violence: the economic costs - A Methodological Review
European Council of Europe
Strasbourg, 8 October 1999
Contact: Olof Olafsdottir Secretary to
GODENZI and Carrie YODANIS
the second wave of the women’s movement, attention was drawn to male
violence against women through presentation of the brutality, the loss of life
and freedom, and the fear that many women experience in their lives
(Brownmiller, 1975; Pizzey, 1977; Russell, 1982).
Based on these profoundly negative consequences, advocates argued that
something must be done to assist battered women.
in the fight against male violence against women have come from a variety of
perspectives. The most common
argument defines violence against women as a legal rights issue.
This argument has taken different forms.
Some argue that victims of male violence have a right to equal
protection from the criminal justice system.
Therefore, laws need to be in place to ensure that violence against
women is defined as a crime and that perpetrators are arrested, tried, and
punished (Stanko, 1985). Others
argue that women have a civil right to be protected from violent men through
government funded counselling and refuge (Dobash & Dobash, 1992).
Still others, most notably at the United Nations’ 4th
World Conference for Women in Beijing, call for an end to violence against
women throughout the world in all its diverse forms, because violence is a
violation of women’s human rights. Therefore,
male violence must be condemned and stopped regardless of cultural traditions
different perspective views violence against women as a health issue.
In 1994, the World Bank published a report, “Violence Against Women:
The Hidden Health Burden”, which examined how male violence contributes to
poor health and early death for women throughout the world
(Heise, 1994). Such
evidence has been used to strengthen laws and policies protecting victims.
For example, the concept of the battered woman syndrome, based on the
argument that abuse results in psychological trauma and dysfunction, was used
to fight for a legal defence for women who kill their abusive partners
(Walker, 1984; Dobash & Dobash, 1992).
the late 1980s and 1990’s, another perspective on violence against women
emerged. This perspective views violence against women as an economic issue.
This perspective does not disagree with earlier perspectives.
Rather, it provides another, quite powerful, angle from which to view
the legal, health, and other consequences resulting from male violence and to
argue for social policies to improve the services and protection for victims
of male violence. In another
paper co-authored with Elizabeth Stanko, we evaluate the benefits of an
economic argument and consider the potential for this perspective to affect
policy (Yodanis, Godenzi, & Stanko, forthcoming).
In this paper, we review cost of violence studies and discuss their
common methodological approaches. We
consider both the weaknesses associated with this methodology, and how these
studies are important for improving the availability of data on violence
against women – a step which is vital for increasing assistance to women.
TABLE 1. Summary of Economic Cost of Violence Against Women Studies, 1991-98
OF THE ECONOMIC COSTS OF MALE VIOLENCE
1986, Straus sought to measure the costs of medical care relating to
intrafamily assault and homicide. By
compiling statistics about the prevalence of injuries and medical attention
resulting from spouse and child assaults, he estimated that homicide within
families may account for roughly 24% (or about $1.73 billion) of the total
costs of homicide as estimated by the Joint Economic Committee of Congress in
1976. Yet, he also stressed that
this figure omits many of the medical costs that are incurred prior to death.
He outlines the types and frequencies of possible costs which need to
be included if we think of homicide as the final outcome of the disease of
violence, but he leaves the “translation of the injury and medical care
dollar costs to those more familiar with medical economics” (p. 557).
The next year, Straus and Gelles (1987) in “The Costs of Family
Violence” used data from a nationally representative study to expand on this
idea and outline the prevalence of additional costly outcomes of violence in
the family, including drug and alcohol use, crime and vandalism, missed work
and daily activities, and psychological distress.
While they list the numerous possible sources of costs, they do not
estimate cost figures. That same
year, Friedman and Couper (1987) published the report, The
costs of domestic violence: A preliminary investigation of the financial costs
of domestic violence.
the 1990’s, costs studies and estimates became even more ambitious.
