A Deeper Silence The Unheard Experiences of Women with Disabilities – Sexual and Reproductive Health and Violence against Women in Kiribati, Solomon Islands and Tonga March 2013 © Copyright United Nations Population Fund Pacific Sub-Regional Office Private Mail Bag, Suva Fiji http://pacific.unfpa.org March 2013 USP Library Cataloguing-in-Publication Data Spratt, Joanna M. A Deeper Silence: The Unheard Experiences of Women with Disabilities and Their Sexual and Reproductive Health Experiences : Kiribati, the Solomon Islands and Tonga / Joanna M. Spratt. – Suva, Fiji : United Nations Population Fund Pacific Sub-Regional Office, 2012. 223 p. ; 26 cm. ISBN 978-982-520-052-9 1. Women with disabilities -- Kiribati. 2. Women with disabilities – Solomon Islands. 3. Women with disabilities – Tonga. I. United Nations Population Fund Pacific Sub-Regional Office. II. Title. HV1569.3.W65 S67 2012 362.4 Disclaimer The views and opinion expressed in this publication are those of the author and do not necessarily represent the views of the Australian Agency of International Development (AusAID) or UNFPA, or any of its other affiliated organizations. The photographs in this publication are used as illustration only and do not imply any opinions, behaviour or activity on the part of those portrayed. Table of Contents Acknowledgements 6 Foreword – UNFPA 7 Executive Summary 10 Background 19 - About This Report 19 - UNFPA 20 - Structure of This Report 20 Overview 22 - Sexual and Reproductive Health and Rights 22 - Violence Against Women and Sexual and Reproductive Rights 23 - Sexual and Reproductive Health 24 Disability 26 Situation Analyses Approach 29 - Purpose 29 - Approach 29 - Interviews with Women 30 - Use of Quotes and Names 31 - Challenges and Limitations 31 • Ethics 31 • Selection Bias 31 • Communication 31 • Triangulation 32 Regional Frameworks on Disability Issues in the Pacific 33 - Biwako Millennium Framework for Action and Biwako Plus Five 33 - Incheon Strategy to Make the Right Real for Persons with Disabilities in Asia and the Pacific 33 - Target 6.D: Increase measures to protect girls and women with disabilities from all forms of violence and abuse.Pacific Regional Strategy on Disability 34 Regional Entities Working on Disability and/or Sexual and Reproductive Health Issues in the Pacific 35 - International Planned Parenthood Federation’s Sub-Regional Office of the Pacific (IPPF SROP) 35 - Pacific Disability Forum (PDF) 36 - Pacific Islands Forum Secretariat (PIFS) 37 - Regional Rights Resource Team (RRRT) 38 Common Findings 39 - Common Strengths 39 • Skills and Talents of Women with Disabilities 39 • Disabled Persons Organizations 39 • Non-governmental Organizations 39 A Deeper Silence - The Unheard Experiences of Women with Disabilities – Sexual and Reproductive Health and Violence against Women in 3 Kiribati, Solomon Islands and Tonga | March 2013 • Government Legislation, Policy and Services 39 - Common Areas to Address 40 • Regional Strategies and National Legislation, Policies and Services 41 • Family 41 • Community 41 • Sexual Identity 42 • Lack of Information and Understanding about SRHR 42 • Need for Improved Services 42 • Health Professionals and Other Social Service Staff 44 • Unplanned Pregnancies 44 • Women in Institutions 44 • Women with a Mental Illness or Intellectual Disability 44 • Involuntary Contraceptive Use or Sterilization 45 Recommendations 46 • Structure of Recommendations 46 • Specifically for Donors 46 • Regional Recommendations 46 • Recommendations for all Three Countries 49 • Kiribati Recommendations 53 • Solomon Islands Recommendations 54 • Tonga Recommendations 55 Kiribati Situation Analysis 56 - About Kiribati 56 - Persons with Disabilities in Kiribati 57 - Kiribati Legislation, Policy and Services for Women with Disabilities 58 • Legislation 58 • Policies and Strategies 58 • Services/Programmes for Women with Disabilities 61 - Experiences of Women with Disabilities 63 • General Characteristics of Women Interviewed 64 • General Health Behaviours 65 • Sources of Support: The Family and Te Toa Matoa 66 • Community Attitudes 68 • Sexual and Reproductive Health Experiences 69 - Concluding Thoughts 79 - Kiribati Recommendations 81 Solomon Islands Situation Analysis 82 - About Solomon Islands 82 - People with Disabilities in Solomon Islands 83 - Solomon Islands Legislative, Policy and Services for Women with Disabilities 84 • Legislation 84 • Policies and Strategies 85 • Services/Programmes for Women with Disabilities 89 - Experiences of Women with Disabilities 92 • General Characteristics of Women Interviewed 92 • General Health Behaviours 94 4 A Deeper Silence - The Unheard Experiences of Women with Disabilities – Sexual and Reproductive Health and Violence against Women in Kiribati, Solomon