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Economic costs of domestic violence: A community study in South Africa

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Abstract

The present study estimated economic costs of domestic violence against women who sought help from a community care centre in South Africa. It aimed to relate the victims' income and victims' family income to violence related injuries and related costs. This was a cross sectional study with face-to-face interviews in a community care center in which victims of domestic violence sought various kinds of assistance. In total, 261 women were interviewed. The average economic cost of each domestic violence incidence was 691 USD while average cost for medical expenditure was 29 USD and average loss of income due to domestic violence was 2092 USD. Larger families and higher individual and family incomes were protective factors for severity of violence related injuries. Pain and discomfort due to domestic violence emerged as expensive for both medical costs and productivity losses. Considering the average monthly income of 482 USD, domestic violence averaged a cost per incident of 691 USD during the previous month, indicating a deficit in household budget. We found that domestic violence against women resulted with expensive injuries, pain and discomforts.
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... 20 Finally, a study in South Africa estimated that abused women paid, on average, US$265 per violent incidence for visiting a health professional (in 2008). 21 The 2015 Tanzania Demographic Health Survey (DHS) documented that 43.6% of women had experienced physical or sexual violence by a partner since the age of 15, or physical violence by a non-partner since the age of 15, or sexual violence as a child or adult by a non-partner. 22 Moreover, 8.1% of ever pregnant respondents reported that they had experienced physical violence during pregnancy. ...
... Thirdly, household self-report on individual women's use of health care and expenditures are subject to recall errors-gathering data on these aspects from health facilities could provide more reliable estimates of how much patients pay for health care. 21 Despite these limitations this study yields insights on the implications of violence against women on the health sector and to individuals and households. Research in this area has received considerable attention in the last few years as prevention and response efforts are scaled up to address the issue. ...
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Background: Violence against women is a major public health concern. In addition to adverse physical, mental, and sexual and reproductive health consequences, violence against women confers a considerable cost to health services and the health sector as well as to individuals and households in the form of out-of-pocket expenditures. This study aimed to assess whether physical or sexual violence against women is associated with higher health-care utilisation rates and out-of-pocket expenditures in Tanzania. Methods: This study used data from the 2015 Tanzania Demographic and Health Survey. Multivariate regression analysis was used to assess the association between health-care utilisation and partner and non-partner violence among 9,304 women. Outpatient and inpatient health expenditures were analysed using means and t-tests. Results: Women who had ever experienced physical or sexual violence (partner or non-partner) were significantly more likely to utilise health services, and in particular outpatient services, than never abused women. Out-of-pocket expenditures for out-patient care, however, did not differ by abuse status. This was in contrast to inpatient care, wherein, although abused women were not more likely to have higher utilisation rates compared with never abused women, abused women were significantly more likely to incur higher average out-of-pocket expenditures for inpatient visits. This significant difference in expenditure was possibly because of the different inpatient services sought-abused women were more likely to seek care because of illness, while never-abused women were more likely to seek care for pregnancy and delivery. Conclusion: This study highlights how violence against women in Tanzania potentially translates to higher health-care utilisation, possibly because of the long-term or chronic effects of persistent abuse. Health-care policies should, therefore, consider issues such as accessibility and affordability for health services. Additionally, governments should address the issue of violence against women more widely, thereby reducing their own costs as well.
... For example, women who would have otherwise accessed healthcare facilities for physical injuries from IPV may be unable to do so during a natural disaster, thus, increasing their risk for secondary infection or long-term disability. Moreover, research has yet to synthesize the non-health related impacts of IPV for survivors despite a growing body of evidence that has highlighted adverse economic outcomes for IPV survivors [18][19][20][21]. Other potential non-health impacts of IPV for survivors include loss of education and opportunity, productivity loss at work and home, stigma and shame, as well as diminished social capital, autonomy, and decision making. ...