Researchers began to combine prevalence rates of violence and various
outcomes of violence with estimates of related costs in order to develop a
total figure which measures the costs of male violence against women.
Such studies have been completed in Canada (Day, 1995; Greaves et al.,
1995), the Netherlands (Korf et al., 1997), New South Wales (NSW Women’s
Coordination Unit, 1991), New Zealand (Snively, 1994), Northern Territory
(Office of Women’s Policy, 1996), Queensland (Blumel et al., 1993),
Switzerland (Godenzi & Yodanis, 1998), and the United Kingdom (Stanko et
al., 1998). Key information about
each study is summarised in Table 1.
this paper, we will use our study as an example.
Our study builds on and adapts the methods used in the previous cost
studies. It focuses on the costs
of male violence against women in Switzerland and is being conducted in three
phases. In 1998 (German version)
and 1999 (English version), we published the results from the first phase of
our project, which focused on state-related costs resulting from male violence
against women. By compiling data
from representative surveys, government publications and reports, social
service agency records and other sources, we estimated an annual state cost of
$290 million. We discuss our
calculations in greater detail throughout this paper.
For the second phase of the project, we are currently studying the
costs of male violence to business. And
in the third phase, we will focus on the costs to individuals, including
victims, family, friends, volunteers and service providers, and tax payers.
METHODOLOGY OF COST STUDIES
their US report, Laurence and Spalter-Roth (1996) offer a basic equation for
determining the costs of domestic violence as follows,
need to know how many people are affected, how many are using services as a
result of domestic violence, how much of these services they are using, and
the costs of these services” (p. 14).
applying the above seems straightforward, accurately computing it is not.
In nearly all countries, we do not know how many women are affected by
male violence, and we do not know how many and how often women use various
services as a result of violence. For years, advocates, activists, and others
have argued that most violence against women remains hidden from official
view. Indeed, crime surveys, when
compared to surveys of women, show that most violence never becomes part of
the official statistics. This is
true not only in criminal justice institutions but also in health care and
social service institutions and work places.
Accurate information on the prevalence and impact of male violence is
lacking in all parts of society. On
one hand, this limits the possibility of cost studies to provide accurate cost
estimates and useful information to service providers and policy makers.
On the other hand, cost studies bring to light and can reduce this lack
of knowledge in parts of society where individuals usually do not consider
themselves impacted by violence.
cost studies with missing data
majority of cost of violence studies rely predominantly on existing data
previously gathered by government agencies or research institutes.
For example, Greaves et al. (1995) compiled their estimate for Canada
based on information from approximately 30 surveys, reports, and studies,
including the Statistics Canada Survey on Violence Against Women.
Laurence and Spalter-Roth’s (1996) review of US material provides an
extensive list of empirical studies, organisations, and government offices,
which can provide information relating to various dimensions of the costs of
violence against women. This data
can be an important starting point for estimating the costs of violence.
Yet, relying too heavily on the existing data creates problems, not due
to inadequate researchers, but because of inadequate data.
Since the existing data is always incomplete, the cost estimates based
on this data, likewise, suffer from shortcomings, which limit their
usefulness. As a result of using
existing data, cost estimates are weakened by methodological problems related
to operationalisation and measurement of economic costs, units of analysis,
time frames, and population inferences.
measuring a concept, it is necessary to first have a clear definition.
Then, one needs to outline the various dimensions, or facets, of the
concept. Finally, data is
gathered on particular indicators which measure the various dimensions of the
concept. When using existing
data, however, it is not always possible to include the full range of
dimensions or indicators required for adequate measurement of a desired
concept. Often the data simply
are not available. This is a
consistent problem in cost of violence studies.
Concepts are often operationalized according to the availability of
information rather than the requirements for valid and reliable measurement.
