Sofia Februanti1*, Tetet Kartilah2
1Diploma 3 Nursing Study Program in Tasikmalaya, Health Polytechnic at the Tasikmalaya Ministry of Health, Indonesia
2Diploma 3 Nursing Study Program in Tasikmalaya, Health Polytechnic at the Tasikmalaya Ministry of Health, Indonesia
*Corresponding Author’s Email: sofiafebruanti@gmail.com
Children are an investment and hope for the future of the nation. Children as the successor generation of the ideals of the nation must be well cared for, educated and protected. Every child has the right to survival, growth, and development and has the right to protection from violence and discrimination as mandated in the 1945 Constitution of the Republic of Indonesia. However, there are many disturbances that can affect children such as sexual violence.
Cases of sexual violence against women are increasingly alarming. Not only is the quantity of violence increasing, but also the quality of sexual violence against women shows a surge in numbers. In 2016 the number of cases of sexual violence against women reached 11,207 cases. Sexual violence against women is categorized into 15 types of violence. Ranging from rape, sexual intimidation, sexual abuse, sexual exploitation, trafficking in women, forced
prostitution to slavery. Handling cases of sexual violence against women is important. Victims of sexual violence generally experience a series of previous acts of violence. According to the Ministry of Health (Kemenkes) director of child health, this case requires the support of many parties in the form of comprehensive, holistic and integrated handling by various sectors related to both the government, non-governmental organizations (NGOs), the private sector and the community including family, relatives and practitioners (UNICEF, 2007). Meanwhile, according to UNICEF (2007), community health centers (puskesmas) is the primary health care provider. Primary Health care center can provide facilities, handle cases of sexual violence among children or if necessary refer to hospitals or related institutions to get further treatment. However, the Puskesmas does not have a special program to prevent sexual violence (Kartilah et al., 2018).
The Central Bureau of Statistics (BPS) survey in 2016, for example, mentions 1 out of 3 women aged 15-64 years is a victim of violence. Cases of violence against women tend to be higher in urban areas than in rural areas. The figure was 36.3% in urban areas compared to 29.8% in rural areas (BPS, 2017). About 120 million girls younger than 20 years old (1 in 10 girls) have been subjected to forced sexual intercourse or other forced sexual acts at some time in their lives. For more than 1 in 4 girls, the first sexual intercourse was unwanted, and a significant proportion of adolescent girls are victims of sexual violence before age 15 (Flowers, 2018). Sexual violence is widespread. In the USA, there are many cases of rape and sexual violence experienced by women aged 18-24 years. The rate of rape and sexual violence among students are twice as in elder women (Sinozich & Langton, 2014). Sexual violence is the form of violence inflicted by perpetrators other than spouses (other people), partners including parents’ in-laws, neighbors, grandparents, uncles, cousins, friends, teachers and strangers. Sexual abuse towards a child can take the form of harassment, touching, rape, sexual exploitation in prostitution, child pornography or sexual slavery (Flowers, 2018).
Some of the study reveal that there are some negative effects of sexual violence on children, including being able to disrupt the growth and development of children and placing children at risk of experiencing various mental and emotional disorders. These disorders may include anxiety, depression, anger, cognitive distortion, post-traumatic stress, dissociation, identity disorders, affect dysregulation, interpersonal problems, substance abuse, self-mutilation, bulimia, unsafe or dysfunctional sexual behavior, somatization, aggression, suicidality and personality disorders (Carson, Foster & Chowdhury, 2014). Social support (the environment in which she lives) greatly affects the victimized child regarding the effects of sexual violence and subsequent revival.
Manaf & Mokhtar (2013), stated that social support act as a buffer to high stress and can protect the victims of sexual violence from developing symptoms and other maladaptive behaviors. Social support provided is generally in the form of emotional care. Their friends and the surrounding environment helped them overcome their traumatic sexual experiences and other everyday problems they faced. The social support they received from fellow victims of sexual violence help each other to overcome their traumatic sexual experiences and the daily problems they faced. They feel that the presence of peers is useful in their efforts to ignore and face the difficulties they experience. According to them social support helps them to believe and feel good about themselves (Manaf & Mokhtar, 2013). Whereas according to Fathiyah, Nurhayati, & Harahap (2011), the social environment around the
victim is one of the potential sources that help overcome violence or the effects caused by domestic violence, through support given towards the victims. This social support is a tool that can help victims adjust with their emotional stress along with the provision of guidance and feedback. Social support has a beneficial impact on the ability of victims of domestic violence to overcome violence. This study aims to determine social support for girls who are victims of sexual violence.