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Intimate partner violence (IPV) is a pervasive form of gender-based violence that exacerbates in humanitarian settings. This systematic review examined the myriad IPV impacts and the quality of existing evidence of IPV in humanitarian settings. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures, a total of 51 articles were included from the 3924 screened. We identified the impact of IPV across two levels of the ecological framework: individual and microsystem. Our findings corroborated previous evidence that indicated IPV to be associated with adverse physical and mental health for survivors. Our findings also uniquely synthesized the intergenerational impact of IPV in humanitarian settings. However, findings highlighted a glaring gap in evidence examining the non-health impact of IPV for survivors in humanitarian settings and across levels of the ecological framework. Without enhanced research of women and girls and the violence they experience, humanitarian responses will continue to under-achieve, and the needs of women and girls will continue to be relegated as secondary interests. Investment should prioritize addressing the range of both health and non-health impacts of IPV among individuals, families, and communities, as well as consider how the humanitarian environment influences these linkages.
... Exactly why these estimates varied by the extent they did is not clear. One possibility is that the difference was due to variation in the estimated number of days off work: 1.8 days in the study by Lince-Deroche et al. (2019) but unstated in the study by Dalal and Dawad (2011). ...
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Evidence demonstrating the economic burden of violence against women and girls can support policy and advocacy efforts for investment in violence prevention and response programming. We undertook a systematic review of evidence on the costs of violence against women and girls in low- and middle-income countries published since 2005. In addition to understanding costs, we examined the consistency of methodological approaches applied and identified and assessed common methodological issues. Thirteen articles were identified, eight of which were from sub-Saharan Africa. Eight studies estimated costs associated with domestic or intimate partner violence, others estimated the costs of interpersonal violence, female genital cutting, and sexual assaults. Methodologies applied to estimate costs were typically based on accounting approaches. Our review found that out-of-pocket expenditures to individuals for seeking health care after an episode of violence ranged from US$29.72 (South Africa) to US$156.11 (Romania) and that lost productivity averaged from US$73.84 to US$2,151.48 (South Africa) per facility visit. Most studies that estimated provider costs of service delivery presented total programmatic costs, and there was variation in interventions, scale, and resource inputs measured which hampered comparability. Variations in methodological assumptions and data availability also made comparisons across countries and settings challenging. The limited scope of studies in measuring the multifaceted impacts of violence highlights the challenges in identifying cost metrics that extend beyond specific violence episodes. Despite the limited evidence base, our assessment leads us to conclude that the estimated costs of violence against women and girls are a fraction of its true economic burden.
... Globally it is one of the most expensive public health problems. The high cost is due to its ability to have a fundamental effect on economic growth that can last several generations (Dalal & Dawad, 2011;Miller, Cohen, & Rossman, 1993). Comprehensive research conducted in developed and developing regions estimates that the cost of violence lies between 1-2 percent of GDP, and it is widely accepted that this may be underestimated in the global South, due to marked underreporting of violence and methodology conservatism (Khumalo, Msimang, & Bollbach, 2014). ...
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Domestic violence is a global phenomenon that concerns disciplines from psychology, public health, development, economics, human rights and others. Domestic violence occurs in all countries and settings, and across socio-economic, religious and cultural groups. Notwithstanding, research evidence and collected service data shows that women are more likely to be victims and men are perpetrators in most situations of domestic violence. All family types: nuclear and extended, traditional and same-sex, are at risk of domestic violence. Similar acts, if perpetrated under public violence would be sanctioned by law, but are often left unattended to in the domestic sphere. This chapter discusses the problem of domestic violence for women in the global South. Whilst the global South shares certain developmental characteristics; official and societal responses to domestic violence prevention and protection differ; some countries have passed the domestic violence act and others have not.
... Violence against women is one of the most expensive public health problems in the world, (Dalal & Dawad, 2011, p. 1931. In 2009, the international Cinancial services consulting Cirm KPMG conducted a study on the cost of violence against women and children in Australia. ...
... It is associated with a wide range of physical, sexual and psychological health consequences [6,7]. Studies have also shown negative impacts of SGBV on the social and economic well-being of survivors [8,9]. These outcomes are particularly exacerbated in humanitarian settings given that crisisaffected populations are more vulnerable to SGBV [10]. ...
