solomon Islands is a Pacific archipelago, with a population of 515 870.¹⁵ The United Nations (UN) Human Development Index ranks the Solomon Islands as a low development country, with a rank of 152 out of 189 countries,¹⁶ with a history of political instability and conflict interrupting government services such as health and education.¹⁵ Unusual injury patterns which would raise concerns in Western hospitals are often not investigated in detail in the Solomon Islands, mostly due to limited resources, with healthcare workers having to accept the history provided.¹⁷ Often the cycle of abuse is carried onto subsequent generations; commonly perpetrators and victims have experienced childhood or adult trauma themselves.^{18 19}

In recent years, the Solomon Islands have demonstrated the political will to address gender equality and gender-based violence. On a community level, 120-hour training courses are available to locals working with non-for-for profit organisations, churches or community-based organisations who frequently see victims in their community and want to offer help.²⁰ The existing national policy for gender equality in the Solomon Islands was written by the Australian Department of Foreign Affairs and Trade,^{21 22} and in mid-2002 was translated through to the provinces, with the Ministry of Provincial Government implementing requirements for provincial performance assessments. However, there is a long way to go until these policies have a long-lasting impact on the incidence and impact of gender-based violence in the Solomon Islands.¹⁷

There are three peer-reviewed studies examining gender-based violence in the Solomon Islands. One is a retrospective chart review of Solomon Islands hospital data,²³ while another documents personal experiences of gender-based violence from overseas healthcare workers on placement.¹⁷ There is also a further descriptive study examining pregnant women’s experiences of intimate-partner violence.²⁴ These studies likely under-report the incidence of gender-based violence due to many victims of domestic violence commonly not disclosing the mechanism of their injuries,²⁵ or not seeking medical treatment,²⁵ and these studies do not address the impact of gender-based violence.

We aimed to undertake a descriptive study, using a face-to-face interview-guided survey of women attending health clinics in Honiara, Solomon Islands, to collect data on women’s experiences of gender-based violence, including self-reported data on the frequency and nature of the violence, the impact on women, including physical and mental injuries, utilisation of healthcare services, police and legal involvement. These data were gathered as part of the Women’s Health and Household Time Survey 2015, Honiara, Solomon Islands, which collected data on women’s health, time spent at home and experiences of gender-based violence over 12 months in 2014/2015.

Methods

Our interdisciplinary team conducts research in collaboration with local islanders based on their needs and requests. This research project sought to better understand gender-based violence in the Solomon Islands. Any woman over the age of 18 who attended a local health clinic in Honiara, Solomon Islands during the time of recruitment (10 consecutive weekdays in May 2015) was eligible to participate in the study. Eligible women were approached by local health professionals and asked (in local language) if they consented to participate in an interview. Women who agreed to participate were referred to a private area of the clinic to complete the study. Written consent (or with a thumbprint where women were illiterate) was obtained. The survey was delivered in Solomon Islands Pidgin by two female researchers. Both researchers received training in working with people who had experienced violence, as well as local cultural training, such as visiting the local services for women who had experienced violence. Both researchers were not originally from the Solomon Islands, but one was living in the Solomon Islands for several years at the time of the study. All data collected were deidentified and names were replaced with an alphanumeric code for study purposes. The survey was drafted in English and was then translated and back-translated into the Solomon Islands Pidgin to ensure accuracy of translation.

The sampling strategy was chosen to protect women. Women seeking health services of any kind were invited to participate. As such, the population recruited is representative only of women who seek health services, and this could have impacted the type of data collected in this study.

