A Review of Economic Consequences and Costs of Male Violence Against Women

This article focuses on male violence against women. As it takes place in what is often considered to be ‘the private sphere’ of the home, violence is difficult to prove, to measure, to prevent and easy to ignore. A multi-country study (WHO, 2005, WHO multi-country study on women’s health and domestic violence against women: Summary report of initial results on prevalence, health outcomes and women’s responses, Geneva, Switzerland: World Health Organization) shows that there are wide variations between countries resulting in 15 per cent to 71 per cent of women aged between 15 and 49 years saying that they have been victims of physical or sexual violence in intimate relationships. This article reviews and summarises literature that analyse types of economic costs that result from domestic violence and abuse perpetrated against women.

quintile are more likely to suffer violence than those in wealthier quintiles. In the remaining countries, greater household wealth does not seem to be a protective factor. In India, parental wealth seems to be positively associated with the risk of a daughter suffering IPV, perhaps because men may use violence as a way to extract additional resource transfers, in addition to the initial dowry, from the parents of their wives (Bloch & Rao, 2002). Furthermore, the relationship between a woman's financial autonomy and exposure to violence has been inconsistent in findings from studies conducted worldwide. In some places, financial autonomy increases the risk of women being beaten by her partner (Babcock, Waltz, & Jacobson, 1993), whereas in others, in developed countries, it protects them as it may enable women to leave an abusive relationship (Babcock et al., 1993;Kim & Gray, 2008).

Approaches to Evaluate the Economic Impact of VAW
Since the late 1980s, efforts to estimate the economic costs of domestic violence have been undertaken in many countries around the world. Studies using a range of approaches have shown that the costs of VAW are high. For example, in the United States, US National Center for Injury Prevention and Control (2003) reported that the health-related costs of rape, physical assault, stalking and homicide against women by their intimate partner exceeded US$5.8 billion annually. The estimation of annual cost of IPV against women in Finland is US$136-198 million (Heiskanen & Piispa, 2001), in the UK, £23 billion (Walby, 2004) and in Australia, US$8.1 billion (Access Economics, 2004). More recently, the National Council to Reduce Violence Against Women and Their Children (2009) estimated that the cost of VAW in Australia had increased to US$13.9 billion, and Roldós and Corso's study (2013), based on a prevalence of 255.267 Ecuadorian women who were victims of IPV 2003-2004, estimated the total economic burden to be approximately US$109 million-adjusted to the 2012 US currency rate.
Each approach on costs, while it offers an important perspective, has inherent limitations: both the case study and population-based approaches use a wide variety of assumptions in making cost calculations. There is a lack of consensus regarding the range of costs to include, especially with respect to health-related costs (Varcoe et al., 2011). Finally, most studies do not distinguish women who have separated from those who have not. Leaving an abusive partner is a critical life transition and women often need support from a wide variety of health, social and legal services to successfully make this transition. However, in spite of these limitations, there are three types of economic costs of domestic violence that have been identified from various studies: direct or tangible costs, indirect or intangible costs and the opportunity costs.
The terms 'direct' and 'tangible' are commonly used to the 'costs associated with the provision of a range of facilities, resources and services to a woman as a result of her being subject to domestic violence' (KPMG Management Consulting, 1994, p. 22). Most studies find that the bulk of these costs are borne by governments. First, García-Moreno (1999) considers direct costs to those referred to loss of lives and expenditures related to gender-based violence, including healthcare services, judicial services and social services.
Second, the terms 'indirect' and 'intangible' refer to the pain, fear and suffering incurred by women and children who live with domestic violence. These kinds of costs are sometimes termed the indirect social and psychological costs of domestic violence (Laurence & Spalter-Roth, 1996). In several studies, indirect costs also include the 'flow-on costs that are incurred when a woman leaves a violent relationship' (KPMG Management Consulting, 1994, p. 22). Examples cited included replacing damaged or lost household items, replacing school uniforms and equipment when children change schools and settlement of a partner's outstanding debts.
Most studies find that women bear the bulk of the indirect costs of domestic violence. García-Moreno (1999) considers that lost working days or a reduction in production at work with an impact on the global economy are indirect costs. In addition, he emphasizes that these costs include other intangibles, which, in most cases, are not accounted for because of the difficulty of quantifying them. Among these are the cost of the loss of self-respect and destroyed lives-victims might develop chronic pain, fear, depression or attempt suicide in addition to the loss of opportunity to achieve goals. Laurence and Spalter-Roth (1996) conclude that in only a few studies are indirect costs included as in most, only the costs of injury and death (direct costs) are considered. However, costs do not only affect the victims but also the family, and the resources of the community in society as a whole. Furthermore, VAW also contributes to other issues such as costs related to public services for victims who are children (childcare and attention services), and problems of mental health, which are not included in the calculations. According to the World Health Organization (WHO, 2008, p. 3), the disability-adjusted life year (DALYs) can calculate the burden of disease for the state by measuring the gap between 'current health status and an ideal situation where everyone lives into old age, free of disease and disability'. DALYs are used to measure the costbenefit of interventions into health and social ills (The World Bank, 1993). In 1993, the World Bank estimated that 9 million DALYs were lost globally as a result of sexual and domestic violence.
Third, the opportunity costs are 'the costs of opportunities which the participant has lost as a result of being in or leaving the violent relationship. An opportunity cost is the cost of the opportunity forgone when the woman's options are limited by the circumstances in which she finds herself' (KPMG Management Consulting, 1994 p. 23). Examples would be loss of employment, promotion and quality of life. These costs are often included as part of the indirect costs. As an example, the US National Center for Injury Prevention and Control (2003) specifies that indirect costs are the value of lost productivity from both paid work and unpaid work, as well as the forgone value of lifetime earnings for women who have died as a result of gender-based violence.
According to the World Bank, not only do abused women often find themselves in need of social services and healthcare, they are also less productive at work because of the violence they experience. In its The Cost of Violence Report, the World Bank (2009) uses the DALYs measurement to quantify economic damages caused by VAW and to argue that disabilities, impairments and trauma resulting from violence cause women to miss work and become less productive labourers.
An Australian study commissioned by the Brisbane City Council Lord Mayor's Women's Advisory Committee (Henderson, 2000) reviews and synthesises the qualitative and quantitative costs associated with employment identified in earlier Australian studies and attempts to estimate the annual cost of domestic violence to employers. Results pointed out that the direct costs to employers are not only end costs in themselves, but affect other aspects of an organisation, such as distribution and production, which can result in late deliveries, bringing about customer dissatisfaction and lost business. Similarly, costs to women, such as the inability to work caused by domestic violence, have 'a domino-effect' on other sectors of the society: income forgone by victims, results in diminished profits for business and decreased tax revenue to government. The annual cost of domestic violence to the business/corporate sector was estimated at US$1.5 billion with an approximate cost of an individual case of domestic violence being estimated at almost US$10,000.
A second approach to evaluate the economic impact of domestic violence takes into account the public sector costs and private costs to women especially in neo-liberal policy contexts, as stated below, and market-economy countries (Varcoe et al., 2011). Costing studies have been profoundly affected by their initial motivating factor, namely to demonstrate to governments the financial costs of violence. Chronic mental and physical health problems associated with abuse may make women less employable, reducing their capacity to acquire economic and material resources to sustain themselves and their children (Ford-Gilboe, Wuest, & Merrit-Gray, 2005), with impacts on absenteeism and work quality and subsequent losses to employers and the state (Max, Rice, Finkelstein, Bardwell, & Leadbetter, 2004;Reeves & O'Leary-Kelly, 2007).
Within neo-liberal policy contexts in which cost containment and fiscal pressures dominate, empirical evidence of the costs of VAW is an essential complement to knowledge about the experience of violence and its social, psychological and health impacts. Consequently, the design of many early studies prioritized public sector costs (Snively, 1994;Stanko, Crisp, Hale, & Lucraft, 1998;Yodanis & Godenzi, 1999a, 1999b although most also paid some attention to the private costs to women (Distaff Associates, 1991), especially in terms of employment.
As Yodanis, Godenzi, and Stanko (2000, p. 273) explain, with evidence from costing studies, it is 'no longer possible to conclude that VAW is a private problem, rather it is unquestionably a public problem because the whole of society pays monetarily'. At the same time, however, a focus on public costs, typically expressed as state or government costs (or direct costs) often obscures business sector costs, and the range, magnitude and duration of private costs and consequences of VAW, including the full range of costs borne by women themselves.
Finally, few costing studies of violence distinguish between costs incurred by women who are in abusive relationships versus those who have left. After leaving, tangible financial costs of multiple moves, legal bills, safety measures, child care, counselling, medications and debts incurred by ex-partners often erode women's financial assets, increasing financial stress and, consequently, negatively affecting women's health (Varcoe et al., 2011). Research shows that for many women, abuse continues or escalates beyond leaving an abusive partner and that the most expensive costs are likely to be the recurring use of services as a result of violence (Yodanis & Godanzi, 1999a). In this sense, Canadian data shows that of women who after leaving a relationship experienced violence (an estimated 19 per cent), for a high percentage, 43 per cent, the abuse began or intensified after leaving (Canadian Centre for Justice Statistics, 1993). Another study quantifies that from a sample of 309 women who left abusive male partners, on average 20 months previously, the overall annual per woman cost attributable to violence was US$13,162.39, including total public sector costs of US$11,369.77 and total private costs of US$1,792.62; Varcoe et al., 2011).