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Background: Sexual and gender-based violence (SGBV) remains a silent epidemic in many humanitarian settings with many survivors concealing their experiences. Attitudes towards help-seeking for SGBV is an important determinant of SGBV service use. This paper examined the association between attitudes towards seeking care and knowledge and perceptions about SGBV among men and women in a humanitarian setting in Uganda. Methods: A cross-sectional survey was conducted from May to June 2015 among 601 heads of refugee households (261 females and 340 males) in Rwamwanja Refugees Settlement Scheme, South West Uganda. Analysis entails cross-tabulation with chi-square test and estimation of a multivariate logistic regression model. Results: Results showed increased odds of having a favorable attitude toward seeking help for SGBV among women with progressive attitudes towards SGBV (OR = 2.78, 95% CI: 1.56-4.95); who felt that SBGV was not tolerated in the community (OR = 2.03, 95% CI: 1.03-4.00); those who had not experienced violence (OR = 2.08, 95% CI: 1.06-4.07); and those who were aware of the timing for post-exposure prophylaxis (OR = 3.08, 95% CI: 1.57-6.04). In contrast, results for men sample showed lack of variations in attitude toward seeking help for SGBV for all independent variables except timing for PEP (OR = 2.57, 95% CI: 1.30-5.10). Among individuals who had experienced SGBV, the odds of seeking help was more likely among those with favorable attitude towards seeking help (OR = 4.22, 95% CI: 1.47-12.06) than among those with unfavorable help-seeking attitudes. Conclusion: The findings of the paper suggest that targeted interventions aimed at promoting awareness and progressive attitudes towards SGBV are likely to encourage positive help-seeking attitudes and behaviors in humanitarian contexts.
... May 4, 2015). The detail of the cost calculation method for SGBV can be seen in Dalal and Dawad (2011). Geo-mapping and other kinds of non-personal data collection do not entail a fraction of those costs and could therefore be funded by both the government and private sector in South Africa, as Seedat et al. (2009, p.1019) suggest when they state: "Successful violence and injury prevention is contingent on the identification by the government of these issues as strategic priorities; … and development and implementation of a prevention and containment plan that is intersectoral, strategic, and evidence based." ...
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Research and media reports indicate that most incidents of sexual and gender-based violence (SGBV) in South Africa, as well as globally, are not reported to the police because of victims’ fears of retaliation, intimidation, stereotyping, secondary abuse and stigmatisation. As a result, there is a lack of accurate data available to the South African public and a certain level of ignorance to the realities of the incidence of SGBV across all sectors of society. The purpose of the study is to explore how non-personal data obtained through mapping the distress calls received on TEARS Foundation’s “Help-at-your-fingertips” service line can be used for SGBV research and prevention purposes. Given that in South Africa the death of women at the hands of an intimate partner has been estimated at six times the global average, the urgent need for alternative SGBV prevention strategies is unquestionable. The study shows how the calls received on the “Help-atyour- fingertips” service line across South African provinces and towns were analysed to identify trends, and visually represent the number of SGBV distress calls over two periods, namely July 2013 to August 2014 and September 2015 to October 2016. The key trends identified include times of year, times of day, highest call volumes in terms of provinces and differences in times of calls in different areas in South Africa as examples of the kinds of information that can be deduced from non-personal data. The study shows how non-personal data can be used as a powerful tool to make SGBV data visible and to raise public awareness of its incidence in South Africa.
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Registry data on costs of injuries due to violence in low-income countries seldom cover the total burden imposed on the victim's family. An extended model was therefore developed, encompassing both socio-economic data and family characteristics. The model comprises 32 cost elements in four main categories : injury, death, deprivation and other costs. The main cost elements were income adjusted by family and years; income impact on the family; costs of physical, psychosocial and family deprivations, and cardinal approach of productivity loss. As a result of the five case studies performed in India, the supplementary variables contributed to a better understanding of the total burden on families. This adapted model could help to increase both validity and equality in household surveys. However, ethical issues related to the data collection procedure need to be considered and more empirical contributions from low-income countries in Africa, Asia and Latin America are warranted.
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The current study has investigated the injury epidemiology in a community health service center (CHSC) under a Safe Community in Shanghai, China. It was a cross sectional study with data generated from hospital records and 'Injury Report Card' (IRC). Open wounds constituted 571 (50.8%) injuries. Majority of the injuries (99.64%) did not need any hospitalization. Among the injured victims, 59.16% were floating population and occupied in the manufacturing or transportation sector (31.49% of the injury), commercial services and farms. Finger, toes, head and face were most affected part of the body due to injuries. Mechanical objects and falls constituted nearly 95% causes of injuries. During start of working hours (9am) and during Wednesday and Thursday the frequencies of injuries were highest. In a WHO Safe Community program, injury epidemiology has great emphasize as it dwelled with proper scientific evidences of the injury etiologies. The study had identified some important issues within its objected framework. Education and supervision of the floating workers can be effective for reducing injuries.