DESIGN
This study uses a qualitative method with a phenomenological approach. The aim of the research with the phenomenology approach is to develop the meaning of the experience of living in a social environments in providing support to girls who are victims of sexual violence.
SETTINGS AND SAMPLE
The research was conducted from May to October 2018 in the city of Tasikmalaya, Indonesia. Participants were selected by Purposive technique with the inclusion criteria of peers of girls who were victims of sexual violence aged 6 to 17 years, neighbors around the house with girls who were victims of sexual violence, heads of puskesmas, and heads of the Tasikmalaya city health department.
The number of participants involved in this study was 2 neighbors, 2 peers of girls who were victims of sexual violence, the head of the puskesmas and the head of the Tasikmalaya city health department. The participant search process was carried out by researchers with the assistance of the social service, the Regional Child Protection Commission of the city of Tasikmalaya, and the Integrated Service Center for Women and Children Empowerment (P2TP2A) in the Tasikmalaya region.
DATA COLLECTION
Strategies for collecting data used in this qualitative research are in-depth interviews, observations and field notes. During the interview, the strategy used was an open-ended interview. Interviews were conducted face-to-face. The researcher had compiled the guideline to the questionnaire so that they could be developed more deeply but still in accordance with the research objectives.
DATA ANALYSIS
Colaizzi’s (1978) as shown by Morrow et al. (2015) used a distinctive seven step process. This provides a rigorous analysis, with each step staying close to the data. The end result is a concise yet all-encompassing description of the phenomenon under study, validated by the participants that created it.
ETHICAL CONSIDERATIONS
Ethical approval was issued by the health research ethics committee of Tasikmalaya. Before the interview begins, the participants are given an explanation by the researcher about the participants' goals, procedures, and rights. Participants who agreed to participate in the study were then asked to sign an informed consent. Thus the researcher can start data collection.
Participants in this study consisted of 2 neighbors, 2 peers of girls who were victims of sexual violence, 1 head of the Puskesmas and 1 head of the city health department, can be seen in table 1.
Participant No. | Gender | Age | Employment | Relationship to victim |
P1 | Female | 52 years | Housewives | Neighbors |
P2 | Women | 16 years of | Student | school friend |
P3 | Female | 49 years old | Housewife | Neighbors |
P4 | Female | 6 years | Student | Friends playing |
P5 | Male | 55 years | Head of Puskesmas | Puskesmas head in the victim's daughter sexual violence |
P6 | Male | 56-year- old | Head of the city health department | Head of the city health department |
The themes that arises from the collected data are emotional support, appreciation support, instrumental support, information support, support for social environment groups, social environmental barriers after the data collected from of head of Puskesmas and Health department heads in dealing with cases of sectarian sexual violence among children.
EMOTIONAL SUPPORT
Support in the form of emotional attention that someone receives from others in the form of warmth, empathy, caring, consideration and feedback and affirmation so that someone feels cared for by others. This support consists of expressions such as attention, empathy, and concern for someone. This support will cause the recipient to feel comfortable, calm, feel owned and loved when she experiences stress, giving assistance in the form of enthusiasm, personal warmth and love.
"... I am the wife of the former head of the citizens association (RW). But if there are people who have problems, people always come to me, do not know why, … after an incident happened to An An, I was asked for help by Mr. A, his grandfather. An An, wanted to be helped to find out who did it ... Then I helped find the culprit, after meeting, just asked to be married in a religious way ... then I helped make a family card because it was needed to make a Social Security Organizing Card (BPJS) ... sorry to see An An, son have mental retardation, are economically incapable, are now victims of sexual violence ... pity ... after giving birth, I help care for the baby ........."(P1)
The concern, care and empathy, was also given by An An's friend.
