Abstract: The aim of the study was to determine the prevalence, associated risk factors, consequences and preventive measures of IPV(intimate partner violence) within the selected population in Goroka, Papua New Guinea. Questions derived from the prevalidated scales were used to measure the IPV. Questionnaires were distributed to both men and women aged from 18 to 60. The participants were staff and students of University of Goroka, staff of the Goroka Secondary school and North Goroka Primary school, Teachers in-charges of the elementary schools in the Eastern Highlands Province and the villagers from Asaroufa and Kotuni villages. Of the 95 respondents, 78.95% were victims of IPV. Among the victims 37.33% were males and 62.67% females. The physical, sexual and psychological abuses were experienced by both men and women. The significant risk factors found to be associated with violence were young age, low education, low socioeconomic status, marital conflicts, history of abuse during childhood, and male patriarchal values. The interpersonal relationship tends to be an important factor for prevailing violence free environment within the intimate partners. Intimate partner violence is prevalent in PNG. The strongest independent predictors were the excessive drinking of alcohol and marital conflict. Preventive measures such as compulsory and free technical education for all children less than 14 years old and life skills training and violence awareness campaign for both men and women must be provided to reduce the intimate partner violence.
　　Key words: Intimate partner, violence, abuse, assault, victim.
　　 1. Introduction
　　IPV (intimate partner violence) involves a pattern of coercion, physical abuse, sexual abuse or threat of violence in intimate relationships [1]. Other terms used in the scientific literature are domestic violence, gender-based violence, battering or spousal abuse. Violence between intimates is difficult to measure because it often occurs in private, and victims are often reluctant to report incidents to anyone because of shame or fear or reprisal [2].
　　1.1 Background
　　Intimate partner violence is a global public health crisis because of its high prevalence and its association with deleterious physical, mental and reproductive health outcomes [3]. According to Rennison [4], intimate partner violence is a pervasive social problem in the United States. An estimated 11 percent of all victims of violent crime in 2001 were victims of intimate partner violence. Both men and women are victims of IPV, but the literature indicates that women are much more likely than men to suffer physical, and probably psychological, injuries from IPV [5]. One out of every five U.S. women has been physically assaulted by an intimate partner, compared with 1 out of every 14 U.S. men [6]. An estimated two to four million women are physically abused every year, which translates into a woman being battered every 18 seconds in the U.S.[7]. It was estimated that 1,247 women and 440 men were killed by an intimate partner in 2000 [4]. Every year in the United States, such violence accounts for some 1,200 deaths and 2 million injuries among women, and almost 600,000 injuries among men, according to new statistics from the U.S. Centers for Disease Control and Prevention [8]. The American Psychiatric Association [9] stated that 15.4 percent of gay men, 11.4 percent of lesbians and 7.7 percent of heterosexual men, are assaulted by a date or intimate partner during their lives. More than 1 million women and 371,000 men are stalked by partners each year. Nearly 7.8 million women have been raped by an intimate partner at some point in their lives [10]. Intimate partner violence affects all ages, ethnic groups and socio-economic classes [4].
　　Around the world at least one woman in every three has been beaten, coerced into sex, or otherwise abused in her lifetime [11]. The World Health Organization(WHO) has reported that population studies around the world have found 10 to 69% of women reported being physically assaulted by an intimate partner at some point in their lives [12]. A study [13] indicates that married women in rural Vietnam are heavily exposed to all forms of serious abuse repeatedly over time from their husbands or male partners. A study in Karachi in 2000 reported that all husbands surveyed admitted that they shouted at their wife, even when she was pregnant, 32.8% admitted to having slapped their wives and 77.1% admitted to having engaged in non-consensual sex with their wives [14]. In Malaysia, 39% of women above 15 years of age were estimated to have been physically beaten by their partner [12].
　　An occasional conflict resulting in the husband’s use of physical violence towards his wife is mostly regarded as acceptable behaviour in family life, although severe violence is both socially and legally unacceptable [15]. Multiple risk factors, including young age, low education, low socioeconomic status, marital conflicts, history of abuse during childhood, and alcohol and drug abuse, have been found to be associated with women being abused by their partners[16]. The events that trigger partner violence include not obeying the man, arguing back, not having food ready on time, not caring adequately for the children or home, questioning the man about money or girlfriends, going somewhere without the man’s permission, refusing the man sex and the man suspecting the women of infidelity [17].