The survey questions were adapted from the UN Women 2012 study ‘Estimating the costs of domestic violence against women in Vietnam’.²⁶ This survey was used to use the study’s methodology estimating the economic costs of injuries due to interpersonal and self-directed violence; to be published in a subsequent paper. The survey sought information on the participants’ demographics and any experience of violence by a male perpetrator in the past 12 months. Questions pertaining to physical violence included being slapped, having something thrown at them, being pushed or shoved, hit by a fist or something else, kicked/dragged/beaten up, choked, burned, threatened with or subject to the use of a gun, knife or weapon. Questions pertaining to sexual abuse included non-consensual intercourse, degrading or humiliating sexual activity, physically forced intercourse, or physical or sexual abuse. If women disclosed experiencing violence by a male perpetrator, data were collected regarding the perpetrator (intimate partner, brother, father, wantok, stranger, other) whether alcohol was involved, mental and physical injuries, utilisation of healthcare services, and number of days children missed school. Mental health impact was assessed using the Self-Reporting Questionnaire (SQR-20), which is a WHO-designed 20 question tool designed to screen for mental well-being, particularly in low-income and middle-income countries.²⁷ Women were also asked to share their experiences with formal and informal reporting of violence to health, police and other individuals or groups. This included reporting to police, church elder, friend of family, hospital or medical professional, village elder, other and time taken to report the event, and if the event reached court. After completion of the survey, all women participating in the study were offered contact details for a local support centre for women who had experienced violence.

Honiara was chosen as the setting where data were collected for several reasons. First, it is the capital city of the Solomon Islands and the most populous city. Second, Honiara has support structures in place for women who have experienced gender-based violence. Third, Honiara, as the capital city, has the country’s key institutions including the national referral hospital, police and legal presence.

This study is descriptive and does not statistically test hypotheses or derive incidence or prevalence estimates. No a priori sample size calculations were conducted. The survey has been used previously by the UN and was also pilot tested locally prior to ethics submissions. The researchers who collected the data obtained training in interviewing, data collection and the local language, culture, gender-based violence globally and locally as well as understanding the local support structures in place for women in order to be able to refer women to these.

Data were collated into an Excel spreadsheet on a password-protected computer at the time of data collection due to weak or no internet access in the Solomon Islands at the time. Later, these data were uploaded to the secure University of Sydney servers used for data storage and the hard drive storage of data removed. Descriptive analyses were conducted to summarise the data using SPSS (V.23). We did not aim to draw conclusions or test hypotheses.

The Solomon Islands is a small community, which made confidentiality for women participating in the study paramount. We chose to use researchers who were not from a Solomon Islands background to try to maximise the participants’ confidence in confidentiality and reduce the possibility that they may be concerned about retribution or gossip due to their participation in the survey. It is difficult to know the impact of this on rates of reporting.

The process of obtaining informed consent included sharing a printed, written, participant information sheet and separate consent form with each woman. These were approved by the overseas university research ethics committee, the Solomon Islands ethics committee and the Solomons government prior to use. These documents were also read out loud to potential participants and in local language to ensure understanding. To protect confidentiality, no names or addresses of participants were ever recorded. As the data did not record details which would allow a participant to be identified, potential risks to participants were largely understood to be emotional for having to relive the trauma of gender-based violence when answering the survey questions. To support participants, we ensured interviewers were well trained and we shared details about the local gender-based violence support organisation. Research staff had visited this organisation in advance of interviewing any women participants.

Patient and public involvement

There was no patient involvement with study design and results will not be disseminated to participants. Several employees of the local health clinic were involved in questionnaire selection, training of researchers and inviting patients to enrol in the study while attending the health centre.

Results

A total of 134 women were invited to participate in the study; 31 women declined to be interviewed, 1 woman recruited was under 18 and was excluded and 2 women gave consent but did not complete the survey. Therefore, a final sample of 100 women consented and completed the survey.

Of the 100 respondents, 46% were 18–25 years old, with 85% of participants under the age of 35 years old (table 1). Seventy-three per cent respondents were married and 94% respondents had children or were pregnant at the time of the study. Five per cent of the respondents had no schooling while the majority (65%) of the respondents had some secondary schooling. In regard to living location, 38% of the respondents were from Guadalcanal and 29% were from Malaita, which are the two most populated provinces in the Solomon Islands.