As Snively (1994) explains, “The results of New
Zealand Economic Costs of Family Violence depend considerably on the
availability of data consistent with the definition of family violence pursued
for estimation purposes” (p. 6). This
is true for our study as well. Most
obviously, while we plan to include additional phases in our study, we first
selected state-related costs, because the most information was available about
limitations of existing data result in a number of measurement problems.
First, there is often inconsistency between conceptualisation and
operationalisation in studies. For
example, in our study, we define violence as “physical, sexual, and
psychological abuse which is perpetrated by men on women or girls as a result
of their gender“. Yet, when we
calculate the costs, we are often not able to include the costs associated
with these various forms of violence. For
example, in our estimate of health costs, we do not include information on
women under 20 years of age, because that information is not available.
the measures often do not include dimensions and indicators which other
studies have shown to be likely costs of violence.
There is substantial evidence to show that women who experience abuse,
including women in Switzerland, are more likely to engage in self-destructive
behaviour, such as alcohol and drug abuse, and report worse mental health
(Stark & Flitcraft, 1996; Gilloz et al., 1997, Kavemann, 1997).
Nevertheless, we are unable to include abuse-related costs for drug and
alcohol treatment or other psychiatric treatment in our cost figure, because
information on the rate of these services sought by women as a result of
violence is not available in Switzerland.
weaknesses in measurement occur, because due to the lack of data, informed
assumptions have to be made. From
the national study of violence against women in Switzerland, we know that
approximately 10,000 women a year sought help from a social worker as a result
of experiencing violence. Yet, we
do not know the reasons behind their help seeking.
Backed with additional information regarding the financial stresses of
women leaving abusive relationships, we make the assumption that about half of
these women sought some form of financial assistance.
other cases, data that is available are used as merely proxies for missing
information. For example,
there is no data recorded on the number of court cases which are related to
crimes of male physical violence against women in Switzerland.
However, we do have information from a national study on the number of
women who contacted lawyers and sought divorces, separations, or protection
orders as a result of violence from partners.
We use these figures, adjusted to account for the often high percent of
the women who will drop charges before trial, to estimate the number of court
cases each year which occur as a result of physical violence against women.
problems of operationalisation, omitted dimensions and indicators, assumptions
and estimates, which are found in most cost studies, weaken the validity and
reliability of measures of the cost of violence against women.
One can not be sure if the studies are accurately measuring the
economic costs and if that same figure would be reproduced if recalculated at
a later point in time. However,
it would be extremely difficult, if not impossible, to calculate the precise
costs of violence against women. Cost
figures must be, to some extent, merely estimations.
Given this, the problems of operationalisation and measurement may at
first appear to be an insignificant problem.
If additional costs indicators or more precise data were added to the
estimates, the total figures would only be higher.
Therefore, omission of additional costs seems to ensure that the
estimates are more conservative and less refutable.
problems of measurement, however, extend beyond the ability to compile an
accepted figure of the costs of violence.
When researchers omit some costs completely or include guesses and
proxies rather than empirical data, the study does not provide solid,
practically applicable information about the problem of violence against
women. Yet, the very fact that
data is not available indicates the lack of information available to
individuals, who are in key positions to support and assist women if they
realise the need.
methodological problems facing cost estimate studies are related to the units
of analysis. The unit of analysis
in cost estimate studies is usually women.
Equations are based on the prevalence of service usage as reported by a
sample of women. Cost figures are
then applied to this prevalence rate to calculate an estimate for the costs of
male violence. Relying on women
as the unit of analysis is very important for establishing differences between
abused and non abused women in costly conditions such as physical and mental
health status (Stark & Flitcraft, 1996; Gillioz et al., 1997), alcohol use
and illegal drug use (Kavemann, 1997), work income and job turnover (Hyman,
1993; Lloyd, 1997), and welfare usage (Allard et al., 1997; Raphael &
weaknesses result when individuals are the unit of analysis in costs of
violence studies. Under these
circumstances, estimates are not based on data from particular agencies,
organisations, or businesses. Rather,
they are calculated based on women’s use of unspecified service agencies and
experiences in unspecified work places. For
example, we estimate from the national study of violence against women that
approximately 4,000 women require hospital care as a result of experiencing
violence. We also know that the
average hospital stay for a patient in a Swiss hospital costs approximately
Sfr. 10,000 and that the federal, state, and local governments are responsible
for paying 75 percent of the expenses. We
compute a fairly convincing cost estimate based on these figures.
the resulting estimate will likely have limited meaning for and effect on
doctors, nurses, and other service providers in individual Swiss hospitals.