　　The longer the abuse goes on, the more serious the effects on the victim. Many victims suffer physical injuries. Some are minor like cuts, scratches, bruises, and welts. Others are more serious and can cause lasting disabilities. These include broken bones, internal bleeding, and head trauma. IPV can also cause emotional harm. Victims often have low self-esteem. The anger and stress that victims feel may lead to eating disorders and depression. Some victims even think about or commit suicide [18]. Intimate partner violence results in more than 18.5 million mental health care visits each year in U.S. [10]. At global level, epidemiological and clinical studies have found that physical and sexual violent acts by intimate partners are consistently associated with a wide array of negative health outcomes, including various chronic-pain syndromes, irritable bowel syndromes, gastrointestinal disorders, and with psychiatric problems, including depression, anxiety, post-traumatic stress disorders and suicidality [15]. Children brought up in a home where domestic violence occurs have the tendency to develop behavioral or psychological problems, with risk of poor health in later life [12]. Children growing up in abusive families may develop problems themselves-they may feel that adults, especially males, can not be trusted; they may develop problems with alcohol or other drugs. When they grow up to have partners and children of their own they may become abusive towards them. There are services that can help by offering counseling, legal advice or emergency accommodation. Seeking help can be a difficult step to take—but it is the first step towards a more peaceful family life [19]. Between 55% and 95% of physically abused women had never sought help from any formal agency or person in a position of authority. To the extent that women do reach out, they do so to family and friends [20]. Low use of formal services reflects in part their limited availability. However, even in countries relatively well supplied with resources for abused women, barriers such as fear, stigma and the threat of losing their children stopped many women from seeking help [21].
　　Health-related costs of intimate partner rape, physical assault, stalking and homicide are estimated to exceed $5.8 billion per year, $4.1 billion for direct medical and mental health care and $1.8 billion for lost productivity [4]. Victims of intimate partner violence lost almost 8 million days of paid work because of the violence perpetrated against them by current or former husbands, boyfriends and dates. This loss is the equivalent of more than 32,000 full-time jobs and almost 5.6 million days of household productivity as a result of violence [10]. According to National Center for Injury Prevention and Control [4], the average loss of lifetime earnings for intimate partner homicides is$713,000. Added to these costs are those for criminal justice system services, social services and costs to businesses and industries [4].
　　1.2 Intimate Partner Violence in Papua New Guinea
　　The Ausaid report indicates that women are amongst the worst in the world affected by all forms of domestic violence [22]. Some of the highest rates of violence and abuse of children and women in the world occur in Papua New Guinea [23]. The Ausaid report says that two out of three women in Papua New Guinea experience all forms of domestic violence [22]. The statistics estimating violence against women indicate that as many as 70% of all women are beaten by their husband [24]. There is another form of domestic violence which involves women as perpetrators, which is violence between co-wives or between a man’s wife and his girlfriend [25].
　　In PNG, much gender-based violence against women is socially and culturally sanctioned, occurring in the private context of family or household, and perpetrated by intimate partners or close relatives [26]. There have been very limited studies carried out on intimate partner violence in Papua New Guinea. Therefore, the purpose of the study was to
　　? estimate the prevalence of IPV in Papua New Guinea;
　　? identify the associated risk factors;
　　? explore the consequences of IPV;
　　? find out the preventive measures of IPV.
　　 2. Methods
　　 2.1 Sample and Data Collection.
　　A questionnaire was designed to carry out the study in different places of Goroka. Goroka is the capital of Eastern Highlands Province of the Papua New Guinea. The estimated population of Goroka by the 2000 census is 25,000. Since the people of Goroka are from the multicultural background, the cultural diversity is predominant in the educational and business organizations.