Conclusion
The relationship between a woman's financial autonomy and exposure to violence has been inconsistent in findings from studies conducted worldwide. Instead, women's decisions to remain in or leave abusive relationships are often dictated by economic considerations (Grana, 2001;Lambert & Firestone, 2000;Tolman & Rosen, 2001). Furthermore, both the short and longer term costs related to the impact on children, and the costs of informal support from friends, family, volunteers and wider society (classified as indirect costs) are often omitted from costing studies (Walby, 2004), yet these costs are critical in understanding the full economic impacts of IPV.
'Leaving' is the primary social solution offered to women, and violence-specific services tend to emphasise this option on the assumption that leaving will 'solve' the problem and reduce women's need for help. However, there is little evidence to support that assumption. This lack of attention to the post-leaving period may be driven, in part, by the assumption that leaving resolves most significant problems that women face and, consequently, that service use is minimal post-leaving. While women's use of services has not been systematically studied after leaving, there is evidence that many face continuing health, social, economic and legal problems after leaving (Varcoe et al., 2011;Wuest, Ford-Gilboe, Merrit-Gray, & Berman, 2003), which may prompt them to seek professional help. Leaving an abusive partner does not mean the end of abuse. Consequently, all these limitations in approaches to evaluate the economic costs of IPV, lead to the conclusion that there are specific areas in the field that need further research.
Finally, the costing studies highlight that VAW is a public problem as the whole of society pays monetarily and that violence prevention programmes and policies can be cost effective compared with other alternatives.