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Violence against children and women is a serious public health and human rights problem. Inlow income countries it is closely related to poverty and culture with major social consequencesand economic burden for the families. The overall objective was to study the specific circumstances of domestic violence, including the child labour’s situation and to develop a costof violence model adjusted for the burden of families. The studies were performed in four countries. In the first study violent behaviour was analysed among 1,400 child labourers divided intofourteen categories of work in five states of India (Paper I). In the short term perspective childlabourers become violent, aggressive, and criminal, following a pyramid of violent behaviour, including cultural deviance, and socio-economic and psychological pressure. When consideringfamily history, it seems that the problem is part of a vicious cycle of violence, which persiststhrough generations and evolves through financial crisis, early marriage, and violence in the family. Of interest was also the problem of maternal abuse of children and mothers’ exposure to andattitudes towards intimate partner violence (Paper II). Nationally representative data of 14,016married women from the Egyptian Demographic and Health Survey of 2005 were used. Less exposure to physical IPV was associated with lower risk of using violent methods, such asshouting, striking, or slapping, to correct child behaviour. Non-tolerant attitudes towards IPVwere also associated with using the explanation method to the children. The current situation of domestic violence against women in rural Bangladesh was studiedusing a cross sectional household survey of 4,411 married women (Paper III). Illiteracy, alcoholicmisuse, dowry, husband’s monetary greed from parent-in laws and wife’s doubt on husband’sextra marital affairs were the risk factors for verbal, physical and sustenance abuse. The social inequalities in intimate partner violence (IPV) was scrutinised in Kenya among3,696 women of reproductive age (Paper IV). The data were collected from the Kenyandemographic and health survey of 2003. Women’s employment and having a highereducation/occupational status than her partner, age differences between the partners, illiteracy, lack of autonomy and access to information increased their exposure to IPV. A cost of injury study based on an adjusted model for low-income countries was tested usingcase studies in India (Paper V). The model comprised 32 cost elements divided into four maincategories: injury, death, deprivation and other costs including encompassing and socioeconomicdata and family characteristics. The main cost elements were income adjusted by family and years,income impact on the family, costs of physical, psychosocial and family deprivations, and acardinal approach to productivity loss. As a result of the case studies, the supplementary variablescontributed to a better understanding of the total burden of families. Poverty, illiteracy, male dominancy in resource control and social acceptance of violencemake children and women more vulnerable to violence. The problem persists over generationsand results in an economic burden on the families for healthcare and disability. The studiesconfirm the need for long term local safety promotion programs supported by national policyand legislation addressing the most vulnerable groups in developing countries. Keywords: Child labour, domestic violence, cost of violence, developing countries
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The current study compared working and non-working groups of women in relation to intimate partner violence. The paper aims to explore the relationship between women's economic empowerment, their exposures to IPV and their help seeking behavior using a nationally representative sample in India. This was a cross sectional study of 124,385 ever married women of reproductive age from all 29 member states in India. Chi-square tests were used to examine differences in proportions of dependent variables (exposure to IPV) and independent variables. Multivariate logistic regressions were used to assess the independent contribution of the variables of economic empowerment in predicting exposure to IPV. Out of 124,385 women, 69432 (56%) were eligible for this study. Among those that were eligible 35% were working. In general, prevalence of IPV (ever) among women in India were: emotional violence 14%, less severe physical violence 31%, severe physical violence 10% and sexual violence 8%. For working women, the IPV prevalence was: emotional violence 18%, less severe physical violence 37%, severe physical violence 14% and sexual violence 10%; whilst for non-working women the rate was 12, 27, 8 and 8 percents, respectively. Working women seek more help from different sources. Economic empowerment is not the sole protective factor. Economic empowerment, together with higher education and modified cultural norms against women, may protect women from IPV. ‎
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