　　The population for this study was chosen based on the level of understanding and cooperation of the people in and around the Goroka. The educational institutions such as the University of Goroka (UOG), Goroka Secondary school (GSS), and North Goroka Primary school (NGPS); Teachers in-charges (TICs) of the elementary schools in the Eastern Highlands Province; and a couple of villages—Asaroufa and Kotuni were chosen for study. The participation of the study population was fully voluntary, and no payment was offered to participants. The questionnaires were hand delivered to 42 students attending a class in the Home Economics section and 7 volunteered staff of UOG in strict privacy. The participants were allowed to read the questionnaire to determine whether to respond or not and were given time to complete the questionnaire and to return it via internal mail to the investigator. The questionnaires were also given to the Deputy Principal of the GSS (also the part time tutor of the Home Economics section) and the coordinator of the upper primary in the NGPS (which is located at the vicinity of UOG) for distributing to staff in their school. The number of the staff in above schools was calculated and thus provided 15 questionnaires to each school. The Home Economics staff (2 members) of the UOG coming from the Asaroufa and Kotuni villages got 10 questionnaires each for their villagers and assisted them as well to complete in private setting at home with no one able to overhear the conversation. Through the coordinator of the workshop the questionnaires were distributed to 51 elementary Teachers in-charges attending the TICs workshop 2010 hosted by the Department of Education (Eastern Highlands Province) held at the Four Square Church, Goroka. The filled in questionnaires were returned through the representatives designated at schools and villages. Of the 150 questionnaires distributed, 95 were received, giving a response rate of 63.3 percent and all of them were completed. The sample consisted of respondents from UOG-35, GSS-6, NGPS-7, elementary schools TICs-38, Asaroufa-3 and Kotuni-6. In order to ensure anonymity the participants were not asked of their name and the completed questionnaires were maintained in secure facilities.
　　2.2 Measures
　　Intimate Partner Violence was measured using a questionnaire developed on the basis of a variety of abuse assessment scales such as Abuse Assessment Screen [27], and American Medical Association [28]. Two-Question Screening Tool [29], Domestic Violence: A Resource Manual for Health Care Professionals [30] and WHO Multi-country Study on Women’s Health and Life Events Questionnaire [31]. The WHO study instrument has high internal consistency and a capacity to discriminate between different forms of violence (psychological, physical and sexual) perpetrated in different social contexts. Cronbach’s alpha coefficients were 0.88 in Sao Paulo and 0.89 in the Zona da Mata [32]. For the two Brazilian sites the Cronbach alphas for psychological, physical and sexual violence were, respectively, 0.78, 0.83 and 0.78 in Sao Paulo, and 0.79, 0.83 and 0.78 in Zona da Mata of Pernambuco [33].
　　The single question threshold approach provided to determine whether the respondents have ever been assaulted by a partner or not. This question allowed the respondents to leave if they were not abused. The respondents who gave positive response continued to fill-in other questions. Prevalence of violence by intimate partner was assessed by type with their age, education, employment, family size, type of family, income of the family and other risk factors involved. The Study’s definition of IPV included physical, sexual and psychological violence committed by a spouse, ex-spouse, or current or former boyfriend or girlfriend. Physical abuse was assessed with 9 items: beating, hurting, kicking, pushing, slapping, shoving, strangling, burning and throwing things. Sexual abuse was assessed with 2 items: using physical force to have sexual intercourse when respondent did not want to and making the respondent do something sexually that found unnatural or distasteful. Psychological abuse was assessed with 8 items: criticize, insult, humiliate, jealous, controlling life, becoming upset when housework was not done, refusing to do housework or childcare and driving away friends and family of the respondent. The responses “yes” or “no” was provided to each item above. This study defined participants as IPV victims if they responded “yes” to at least 1 item on physical violence or sexual violence or psychological violence. Risk factors were examined for intimate partner violence in the areas such as demographic characteristics—age, province, marital status, number of children, type of family, education, employment, age at marriage, partner’s age, province, education, and employment; behavioral characteristics—intake of alcohol and illegal drugs, dependency, low self esteem, insecurity, marital conflict, extramarital affair, witnessed or experienced violence as a child, peer pressure, easy access to weapons, infidelity, not helping, jealousy, sex before marriage and unwanted pregnancy and dislikes spouse’s family members; and socioeconomic and cultural characteristics—having many children from different women, bride price, traditional notion, overcrowding at home, low academic achievement of the partner, unemployment of the partner and family income. A two point scale agreed or disagreed statements were provided to determine the consequences of IPV. To explore the preventive measures of IPV an open ended question was included. 2.3 Statistical Analysis
　　The descriptive statistics charts were used to explore the prevalence of violence among both gender, types of abuse experienced and risk factors with software statistical package MS excel. This statistics was also used to find out demographic, behavioral and socioeconomic and cultural factors influencing IPV, the consequences and preventive measures followed by the respondents.
