Understanding childhood adversity in West Sulawesi, Indonesia.

BACKGROUND:Despite research indicating the long-term impact of adverse childhood experiences (ACE), few studies identify cultural variations in perceptions of ACE in low-resource settings. OBJECTIVE:This study explores culturally-rooted notions of ACE and sources of vulnerability in two culturally distinct districts in West Sulawesi, Indonesia. METHODS:Data from 50 stakeholders were collected from four focus group discussions and nine semi-structured key informant interviews in Mamasa and Mamuju districts in West Sulawesi. All interviews were conducted in Bahasa Indonesia, recorded, transcribed verbatim, and translated into English. Constant comparative analysis was used to identify key themes. RESULTS:Primary ACE were violence, abandonment due to parents migrating for work, and malnourishment. While individual child characteristics appeared to play a minimal role in vulnerability to ACE, factors at the community and familial levels such as widespread poverty and low levels of parental education led to early transitions to adulthood through child marriage and employment. Cultural norms, particularly adherence to customary law, impacted both vulnerability and responses to violence against children. CONCLUSIONS:ACE interventions should expand beyond individual and family-level interventions to address these structural and cultural barriers to resilience.