Table 1

Demographics of the study sample (n=100)

Variable		N (%)
Age in years	18–25	46 (46.0)
	26–35	39 (39.0)
	36–45	14 (14.0)
	46–55	1 (1.0)
	>55	0 (0.0)
Marital status	Married	73 (73.0)
	Single	18 (18.0)
	Living with partner but not married	9 (9.0)
Children and/or pregnant	Yes	94 (94.0)
	No	6 (6.0)
No of Children (n=69)	1	29 (42.9)
	2	15 (1.4)
	3	10 (14.5)
	4	9 (13.0)
	>5	6 (8.7)
Education	No school	5 (5.0)
	Primary	17 (17.0)
	Secondary	65 (65.0)
	Tertiary	13 (13.0)
Province (n=94)	Guadalcanal	38 (40.4)
	Malaita	29 (31.0)
	Central	1 (1.1)
	Western	12 (12.8)
	Temotu	3 (3.2)
	Isabel	4 (4.3)
	Choiseul	3 (3.2)
	Makira	4 (4.3)
Paid work	Yes	26 (26.0)
	No	74 (74.0)
Hours of paid worked per week (n=26)	0–5	1 (3.8)
	6–20	6 (23.1)
	21–40	10 (38.5)
	>40	9 (34.6)

Of the 100 respondents, nearly all (99%) of the women agreed to answer the specific survey questions about their experience of gender-based violence. Approximately half of the women surveyed (47%) reported experiencing physical or sexual violence in the past 12 months.

The most common type of physical violence experienced by women by a male perpetrator in the past 12 months was being hit by a fist or something else (28%), closely followed by being slapped (24%), pushed or shoved (24%) or having something thrown at them that could hurt (22%). Seventeen per cent of the respondents had been kicked, dragged or beaten up, 13% had been threatened with a gun, knife or weapon, or had these weapons used against them and 6% had been intentionally choked or burned. Of the women who reported experiencing physical violence, 73% reported that their husband or boyfriend perpetrated the violence.

In terms of sexual violence, 15% reported having sexual intercourse because they were afraid, 11% had experienced non-consenting sex, 9% had experienced degrading or humiliating sexual activity and 6% had physically forced sexual intercourse. The most likely perpetrator of sexual violence against women surveyed was their husband or boyfriend (77%), followed by someone that they did not know.

Among the women who reported ever having experienced either physical or sexual violence, 30% reported being injured at least once. Of the reported injuries, 16% stated that they had previously been hurt badly enough to need healthcare. In answering the SQR-20 questions, women who reported experiencing violence were more likely to report being easily frightened, feeling like a worthless person and feeling tired all the time.

Of those who experienced violence, 42% of the women reported the assault to someone. The people women were most likely to report an alleged assault to were friends or family (57%), village elders (20%), others (15%) or church elders (10%). No women in this study had reported their experience of violence to a hospital or medical centre.

Reporting on their past 12 months, 77% of respondents had witnessed violence against women. Seventy per cent of cases were reported immediately following the incident, and 16% of the victims had children miss days off school because of the assault. Alcohol was involved in more than half (53%) of the cases of both physical and/or sexual violence.

Discussion

Violence against women is common in the Solomon Islands, with almost half of the women in this study experiencing at least one episode of violence perpetrated by a male in the past 12 months. We also found alcohol was involved in nearly half of the incidents of violence. Despite gender-based violence commonly occurring, few women who experienced or witnessed violence reported the violence to an authority.