　　 3. Analysis and Results
　　 3.1 Prevalence of IPV in the Selected Population
　　Intimate partner violence (IPV) is abuse that occurs between two people in a close relationship. The term“intimate partner” includes current and former spouses and dating partners. IPV exists along a continuum from a single episode of violence to ongoing battering. Often, IPV starts with emotional abuse. This behavior can progress to physical or sexual assault. Several types of IPV may occur one after the other. In this study out of 95 total respondents 78.95% have experienced intimate partner violence and 21.05% have not been abused(Table 1).
　　
　　3.2 Gender
　　Among the total victims of the selected population-based study, 37.33% were men and 62.67% women. From the University of Goroka 12% of men and 18.67% of women reported that they were being abused by their intimate partner. There were no indication of violence against men but 6.67% women experienced violence in the Goroka Secondary school. Both men (4%) and women (2.67%) from North Goroka Primary school were abused. Of the respondents from the TICs workshop 18.67% of men and 29.33% of women were assaulted. There were no men reported from the Asaroufa village however 4% of women were abused. From the Kotuni village 2.67% of men and 1.33% of women were the victims of violence.
　　3.3 Type of Violence
　　The physical violence was experienced by men (4%) and women (5.33%). Sexual abuse was reported by both men and women (12%) each. Psychological abuse was not prevalent in men and 1.33% of women were being abused emotionally. 9.33% of men and 10.67% of women assaulted both physically and sexually. 2.67% of men and 1.33% of women experienced sexual and psychological violence. No men and 5.33% of women were both physically and psychologically abused. 9.33% of men and 26.67% of women were victimized physically, sexually and psychologically. There was an overlap between sexual, physical and psychological abuse experienced by both men and women.
　　3.4 Risk Factors Associated with Violence Demographic Characteristics of the Victims
　　The violence rate was high between the ages ranged from 20 to 40. The prevalence of violence was high in Eastern Highlands province among the married and dating relationship. The early marriage, cohabitation and dating relationship contributed to the higher rate of violence. The higher rate (41.33%) of the perpetrators was from the eastern highlands province (Table 2).
　　
　　3.5 Behavioral Characteristics of the Partner
　　The multiple behavioral characteristics of the partner contributed significantly for the violence in the intimate relationship. The intake of alcohol influenced 45.33% of the partners to be involved in violence. About 42.67% of the partners had marital conflict as the prime cause; the extramarital affair contributed to 36%; 30.67% was due to peer pressure; and 22.67% was caused by dependency. About 13.33% of the partners had witnessed or experienced violence in childhood and demonstrated male honor through violence. The partners’ low self esteem (12%); consumption of illegal drugs (9.33%); the feeling of insecurity (6.67%); jealousy (4%); easy access to weapons (2.67%); infidelity (1.33%); non-cooperation(1.33%); Sex before marriage and unwanted pregnancy(1.33%); and disliking spouse’s family members(1.33%) all these behavioral characteristics led to abuse.
　　3.6 Socioeconomic and Cultural Characteristics
　　The family income of about 42.67% of the victims ranged between Kina 100 and 499 per month which was considered as low family income. The unemployment (16%) and low academic achievement(13.33%) of the partner; overcrowding (10.67%) at home; traditional notion (29.33%); bride price (22.67%) and children from different women (1.33%) all contributed to the violent relationship.
