سوء استفاده جنسی در دوران کودکی و بهداشت جنسی بزرگسالان در میان زنان کاناک بومی و زنان غیرکاناک کالدونیای جدید

Objectives Few studies have addressed the long-term consequences of adverse childhood experiences among women in Oceania, in particular among indigenous women. This paper aims to report prevalences of childhood sexual abuse (CSA) and to asses the negative sexual health consequences in adulthood by comparing indigenous Kanak to non-Kanak women in New Caledonia. Methods Data come from a population survey on violence against women and health. Face-to-face interviews were conducted in 2002–2003 with adult women randomly selected from the electoral list. Separate models for Kanak (n = 329) and non-Kanak women (n = 426) were performed. Regression models adjusted for relevant socio-demographics factors were conducted to estimate the odds ratios for the associations between childhood sexual abuse and adult sexual health outcomes. Results A non-significant difference between Kanak (11.8%) and non-Kanak women (14.4%) was found for the prevalence of CSA. Among Kanak women, CSA increases the risk of sexually transmitted infections, of non-desired sexual intercourse with an intimate partner and of experience of adult sexual violence. However, use of modern contraception as an adult was more frequent among CSA Kanak victims, as compared to other Kanak women. Among non-Kanak women, only abortion appeared significantly associated with CSA. Conclusions and Practice implications The findings show that in all ethnic communities of New Caledonia, a history of child sexual abuse is not rare among women. They also shed light on the long-term consequences of CSA, suggesting that the effect of CSA may differ according to ethnic membership and subsequent social stratification and gender norms. Efforts to break the silence around violence against girls and establish a stronger foundation are required in New Caledonia. Prevention programs on violence against women and sexual health that take into account the cultural and social heterogeneity are needed.