Such figures may not be viewed as applicable to their organisation and
can not provide advice for how to alter daily operations and services to
better meet the needs of women experiencing violence.
problem related to the unit of analysis is the issue of time frames.
Researchers primarily aim to estimate the annual cost of violence.
Ideally, costs could be calculated for every year and changes could be
observed over time. However when
using infrequently and sporadically gathered data, researchers must compromise
by gathering data from the various years in which figures are available and
computing a cost estimate for an “average” year.
For example, within our study, some cost figures are based on 1993 data
while others are based on 1996. In
another example, when calculating the cost of research, we knew the amount of
research grants that were awarded in 1996 by the largest national granting
agency to study violence against women. The
funding amounts were unusually large for that year as a result of a one- time
research program on violence against women.
Few grants to study violence against women have been awarded before or
after this program. In order to
estimate the expenditures on research over time, we assumed that grants of
this amount would be given every 20 years and divided the total amount of
research funding by twenty to get an annual cost.
the best given the circumstances, this solution is not optimal. Not only is it
impossible to observe changes in costs across years, but it also omits many
costs. The U.S. National
Institute of Justice measures costs as “the total losses imposed by crimes
that occur in a given year - regardless of when the losses actually occur”
(Travis, 1996). Laurence and
Spalter-Roth (1996) explain the need for a prevalence-based approach measuring
all service usage, both new and recurring, which occur in a given time period.
In their outline of an ideal study, they suggest a five year period.
Both of these specified time frames are able to capture the full extent
of costs occurring from violence. Yet, most current cost estimates are unable
to use these defined time frames and thus, can not know the long term costs of
violence. Recurring use of
services as a result of violence are likely to be the most expensive costs.
Knowing how long and how many times women use particular services is
also essential for understanding the role of the services in assisting victims
and evaluating the cost effectiveness of a program.
final methodological problem in cost of violence studies is the inability to
make accurate inferences to the desired study population.
Often, data is available from only one organisation or region and does
not allow accurate extrapolation to a whole country or state.
For example, we use figures on the costs of public assistance from one
state to estimate a national figure in this area.
When researchers use the available data to make inferences to the
entire country, estimates gain substantially more error.
sum, use of existing data to calculate cost estimates is not optimal.
Yet, cost studies, relying on existing data, can be and often are used
to highlight and correct this lack of information. Bringing this lack of
information to light is one of the primary benefits of cost of violence
awareness and data with cost studies
researchers using existing data in cost studies, including us, recognise the
problem of unavailable and partial data and have stressed the need for better
systems of gathering data on the effects of violence on the workplace, service
agencies, and organisations. In
their estimates of the economic costs of violence against women in Canada,
Greaves et al. (1995) write, “The main difficulties in establishing full
cost estimates of violence against women in Canada are the lack of data and
inconsistent data collection systems particularly at the federal and
provincial levels” (p.1). After
their review of the existing data in the United States, Laurence and
Spalter-Roth (1996) conclude, “We found considerable gaps in the research
literature in all of the areas studied, suggesting that considerable research
is needed before reliable cost figures can be determined” (p. 4).
cost of male violence studies can be designed to improve the very problems
from which they suffer. They can
increase the availability of data in two ways.
First, cost studies, by their very design, suggest the many areas
within a society which are impacted by male violence against women.
