Economic Consequences of Sexual Violence for Survivors: Implications for Social Policy and Social Change A Dissertation presented to The Faculty of the Heller School for Social Policy and Management Brandeis University In Partial Fulfillment Of the Requirements of the Degree Doctor of Philosophy By Rebecca Marie Loya, M.A. June, 2012 Thomas Shapiro, Ph.D., Chairperson UMI Number: 3540084 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. UMI 3540084 Published by ProQuest LLC (2012). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, MI 48106 - 1346 The signed version of this form is on file at The Heller School for Social Policy and Management. This dissertation of Rebecca Marie Loya entitled Economic Consequences of Sexual Violence for Survivors: Implications for Social Policy and Social Change, directed and approved by the candidate’s Committee, has accepted by the Faculty of The Heller School for Social Policy and Management and the Graduate Faculty of Brandeis University in partial fulfillment of the requirements for the degree of: DOCTOR OF PHILOSOPHY Lisa M. Lynch, Ph.D. Dean, The Heller School for Social Policy and Management June, 2012 Dissertation Committee: Thomas Shapiro, Ph.D. Janet Boguslaw, Ph.D. Grant Ritter, Ph.D. Ilene Seidman, J.D., Suffolk University Law School Copyright by Rebecca Marie Loya 2012 ACKNOWLEDGEMENTS I would like to thank my dissertation committee members, who have seen this project through from the beginning. My advisor and chairperson, Tom Shapiro, has been a valuable resource throughout the process. By believing my questions and ideas were important, he helped ensure this project came into being, and by asking me the hard questions, he facilitated my growth as a researcher. Janet Boguslaw has also been a tremendous support throughout my time at Heller. She listened to my ideas, encouraged me, and guided me through every step of mygraduate education. Grant Ritter has offered assistance and support with a quantitative analysis that was more complex than we initially imagined, and he offered valuable insight into my use of theory. Ilene Seidman served as an inspiration for this work and has been a tremendous ally and resource throughout the research process. I would also like to thank the service providers who contributed to this study. They generously shared their time and wisdom to help shape this project from the very beginning. They connected me with others in their networks, and many also participated in interviews. Their knowledge, experience, and compassion have been invaluable resources for me and for the community as a whole. This research could not have been done without them. I am grateful to the scholars who maintain the CPES data set for answering my many, many questions. I feel fortunate to have had access to a data set of this quality. I’d also like to thank the Ford Foundation for the Pre-doctoral Diversity Fellowship, which has supported my education for the past three years. I also want to thank my friends and family members who have supported me and encouraged me throughout this process. Delia Kimbrel has been a constant ally from my first day at Heller, and it is hard to imagine making it through without her. Nicky Fox has been an incredible source of support throughout this process. Her belief in me and in this work has been unwavering, and I am grateful for every conversation, every piece of feedback, and every encouraging word. Thank you also to Maria Torres for connecting me with the CPES and for her encouragement and assistance each step of the way. I also want to thank my other friends who have listened to me, studied with me, and encouraged me throughout, especially Samantha Illangasekare, Monika Kunz, Emily Whitgob, Casey Clevenger, and more names than will fit here—but you are in my heart. I want to thank my love, Nikhil Bhatla, for seeing me through from the beginning, when grad school was just an idea, for supporting me through the very difficult moments, listening to my ideas, and reading my drafts. He has helped keep me sane and encouraged me to grow and develop intellectually. I am also grateful to my mom, Lindy Lampe Loya, for raising me and setting an incredible example of the importance of education. Thank you also to the rest of my family—Jason, Joshua, Sarah, Felix, Kathy, Joe, Patsy, Poonam, Ajay, and Nitin—for believing in me. Finally, and most importantly, I offer my deepest gratitude to the survivors who courageously agreed to share their stories and generously gave their time to participate in