Violence against women is increasingly recognized as a major public health concern in Oceania. Studies relating to this issue, mostly carried out in countries of the region with populations of predominantly European origin, have revealed the impact of abuse suffered by girls and women on their sexual and reproductive health (Fanslow et al., 2007, Fergusson et al., 1997, Secretariat of the Pacific Community, 2003 and Taft et al., 2004). However, very few studies have described the long-term consequences of gender-based violence on indigenous women's sexual health, even though women within these communities have often been described as being at higher risk from abuse and in poorer health compared to other groups (Anderson et al., 2006, Bramley et al., 2005 and Salomon et al., 2003). This paper aims to analyze the associations between childhood sexual abuse (CSA) and adult sexual health among indigenous Kanak and non-Kanak women in New Caledonia. Epidemiological studies have revealed an association between CSA and a long-lasting alteration in the capacity of victims to manage their fertility and sexuality. Studies focusing on sexual risk behavior in adult women are less concordant than those focusing on sexuality and reproductive health in adolescence (Littleton, Breitkopf, & Berenson, 2007). Nevertheless, numerous other studies suggest that, alongwith factors linked to a context of both gender inequalities and globally unfavorable social and economic conditions, adult sexual and reproductive health also depends on adverse personal experiences in childhood, especially CSA. Indeed, CSA has been found to be associated with reduced condom use (Maman et al., 2000 and Molitor et al., 2000), less contraceptive use (Heise, Ellsberg, & Gottmoeller, 2002), unintended pregnancy (Dietz et al., 1999 and Steel and Herlitz, 2005), abortion (Russo and Denious, 2001 and Wingood and DiClemente, 1997) and sexually transmitted infections (STIs) (Hillis et al., 2000 and Petrak et al., 2000). Abused women were also found to be at significantly higher risk of experiencing dissatisfaction in their sex lives and of presenting sexual difficulties in adulthood (Loeb et al., 2002 and Mullen et al., 1996). Finally, early sexual abuse has been found to be a major risk factor for sexual assaults occurring in adult life and for abuse suffered from partners (Fergusson et al., 1997, Fleming et al., 1999 and Steel and Herlitz, 2005). Among indigenous women, although the association between early sexual violence and heavy alcohol use has been investigated (Hamelin et al., 2009, Koss et al., 2003, Kunitz et al., 1998 and Libby et al., 2004), very few studies have focused on sexual health indicators linked to childhood sexual abuse. Work carried out by Young and Katz (1998) in Canada, made the distinction between aboriginal and non-aboriginal women. In both groups, a history of sexual abuse was associated with an increase in the probability of STIs, sexual intercourse before the age of 12 years, and multiple sexual partners. While no association was observed with the conjugal or social situation of indigenous women, divorce or separation from a partner, as well as unemployment was associated with a previous history of sexual abuse in non-indigenous women. Yuan, Koss, Polacca, and Goldman (2006) studied physical assault and rape in adults from six US Native tribes. They found that, as in the general population, childhood victimization was a predictor, whereas other predictors (e.g., level of tribal affiliation) were group specific. New Caledonia is still a French ruled country, where the indigenous Kanak population is neither an overwhelming majority, as it is the case in the neighboring Melanesian states, nor a small minority as in Australia and New Zealand. The Kanaks represent 44% of the total population of 230,000 inhabitants while Europeans (i.e., born in France or of European descent) account for 34%, Polynesians 12% (Wallisians and Futunians, and Tahitians), Asians 5% and persons from another community 5% (Institut Territorial de la Statistique et des Etudes Economiques, 2001). In the 1980s, a nationalist rebellion for Kanak independence forced concessions from France and a process of re-balance of power in favor of the Kanak community (Matignon Accords, 1989 and Nouméa Accord, 1998). The political and economic transformations that have taken place since then have led to increasing social heterogeneity within the Kanak community and have fostered significant changes for women: consolidation of a female urban population, increased level of girls’ education, subsequent better access to employment and opportunity to earn a personal income, and implementation of gender parity in politics (Berman, 2005, Hamelin, 2000 and Salaün, 2009). However, these major ongoing changes are not sufficient to counterbalance more than 150 years of colonial domination. Significant socio-economic inequalities persist today. The Kanak population, who lives mainly in rural areas and islands, still holds a socio-economically disadvantaged position in New Caledonian society. The 2004 census indicated that in the Northern Province and in the Loyalty Islands, where Kanaks are the overwhelming majority, the proportion of women aged 14 and over with no diploma was respectively 56% and 63%. In the Southern Province, which is home to a mainly non-Kanak population, this proportion was 32% (Institut de la statistique et des études économiques, 2007). The non-Kanak population resides mostly in the Noumea metropolitan area but is quite heterogeneous regarding socio-economic characteristics and ethnicity. It is composed of successive migration waves, from the initial French convicts and settlers, and from the descendants of the Oceanian and Asian labor trade in the 19th and first part of the 20th century to more recent immigration from Polynesia and France (Merle, 1995). The Europeans, particularly wealthy French expatriates, have the highest position in terms of education, employment, and economic resources. The Polynesian and Asian inhabitants are well represented in certain segments of the local economy (as construction workers or small entrepreneurs for example), though their socio-economic position is lower than the Europeans’. Although there is a certain amount of cultural mixing between the different communities several distinct cultural contexts and sets of social features exist. In particular, male domination remains a central element of gender relations among Kanaks. This is mostly evident in the division of daily activities, and the confining of women within the domestic sphere and obligatory maternity, as well as in obstacles faced by women wishing to escape an unhappy union, since divorce is almost impossible in Kanak rules and separating from a partner means leaving the children with him. These patterns, the value placed on reproduction and the license previously given to men to appropriate women's reproductive capacities through marriage and to impose discipline, as well as the scale of gender violence, all contribute to explain the narrow margins within which Kanak women can negotiate their sexuality (Berman, 2006, Salomon, 1998 and Salomon, 2002). Prior to the present study (2002), only data from police, criminal justice or women's organizations were available regarding CSA without any information on ethnicity. Prison records indicated that among male inmates, 15.9% were sentenced for violence against adults or minors and 39% for rape or other forms of sexual assault (Guillonneau & Kensey, 1999). In 2002, in a total population of 200,000, 200 sexual assaults and rapes of minors were reported to law enforcement officials (Les Nouvelles Calédoniennes July 1, 2003). The same year, two thirds of the victims seeking help from “SOS Sexual Violence,” an association helping victims of abuse, were minors (Les Nouvelles Calédoniennes July 1, 2003). However, because childhood sexual abuses are rarely denounced, such data from administrative or associative sources largely underestimated CSA rates. To date, reproductive and sexual health have not been well-documented in New Caledonia and data on the ethnic community are even rarer. An existing system monitoring STIs, providing underestimated figures, nevertheless indicates an average annual incidence rate between 1997 and 2007 of 30 per 10,000 inhabitants, 103.4 per 10,000 in the 20–24 years age group. The average incidence appeared to be 5 times higher in women compared to men (Direction des Affaires Sanitaires et Sociales, 2007). The scarce ethnic data confirm the existence of strong inequalities. Indeed, one survey conducted in 1999 indicated a significant difference between communities in the frequency of pregnancies without medical follow-up, with Kanak women showing the highest rate (25.7%) and European and Asian women showing the lowest (4.4%) (Barny, 2001). In addition, the number of Kanak women declaring their last pregnancy as unwanted is double than that of European women (32% versus 16%) even though the rate of abortion does not differ significantly between communities (Salomon et al., 2003). The present analysis examines the association between early experiences of sexual abuse and adult sexual health among both Kanak women and non-Kanak women. Such a comparative perspective allows examining whether or not CSA is associated with adult sexual health in New Caledonia irrespective of ethnic group membership and other socio-demographic characteristics. Thus, it affords the opportunity to explore whether poor sexual health indicators among adult Kanak women might be linked to exposure to sexual abuse during childhood.

This study shows that in all ethnic communities of New Caledonia, a history of child sexual abuse is not rare among women. These findings also shed light on the long-term consequences of CSA in women. However, the comparison between indigenous Kanak women and other New Caledonian women suggests that the effect of CSA may differ according to ethnic membership and subsequent social stratification and gender norms. It seems all the more important to underline the extent and the impact of CSA since it was previously unrecognized: more than half (54%) of Kanak women and 38% of non-Kanak women who declared having suffered CSA before the age of 15 in the current survey had never disclosed their experience. The results suggest a range of implications for clinical practice and prevention programs. Sexual risk-taking behavior and violence appear to be multidimensional public health concerns, calling for comprehensive programs that include awareness campaigns, education targeting both the male and female population, and care. In a country where distinct cultural contexts and sets of social features exist, appropriate prevention programs on violence and sexual health using diversified indicators to match the cultural and social heterogeneity are needed. Anthropological studies could help to further understand this issue. Interventions must address the complex factors contributing to a long-lasting alteration in the capacity of women to manage their sexuality. Since early sexual violence often remains a secret, a possible history of violence should be taken into account when assessing individual needs of women with sexual-health related problems. More generally, efforts to break the silence around violence against girls and establish a stronger foundation are required in New Caledonia.