The majority of women in our study were less than 35 years old and nearly all (94%) had children or were pregnant at the time of interview. This is consistent with the population demographics of the Solomon Islands, noting approximately 60% of the population were under the age of 24 in the 2007 census; further data on population age distribution from the 2019 Solomon Island Census are forthcoming in 2023, delayed by the COVID-19 pandemic.¹⁵

In our study, approximately half of women reported experiencing gender-based violence. The level of violence reported is consistent with the literature. A 2016 cross-sectional descriptive study of intimate partner violence among pregnant women seeking antenatal care in the Solomon Islands found that 56% of participants reported experiencing intimate partner violence in pregnancy, with a prevalence of emotional, sexual and physical abuse of 45%, 33% and 17%, respectively.²⁴ Other studies have reported high rates of intimate partner violence, with the Solomon Islands Family Health and Safety Study finding 64% of women aged 15–49 who have ever been in a relationship reporting experiencing physical or sexual violence, or both.²⁸ Evidence from other countries has unfortunately shown that rates of intimate partner violence increased during the COVID-19 pandemic, where women, and even more so, pregnant women, were adversely affected by the lockdowns, school closures and economic instability.²⁹

In our study, few women who experienced or witnessed gender-based violence reported the violence to an authority. This is consistent with other data that has found low rates of reporting of gender-based violence to formal authorities.^{17 28 30} There may be several reasons for this under-reporting including: social perceptions of violence against women, shame, financial barriers, fear of retribution, lack of awareness of services available for women who experience violence and lack of trust in healthcare workers, police or law enforcement.^30–33 Other papers have noted that reporting behaviour among people who have experienced gender-based violence is lacking in the literature, with the peer-reviewed literature providing few quantitative estimates of reporting behaviour.³⁰ There are emerging data about the rates of intimate partner violence in the Solomon Islands, who is affected, who the perpetrators are and what the impact is.^{17 30–32} This study contributes new data to these questions, including confirmation that almost half of women report experiences of intimate partner violence and that this can have wider social impacts, such as children missing school.

There were several limitations to this study. First, this was a small study with a sample of only 100 women, with 25% declining participation. However, this is the first study to our knowledge interviewing women on their personal experiences, and it is likely that the highly sensitive nature of the interview led to people declining involvement even considering our approach using overseas researchers and anonymous survey reporting. This is a retrospective study, so there is a risk of recall bias, with participants either under-reporting or over-reporting previous experiences of violence. The previous studies were retrospective chart reviews of Solomon Islands hospital data, or personal experiences from overseas healthcare workers on placements,^{17 23} and likely under-reported the incidence and nature of gender-based violence. The results also may not reflect women’s experience of violence in other provinces of the Solomon Islands or in rural areas. Though our study collected data only in Honiara, women who were interviewed originated from eight provinces. Lastly, our study collected data only from women who were presenting to a health facility for healthcare and thus the participants of our study may differ from the general population of women in Honiara.

Increased understanding of women’s experiences and the subsequent impact of gender-based violence can assist in developing policies to prevent and respond to gender-based violence. Ways to improve reporting of gender-based violence in the Solomon Islands may include improved communication of support services available,¹⁷ and improved collaboration between police and healthcare providers, as many victims of gender-based violence present for medical care with suspicious injuries.

To reduce the incidence of gender-based violence, interventions could draw on culture and customs to empower men to be protectors of women as they were in the past. For example, the Malaitan Ramos warriors were renowned for protecting women and children from battle and kidnapping by other tribes.³⁴ Using these cultural examples, finding male champions for behavioural and cultural change, empowering women to be financially independent,³⁵ supporting and upscaling training workshops organised by the Pacific Community Regional Rights Resource Team (now known as the Human Rights and Social Development Division),¹⁴ and ensuring that police enforce legal ramifications when personnel break the Family Protection Act³⁶ or commit marital rape,³⁷ are paramount to improve rates of gender-based violence in the Solomon Islands. However, it should be acknowledged that it will likely remain difficult for women to leave their partners due to strong ties with culture and family,^{38 39} and the status of women in customary law constraining their ability to access resources, family property and child custody.^{39 40} Hopefully with poverty reduction, higher education attainment, and cultural change encouraging gender empowerment and equitable relationships, women will feel more equipped to leave dangerous relationships where they experience gender-based violence.^{19 29}

Furthermore, interventions targeting alcohol consumption could help reduce gender-based violence,^{8 19 41} with programmes focusing on education around safe alcohol consumption and reducing alcohol misuse, and interventions such as reducing alcohol availability, regulating alcohol prices and increasing access to treatments for alcohol use disorder.⁴² In the Solomon Islands, improving safe alcohol consumption is further complicated by the common use of high alcohol concentration ‘homebrews’ produced through home fermentation and distillation.