Islands and Tonga | March 2013 • Community Attitudes 96 • The Significant Role of the Family 98 • Sexual and Reproductive Health Experiences 100 - Concluding Thoughts 118 - Solomon Islands Recommendations 121 Tonga Situation Analysis 123 - A Note on Methodology 123 - About Tonga 123 - Persons with Disabilities in Tonga 124 - Tonga Legislation, Policy and Services for Women with Disabilities 126 • Legislation 126 • Policies and Strategies 127 • Services/Programmes for Women with Disabilities 131 - Family, Community and Sexual and Reproductive Health 135 • The Family 136 • Community Attitudes 137 • Sexual and Reproductive Health Experiences 139 Concluding Thoughts 148 Tonga Recommendations 150 Appendix One: Terms of Reference 152 - Proposal to conduct situation analyses in Solomon Islands 152 • Purpose 152 • Specific activities 153 • Methodology 154 • Output 154 • Timing 154 • Qualifications 154 - Proposal to conduct situation analyses Kiribati and Tonga 155 • Purpose 155 • Specific activities 155 • Methodology 156 • Output 156 • Timing 157 • Qualifications 157 • Details for the work to be delivered 157 Appendix Two: Lists of Interviews 158 - Kiribati List of Interviews 158 - Solomon Islands List of Interviews 158 - Tonga List of Interviews 159 Appendix Three: General Disability Issues and Recommendations Emerging from Situation Analyses 161 General Disability Recommendations 164 End Notes 166 A Deeper Silence - The Unheard Experiences of Women with Disabilities – Sexual and Reproductive Health and Violence against Women in 5 Kiribati, Solomon Islands and Tonga | March 2013 Acknowledgements Joanna Spratt undertook these situation analyses and wrote this document, with contributions from UNFPA staff and reviewers. The author expresses her deep gratitude to the women who took part in the interviews for these situation analyses. Your willingness and enthusiasm to share your time, knowledge and experience, about sometimes personal and painful subjects, was extraordinarily generous. The author is confident that the important information you have shared will motivate and inspire action to improve the lives of women with disabilities in Kiribati, Solomon Islands and Tonga. The assistance and support given by volunteers of Naunau O’E’ Alamaite Tonga Association (NATA), People with Disabilities Solomon Islands (PWDSI) and Te Toa Matoa were invaluable. The author is indebted to those of you who gave of your knowledge experience and time, and these situation analyses would not have happened without you. In Kiribati, the reproductive health coordinator at the Ministry of Health and Medical Services (MHMS) provided excellent support and assistance. In Solomon Islands the team of the community- based rehabilitation (CBR) programme at the MHMS were pivotal in the Solomon Islands situation analysis. Staff from CBR worked out of hours, all days of the week, to ensure we could talk to as many women as possible. Finally, the reproductive health coordinator at the Ministry of Health in Tonga was also very helpful. Collectively, your skills and understanding of your communities were an important contribution to these situation analyses. Many thanks also to other stakeholders for giving your time for interviews and technical review, including colleagues: Naomi Navoce, gender & youth officer at Pacific Disability Forum; Frederick Miller at Pacific Islands Forum Secretariat; Sandra Bernklau, programme manager at Secretariat of the Pacific Community/Pacific Regional Rights Resource Team; Dr Helen Tavola, social development consultant at the Economic and Social Commission of Asia and the Pacific; UNFPA international researcher and consultant Henriette Jansen; Edwina Kotoisuva at Fiji Women’s Crisis Center; and Melissa Alvarado, programme specialist, Ending Violence against Women Programme at UN Women. Special acknowledgement is due to UNFPA Pacific Sub- regional office gender advisors Maha Muna and Riet Groenen for their review, support and contributions to the report. Technical review and comments were also provided by the AusAID, Gender Equality Policy Section and the Disability Inclusive Development (Pacific) Section. The publication was commissioned by the UNFPA Pacific Sub-regional Office in Suva, Fiji, and produced in collaboration with AusAID. Funding for the research and the publication was provided by UNFPA Pacific Sub-regional Office and AusAID. 6 A Deeper Silence - The Unheard Experiences of Women with Disabilities – Sexual and Reproductive Health and Violence against Women in Kiribati, Solomon Islands and Tonga | March 2013 Foreword – UNFPA UNFPA is guided by the idea “Everyone Counts”, and while this is often referred to with regard to work on population, it is equally true in the mandate of the Fund to ensure universal