this study. This project literally would not have been possible without them. This research is dedicated to these survivors, in the hopes that these findings will make a difference for survivors everywhere. iv ABSTRACT Economic Consequences of Sexual Violence for Survivors: Implications for Social Policy and Social Change A dissertation presented to the Faculty of The Heller School for Social Policy and Management and the Graduate Faculty of Brandeis University Waltham, Massachusetts By: Rebecca M. Loya, MA This study examined whether the myriad known consequences of sexual violence, such as post traumatic stress disorder (PTSD), together with costs like counseling bills, affect survivors’ economic wellbeing. This study responds to the central research question, “What are the economic effects of sexual violence for survivors, and how do assets, services, and policies affect recovery?” This research was informed by trauma theory, asset theory, and intersectionality. This study was conducted using a mixed-methods design. Interviews were conducted with rape crisis service providers and survivors of rape or sexual assault. A grounded theory approach was used for analysis. The quantitative analysis included an examination the Collaborative Psychiatric Epidemiology Surveys (CPES) data. Analyses included linear and logistic regression models for the effects of rape on income and low- income status, including differences by race/ethnicity. The qualitative findings offer evidence of a range of expenses and economic consequences associated with sexual violence, such as medical bills and mental health issues. Sexual violence frequently triggered changes in educational attainment, occupation, and earnings, which negatively affected survivors’ short- and long-term economic stability. Survivors of color, low-income survivors, and immigrants faced numerous additional burdens and barriers in the pathway to recovery. v The quantitative findings show that survivors of rape also had lower household income, even when controlling for demographic variables. The effects of rape may attenuate over time, as rape within the past 20 years had a stronger effect on income than did rape overall. Rape may act on income through mental health symptoms, specifically PTSD. Unexpectedly, rape had significant, negative effects on income for non-Hispanic white survivors, while women of color had no such effect. Black and Latina women had significantly lower income than white participants, regardless of their victimization status. In terms of recovery, financial assets served as a crucial bridge to economic recovery by covering unexpected expenses and increasing flexibility. Those without access to assets relied on social welfare policies, such as cash assistance and subsidized housing. However, existing policies, while offering crucial supports, do not adequately address the needs of sexual assault survivors. Recommendations are provided for both policy reform and new policies. vi TABLE OF CONTENTS ABSTRACT v LIST OF TABLES AND FIGURES ix CHAPTER 1. INTRODUCTION AND STATEMENT OF THE PROBLEM 1 A. Introduction 1 B. Defining Terms 1 C. Scope of the Problem: Prevalence and Key Characteristics 3 D. Research Questions 5 E. Parameters and Focus of This Inquiry 5 F. Overview of the Dissertation and Summary of Findings 7 G. Policy Significance 9 CHAPTER 2. LITERATURE REVIEW AND THEORETICAL FRAMEWORK 11 A. Overview 11 B. Trauma Theory 11 C. Documented Consequences of Sexual Assault 25 D. Asset Theory 36 E. Open Questions in the Literature 41 CHAPTER 3. METHODS: RESEARCH PLAN AND DESIGN 44 A. Overview 44 B. Research Questions 44 C. Methodological Design 45 D. Data Sources and Limitations 46 E. Data Analysis 65 F. Conclusion 71 CHAPTER 4. QUALITATIVE FINDINGS: FINANCIAL COSTS AND ECONOMIC IMPACT OF SEXUAL VIOLENCE 72 A. Overview 72 B. Expenses: Qualitative Findings 73 C. Economic Consequences: Qualitative Findings 78 D. Differential Impact on Marginalized Populations 104 E. Conclusion 111 CHAPTER 5. QUANTITATIVE FINDINGS: EFFECTS OF RAPE AND SEXUAL ASSAULT ON HOUSEHOLD INCOME 113 A. Overview 113 B. Descriptive Statistics 114 C. Bivariate Analyses 117 D. Multivariate Analyses Using Linear and Logistic Regression Models 132 E. Limitations to This Analysis 148 F. Discussion and Conclusion 150 vii CHAPTER 6. QUALITATIVE FINDINGS: STRATEGIES, POLICIES, AND SERVICES FOR WELLBEING AND RECOVERY 153 A. Overview 153 B. Private Payment Strategies 154 C. The Role of Assets in Recovery 158 D. Services and Policies 176 E. Differential Impact