Future research could investigate the impact of implementation of training for judges regarding the Family Protection Act in the justice system, the support available for women to report and be protected from gender-based violence,¹⁷ impact of gender-based violence on children in the Solomons, what coping mechanisms are used, how women view their place in society in a country where contraception use is commonly opposed by male partners⁴³ and relationship intimacy is often forced.²⁸ Additionally, this study was conducted prior to the COVID-19 pandemic, and during the pandemic, domestic violence increased worldwide⁴⁴ and especially in pregnancy,²⁹ and further work could examine the incidence of gender-based violence postpandemic in the Solomon Islands.⁸

Conclusion

This survey of women attending healthcare clinics in Honiara, Solomon Islands provides additional information about the experiences and impact of gender-based violence. Women in our study report high rates of gender-based violence, most commonly perpetrated by a woman’s husband or boyfriend. There are low rates of reporting, particularly through formal avenues such as to police or village leaders. Alcohol was involved in more than half of the cases of reported violence. Women who reported experiencing violence were more likely to report being easily frightened, feeling like a worthless person and feeling tired all the time. Efforts to reduce gender-based violence should focus on cultural shifts towards gender equity and ensuring there are significant legal consequences when perpetrators violate the Family Protection Act.

Ministry of Women, Youth, Children and Family Affairs, Solomon Islands Government. Ministry of Health and Medical Services, Solomon Islands Government. Seif Ples. The Pacific Community. Office of Director of Prosecutions, Solomon Islands. Regional Assistance Mission Solomon Islands. Honiara City Health Clinics

Data availability statement

Data are available on reasonable request. The original dataset is available and those with interest in accessing the original dataset can contact the corresponding author ALCM.

Ethics statements

Patient consent for publication

Not applicable.

Ethics approval

This study involves human participants and was approved by Ethics approval was obtained from the University of Sydney Ethics Committee (2014/948), the National Health Ethics and Research Committee of the Solomon Islands (Ministry of Health and Medical Services), and the Solomon Islands Government Ministry of Women, Youth, Children and Family Affairs. Participants gave informed consent to participate in the study before taking part.

Footnote

Contributors ALCM, MR, HH and KM were responsible for the conception of the study, wrote the protocol and obtained ethical approvals. KM, HK, VW, SH and BR collected the data with a local translator and reported the results. The results were analysed and interpreted by the entire coauthorship team. The final paper was written by VC, edited by ALCM and approved by the entire coauthorship. AM is the gaurantor of this work, and accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.

Funding The data collection for this study was in part funded by a University of Sydney International Partnership Development Fund (IPDF) (no grant number). ALCM conducted this work while an Adjunct Professor at the University of Sydney and Honorary Senior Research Fellow at the George Institute for Global Health. HK, KM, VW, BR and SH were graduate students at the University of Sydney, VC was a medical registrar at Royal Prince Alfred Hospital—all contributed their time and expertise pro bono. MR and HH contributed their time as part of their roles with the SPC (Rimon) and Solomons Ministry of Women, Youth and Children (Hebala).

Competing interests HK, VC, KM, VW, BR, SH and ALCM declare no competing interests. MR is regional director, Melanesia (Port Vila) of the Pacific Community (SPC) which is the principal scientific and technical organisation in the Pacific region. HH worked in public service at the Solomon Islands Ministry of Women, Youth and Children during this project. He is now with the Ministry of Rural Development Solomon Islands. None of the authors have associations with commercial entities which would put them in conflict with this work.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

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