As Stanko (1999) states, “The lessons of the costs study point to the
multiple intervention sites where it is possible to disrupt the serial
patterns of domestic violence.” They
can capture the attention and increase the awareness of police officers,
judges, lawyers, social workers, employers, doctors, nurses, and political
leaders – individuals and organisations who previously did not consider
themselves affected by violence against women.
As a result, violence will no longer be an unknown cause of health,
financial, and workplace problems, and victims will no longer remain
“hidden” in the social institutions.
addition to creating awareness, cost studies can also be designed to increase
data and thus, knowledge about the extent and effects of violence within these
social institutions. Some
researchers have taken steps in this direction. Blumel et al. (1993) and the
Office of Women’s Policy (1996) conducted interviews with abuse survivors
and asked for detailed information regarding their service use.
Stanko (1997) gathered data about experiences with abuse from patients
in a medical office waiting room. We
compiled and recorded data about violence against women from hundreds of
separate files in a victims’ assistance service department.
In the future, researchers can continue to play an important role by
working with police departments, courts, prison systems, public assistance
offices, hospitals, and physician offices to develop accurate and on-going
systems of gathering data on experiences of abuse among their clients.
the second phase of our costs of violence against women study, we are working
with researchers at the International Labour Organisation (ILO) to conduct a
study of the costs of violence to business.
The workplace is possibly the setting in which male violence is most
hidden. Afraid of losing their
jobs, women hide bruises, call in sick, and sit in fear instead of doing work
all without the knowledge of co-workers and managers.
there is some evidence that many companies may be willing to assist women who
experience violence if they are aware of the need.
As was posted on the list-serve for the European Network on Conflict,
Gender, and Violence, on October 1, 1998, the Family Violence Prevention Fund
sponsored the third annual Work to End Domestic Violence Day in which hundreds
of American businesses, public agencies, and organisations participated.
On this day, Bell Atlantic Mobile introduced a toll-free link to the
National Domestic Violence Hotline. They
also continue to provide awareness cards to employees and customers and work
with police and social service agencies to provide wireless phone and
voicemail boxes to victims of domestic violence.
At the Limited, Inc., human resource and security managers have
attended domestic violence education and response training courses lead by a
women’s shelter director. In
addition, associates receive
information on violence against women and have access to an internal company
domestic violence hotline number. Numerous
other companies, including Liz Claiborne, Inc., Levi Strauss, Blue Shield of
California, Gap Foundation, Marshalls, Wells Fargo, Polaroid, and Time Warner,
sponsored the program, have taken measures to educate managers about violence
against women, and provide support for employees who experience abuse.
By aiming to continue or expand such efforts, economic cost of violence
studies are likely to contribute to creating policies in the workplace which
will support rather than punish women who experience violence (NOW Legal
Defense and Education Fund, 1996).
we are conducting a study that will both generate information regarding the
impact of male violence on the workplace and estimate a cost figure, which is
useful for convincing businesses to implement helpful policies. The study will
focus on violence against women which occurs outside of the workplace,
including physical, sexual, and psychological violence in and outside of
intimate relationships, as well as, violence which occurs in the workplace,
such as sexual harassment. We
seek to estimate lost employee days, productivity, profits, and additional
expenses resulting from the actions of perpetrators and needs of victims.
Examples include a male employee missing work as a result of court
appearances related to an arrest for assaulting a female partner and a female
employee missing work as a result of abuse-related injuries.
Data for the study will be gathered through the distribution of a
survey to women and men in a sample of work settings.
Key managers will also be interviewed to determine the measures which
are taken to create a safe work environment and the costs of such measures and
their knowledge of the effects of male violence on business.
data gathering can and ideally should not be a one time occurrence.
Rather, on-going data gathering systems can be institutionalised to
become part of the daily operations of the organisation.
These systems do not need to be time consuming or cumbersome.
Often the information is currently being collected from clients but is
recorded in separate files and on inconsistent forms rather than in ways that
make it readily accessible and analysable.