"... I was a close a friend when I was in elementary school (SD). Because An An only went to elementary school. Poor An An, the situation can't be heard and spoken, coupled with events like this ... so I visited her every week, sometimes I brought her favorite food..."(P2).
APPRECIATION SUPPORT
All participants stated that they appreciated the feelings and decisions taken, supported or agreed on the decisions and support the feelings of the experience.
"... I feel sorry for An An sorry ... maybe it's fate ... her pregnancy will be aborted, it's better to continue her pregnancy. I support the decision of An An's grandfather, ... I love to see it
..."(P1)
The form of appreciation given by participants to An, included positive appreciation to An V's parents, support or approval of An V's parents' feelings
" ... I will support An V's life next... his child is still small. Actually, young children follow parents' decisions ... I appreciate all decisions for the progress of her children ..."(P3).
Such award support helps the individuals receiving support to develop a sense of respect, self-confidence and value. This support is needed by girls who are victims of sexual violence because victims need appreciation to understand their feelings so that victims feel confident and feel valuable.
INSTRUMENTAL SUPPORT
Support provided by one participant in the form of material
"... at that time, I helped make a BPJS card, to prepare for childbirth, ... people who can't afford ... besides that, I also helped buy baby milk, baby clothes. ... how about ... the baby was told to suckle, but he didn't want to ... ". (P1)
The real support provided in the form of finance is also provided by the participants
".... sometimes I give money for school supplies and recitation, although not every day ... because I also have needs ... …. ... Sometimes I also give books or other writing instruments so that An V will be enthusiastic about school ... " (P3).
Instrumental support is the simplest support to define, namely, support in the form of direct and real assistance such as giving or lending money or helping to ease the task of people who are stressed. This support is very meaningful for girls who are victims of sexual violence.
INFORMATION SUPPORT
Participants provide information support to girls who are victims of sexual violence by giving advice and guidance
"... I only suggest to forget this incident, don't try to remember it again ... then encourage the school, don't stop ... because after the incident, the child went on strike, about two weeks, ... he said he was traumatized, scared ... while at home he was quiet, not cheerful, did not want to eat, did not want to go out, did not want to play ... but now the child wants to go to school again ..."(P3)
Participant 2 gives advice more likely to accept her pregnancy.
"... I suggest to keep eating, don't eat too much spicy, hrmful for the fetus, .... take good care of the baby because the baby does not have a father, because if An An is not loved then who will love her again?... " (P2) The
The environment surrounding victims of sexual violence can provide information support to girls who are victims of sexual violence by providing advice, guidance or advice. People around the individual will provide information to support by suggesting several choices of actions that individuals can take in dealing with problems that make them stressful.
SUPPORT THE SOCIAL ENVIRONMENTAL GROUP
The group support given by their playmates is
"... I invite to play together, riding a bicycle together, riding a car, drawing, and coloring ... I play together every day ... sometimes she likes to play with other people but not in a crowd ... " (P4)
" ... I am an elementary school friend to An. An An use to go to special school (SLB) but because his parents were not capable, so An An was sent to public elementary school. When I was in elementary school, An An didn't have many friends, I often felt sorry, so I often accompanied her ... but now I rarely play with An An because I'm busy going to school until late afternoon. But now I like to meet An An every week ... " (P2)
Social group support is a support that can cause individuals to feel that they are part of a group where members can share. Social group support for example, accompanying people who are stressed when resting or during recreation. Group support gives a feeling that individuals are members of a particular group and have similar interests, a sense of togetherness with group members is support for the individual concerned. The existence of social group support will help individuals to reduce the stress experienced by fulfilling the need for friendship and social contact with others.
THE CONSTRUCTION OF THE SOCIAL ENVIRONMENT FOR WOMEN AND CHILDREN FACING THE CASE OF SEXUAL VIOLENCE
The obstacles faced by participants in dealing with cases of girls who are victims of sexual violence are
"... how come ... the most troubling is when looking for the perpetrators who caused An An to be a victim of sexual violence ...... I don't know whether An An was raped together by many young people ... because An has never been steady, he changes her statement often ... " (P1).