　　3.7 Consequences of Intimate Partner Violence
　　The consequences of violence were identified by the respondents in terms of impact on both physical and mental health, impact on children and economic impacts. About 88%-98.67% of the respondents agreed that the violent relationship affects the sense of self-esteem and the ability to participate in the world; increases the risk of ill health; leads directly to unwanted pregnancy and sexually transmitted infections including HIV infection through forced sex; violence during pregnancy may lead to miscarriage or affect the development of the fetus; young women/men who were abused by their partners suffer from depression, anxiety and phobias; and children who witnessed marital violence were at a risk of emotional and behavioral problems (Table 3).
　　3.8 Prevention
　　
　　More than half of the population (66.67%) believed that the individual characteristics such as trustworthy, faithfulness, respect, genuine, love, understanding and willing to get counseling would help the partners to prevent violence in all situations. A few victims (8%) said that prevention was possible through appropriate education and awareness. The victims of about 5.33% stated strict government law must be imposed and another 5.33% believed that the prayer and faith in god would protect the partners from violation. A few more preventive measures stated were abstain from alcohol(2.67%) and drugs (2.67%); walk away from the problem (2.67%); do not argue back (1.33%); manage finance well (1.33%); listen to partner (1.33%); keep away from troublemakers (1.33%) and communicate well (1.33%).
　　 4. Limitations
　　We acknowledge that our results might have limited generalizability because the study was conducted only in Goroka, however had several social groups and served a large number of diverse populations. Furthermore we recruited participants from different places to cover all kinds of ethnic groups to increase generalizability. The study had a high response rate, and reassuringly, participants were similar to people residing in other towns and cities of Papua New Guinea in terms of family background and cultural practices. The results, therefore, can likely be generalized to similar Papua New Guinean family practices. Our rates of IPV, however, might underestimate the real magnitude due to under-reporting.
　　 5. Recommendations
　　The Government of Papua New Guinea should revise the customary laws and practices related to marriage and family life and make amendments if they are inconsistent. Promote gender equality and women’s human rights, in line with relevant international treaties and human rights mechanisms including addressing women’s access to property and assets, and expanding educational opportunities for girls and young women[21]. Policy makers should give priority in creating a social environment that encourages gender equity in education and employment. Curricula that teach non-violence, conflict resolution, human rights and gender issues should be included in elementary and secondary schools, universities, professional colleges and other training settings [34]. Police stations should have a separate section to be staffed entirely by women and located in all towns and villages for the women to reach easily even in night. Women’s organizations should be funded adequately to address the issues of violence and assist victims by providing shelter, counseling, and services. Provide training to staff at health centers to handle the victims with care and allow them for treatment and counseling. Various sectors such as the police, health services, judiciary and social support services should work together in tackling the problem of intimate partner violence [17]. International Organizations should continuously support the national programs run both by government and non-governmental agencies. The victims both men and women should be encouraged to seek assistance from the formal agencies assuring the safety of the victims and their children.
　　 6. Conclusion
　　This study found that intimate partner violence is prevalent among Papua New Guineans and they are willing to disclose violence. However, the prevalence rates still could be underestimated because some women believed that family problems should be discussed only within the family. The rates of partner violence perpetrated by males are higher than females. Violence is more frequent where individuals experience loss of physical health and/or wage earning power. Women’s low socioeconomic status may be a precursor to violence. The financial dependency on the partner puts her at risk for being abused. By providing skill based technical education and training for both men and women the government can open the gateways for employment opportunities for the betterment of their own life and society. It is also essential to provide compulsory and free technical education for all children below 14 years of age for learning life skills to achieve high quality life and live in violent free environment in the society.
　　To have a happy family and grow children in a healthy environment at home, both husband and wife should be cooperative, comprehensive, adaptive to the established family, faithful to the partner, abstained from alcohol and ill-legal drugs, love partner and children, sustain peer pressure, and avoid unhealthy parties and dining outs with friends. Of course both men and women produce the family, children need both parents for their all round developmental process, if a parent is not at home due to separation or divorce, children might lose a greater part from the family life that influences their cognitive and social development.
　　The high rate of IPV among women in the family practice of Papua New Guinea calls for significant authorities to be vigilant. Future research should examine ways the victims seek to protect themselves and children at the crisis; how helpful the shelters for battered women in Papua New Guinea; and the attitudes of victims toward these shelters based on the underlying social stigma.
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