Many organisations merely need assistance in order to make the
relatively minor adjustments needed to establish ongoing data collection
are examples of such successful efforts.
In the London Borough of Hackney, the Metropolitan Police have
established a Crime Report Information System (CRIS).
As described by Stanko et al. (1997), this system records all incidents
reported to the police and highlights any incident or crime which is domestic
in nature. These would include
offences of violence, sexual offences, offences against property, public order
offences, breach of an injunction where there is a power of arrest, and
incidents which are not later recorded as crime but where the police have been
in the Hackney examples, we also believe that studies should begin to consider
a new unit of analysis, the organisation, in order to improve estimates, as
well as, the usefulness of the data to service providers and employers.
Collecting data at the institutional level will improve estimates of
the costs of violence. By
gathering data from all individuals who seek services from a particular
organisation, it is possible to have accurate knowledge of the portion of
service usage which occurs as a result of violence against women.
By knowing which services were used, more exact cost figures can be
used in the calculations. For
example, when data is gathered from a hospital emergency room, we will know
the number of cases which were related to domestic violence, the medical
treatment that was given, and have a better estimate of the cost of the
from that, we believe that less attention can be spent on trying to compute
precise national figures. By
focusing instead on gathering data at the institutional level, organisations,
agencies, and businesses will have access to data on an ongoing basis to
observe changes over time in the relationship between violence and service
needs. The need for additional
support services, the quality, and cost effectiveness of existing programs can
be evaluated. In the end, the
cost estimate will not just be a large number, but directly meaningful for
developing effective services to assist victims and reducing all costs of
violence – monetary and non-monetary.
this paper, we present studies on the economic costs of male violence against
women and discuss their methodological approaches and weaknesses.
But why study costs? In
this paper, we present one benefit of these studies – cost of violence
studies can solve the very problems they suffer from.
By raising questions regarding where the costs fall, the studies bring
to light the many diverse social institutions and organisations which are
impacted by male violence against women.
With adjustments in methodological approach, cost studies can be used
to increase the availability of data and knowledge regarding the pervasiveness
of male violence throughout societies. The
elimination of ignorance and blinders is the essential first step in reducing
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review and agenda for studies on the economic costs of violence against women.
1. Summary of Economic Cost of
Violence Against Women Studies, 1991-98.
Cost Estimate (USD)
of Costs included in Estimate
Women’s Co-ordination Unit
violence of women at various stages.
Government, Employer and Third Party – Health care, Legal, Criminal
justice, Social welfare, Employment, Child care, and Housing
Coast Interagency Research Group
abuse, psychological abuse, rape, sexual assault of women
Public/community, and Other individuals – Housing and Refuge, Social
Security, Health care, and Criminal justice
1.2 - 5.3 bn - 9 figures given)
violence, including threats of violence, on women and children
Government, Third party, and Employer – Medical care, Social welfare
and assistance, Legal and Criminal Justice, and Employment
and sexual abuse of women
costs – Medical, Dental, and Psychiatric care, Paid and Unpaid Work
loss, Housing and refuge, Long term costs
violence, Sexual assault, rape, incest, child sexual abuse
Government, and Third party - Social services & education,
Criminal justice, Labor & work, Health & medical
of Women’s Policy
sexual, and psychological domestic violence – effects on women and
community and other costs – Crisis support, Police, Housing,
Financial, Medical, Child care, Legal services, Employment
J. Korf, H. Meulenbeek, E. Mot, & T. van den Brandt
and sexual domestic violence against women
and justice, Medical, Psychosocial care, Labor and social security
A. Stanko, D. Crisp, C. Hale, & H. Lucraft
and sexual abuse of women and children
Civil justice, Housing, Refuge, Social services, and Health care
sexual, and psychological
of women and girls
costs - Medical treatment, Police and justice, Victim-related support,
Support and counseling, Research