THE ROLE AS WELL AS PUSKESMAS AND HEALTH DEPARTMENT IN HANDLING THE CASES OF VICTIMS OF CHILDREN OF SEXUAL VIOLENCE
".... the reality ... …… victims of sexual violence, continue to complain or go to the puskesmas, the puskesmas only conduct referrals to regional public hospitals (RSUD), ... if there is a need of post mortem the puskesmas refer it to the RSUD ... after result, it can be seen whether the victim is a victim of sexual violence or not ..... ... "(P5)
" ... actually, there is already a regulation from the government, that puskesmas are primary health care provider, handle cases of sexual violence against children ... but there may be many health centers that are not experienced to deal with children who are victims of sexual violence, so maybe the puskesmas referred victims to the public hospital public only for administration ... actually puskesmas is only for handling the sexual violence cases ... only dealt with minor physical injuries and stabilization of the victim if you want to be referred to
... so ... well if it is for post mortem, it is not at the puskesmas level, ….. If there are victims who come to the puskesmas, then the victim is examined whether the victim has physical injuries or not,... now if there are new physical injuries, but if that is limited to light and if you want to be referred, ... then the victim prepare a reference letter, a brief chronology of the case ... based on the reason why she was taken to the puskesmas ... then if it happened just once, it might be proof of the case, for example, his pants or skirt were torn but if the incident happened a long time ago then no need to use evidence, what or how to prove it ... ..
... " (P6)
So, according to the head of the Puskesmas and the head of the health department regarding the healthcare management of children, victims of sexual violence in the health center are referred to the RASU. It was explained that if the reports of children who were victims of sexual violence is not only limited to handling mild physical injuries, then a reference letter is made with a reference cover letter along with a brief chronological representation of the case and then they were referred to the RSU.
There are four types of social support: (1) emotional or esteem support that provides comfort and reassurance with a sense of belongingness and of being loved in times of stress, it includes sense of empathy, caring, concern, positive regard, and encouragement toward the person; (2) tangible or instrumental support in form of direct assistance; (3) informational support in form of suggestion, feedback, and advice; and (4) companionship support by giving a feeling of membership in group such as spending time with the person (Sarafino & Smith, 2012).
The impact on victims of sexual violence included post-traumatic stress disorder (PTSD). The girls who were victims of sexual violence need family support (mother and father support, sibling support) and social support such as peers to reduce the risk effects of PTSD on victims. This is in line with the results of a study conducted by Hébert, Lavoie & Blais (2014) which stated that family support and social support contributions influence the clinical level predictions of PTSD symptoms in adolescents who report sexual abuse. In addition, peers really help victims to recover the trauma they experience. Social support like friendship make them feel supported and become more alive so that they can continue their life better (Manaf & Mokhtar, 2013).
The existence of negative stigma or negative reactions, taboo sexuality, blaming the victim, lack of available services from the social environment for these girls who are victims of sexual violence will make them embarrassed and they will blame themselves (Kennedy & Prock, 2016; Sylaska & Edwards, 2014; Collin-Vézinaa et al., 2015). Whereas social support such as trusting victim’s reports, validating victims' experiences is necessary for girls who are victims of sexual violence so that they can rise again from the deterioration that happened to
their lives (Sylaska & Edwards, 2014). This is supported by the results of a study conducted by Schönbucher et al., (2014) where it was found that although parental support is the type of support that is most needed, adolescent victims feel more satisfied when they get peer support. They hope to receive more emotional support from their parents to deal with abuse. In addition, support from schools and provision of counseling is needed for the teenagers who are victims of sexual violence (Schönbucher et al., 2014).
The increasing incidence of sexual violence in children, especially girls, requires government intervention to deal with all aspects starting from preventive, promotive, curative, and rehabilitative. The in-depth interviews with one of the heads of the puskesmas and the Tasikmalaya city health department found that in one of the puskesmas they did not have the support of resources, technical assistance, and guidance from the Ministry of Health so the algorithm could not be implemented perfectly. The existing algorithms are only curative and rehabilitative, not including preventive and promotive aspects. In fact, this is very necessary to prevent the incidence of recurring sexual violence.
Social support in the form of emotional support, award support, instrumental support, information support, social environment group support, is needed by girls who are victims of sexual violence. In addition, the role of puskesmas and the head of the health department in dealing with cases of sexual violence in children is very necessary so that the victims can continue their survival in future.
The authors would like to thank the head of the Human Resource Development Center (PPSDM) Ministries of Health and Health Polytechnic director Tasikmalaya for facilitating this research funding. I would like to express my thankfulness to all participant who were the study population in my research for their cooporation
Auliani, P.A. (2017). Survei BPS: Satu dari Tiga Perempuan Indonesia Pernah Jadi Korban Kekerasan. Kompas.com.
Badan Pusat Statistik (BPS) (2017). Satu dari Tiga Perempuan Usia 15–64 Tahun pernah mengalami Kekerasan Fisik dan/atau seksual selama hidupnya. Jakarta. Available at: https://www.bps.go.id/pressrelease/2017/03/30/1375/satu- dari-tiga-perempuan-usia-15---64-tahun-pernah-mengalami-kekerasan-fisik- dan-atau-seksual-selama-hidupnya.html.
Carson, D.K., Foster, J.M. & Chowdhury, A. (2014). Sexual Abuse of Children and Youth in India An Anthropological Perspective. The Oriental Anthropologist, 14(2), pp149–170.
Collin-Vézinaa, D., De La Sablonnière-Griffin M2, Palmer, A.M. & Milne, L. (2015). A preliminary mapping of individual, relational, and social factors that impede disclosure of childhood sexual abuse. Child Abuse & Neglect, 2015(43), pp 123–134.
Fathiyah, K.N., Nurhayati, S.R. & Harahap, F. (2011). Pengembangan Model Dukungan Sosial Bagi Perempuan Korban Kekerasan dalam Rumah Tangga. Jurnal Penelitian Psikologi, 2(1), pp 187–200.
Flowers, R. (2018) Child sexual abuse: Time for action. UNICEF, China. Available at: https://www.unicef.org/china/en/stories/child-sexual-abuse.
Hébert, M., Lavoie, F. & Blais, M. (2014). Post Traumatic Stress Disorder / PTSD in adolescent victims of sexual abuse : Resilience and social support as protection factors. Ciência & Saúde Coletiva, 19(3), pp 685–694.
Kartilah, T., Februanti, S., Sakti, B. & Hidayat, U.A. (2018). The Role of Community Health Centres (PUSKESMAS) in the implementation of sexual violence for school age children in elementary school. Journal of Maternity Care and Reproductive Health, 1(2), pp 341–350.
Kennedy, A.C. & Prock, K.A. (2016). “I Still Feel Like I Am Not Normal” A Review of the Role of Stigma and Stigmatization Among Female Survivors of Child Sexual Abuse, Sexual Assault, and Intimate Partner Violence. Trauma Violence & Abuse, 19(5), pp 512-527.
Manaf, Abd. R.A. & Mokhtar, N. (2013). Social Support for Child Abuse Cases in Institutional Care. Journal of Social and Development Sciences, 4(11), pp 508–513.
Morrow, R., Rodriguez, A. & King, N. (2015). Colaizzi’s Descriptive Phenomenological Method. The Psychologist, 28(8), pp 643-644.
Sarafino, E.P. & Smith, T.W. (2012) Health psychology: Biopsychosocial interactions. New York: John Wiley & Sons Inc.
Schönbucher, V., Maier, T., Mohler-Kuo, M., Schnyder, U. & Landolt, A.M. (2014). Adolescent Perspectives on Social Support Received in the Aftermath of Sexual Abuse: A Qualitative Study. Archives of Sexual Behavior, 43(3), pp 571–586.
Sinozich, S. & Langton, L. (2014). Rape and Sexual Assault Victimization Among College-Age Females, 1995–2013. USA. U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics Special Report.
Sylaska, K.M. & Edwards, K.M. (2014). Disclosure of Intimate Partner Violence to Informal Social Support Network Members A Review of the Literature. Trauma, Violence, & Abuse, 15(1), pp 3-21.
UNICEF (2007). Pedoman rujukan kasus kekerasan terhadap Anak Bagi Petugas Kesehatan. Jakarta: UNICEF. Available at: