APPENDIX L Challenges in Estimating the Costs of Violence against Women and Girls Data Availability Public Disclosure Authorized The availability of data to estimate violence and its costs has evolved tremendously (Day, McKenna and Bowlus 2005). Before the availability of national surveys that included questions to establish the prevalence of at least some forms of violence against women and girls, researchers were constrained to rely on small surveys or case studies and based prevalence rates on proxy measures and extrapolated data (Blumel et al. 1993; KPMG 1994). Increasing access to representative national survey data on prevalence rates of violence has allowed researchers to approximate costs at national levels. Finally, in recent years, researchers have access to significant nationally representative datasets that allow sophisticated and comprehensive analyses. Yet, data availability remains a critical challenge for estimating costs of violence against women and girls, particularly in the developing world. Some key challenges include: 1. Inaccuracy of prevalence rates for violence: as noted in chapter 2, even the best Public Disclosure Authorized calculations of prevalence rates are most likely underestimates, thus even with the Most cost studies are based on best data and methodology, one should estimates of costs of intimate partner assume that cost calculations are violence (IPV), probably because underestimates. Moreover, prevalence IPV is the most frequently reported rates barely exist for certain forms of type of violence, has the largest violence, such as girl child sexual abuse, amount of data and prevalence trafficking, or honor killings, making estimates, and the largest amount of costing impossible in these cases. Thus costing information. Yet, it is costs of violence likely reflect only certain inaccurate to describe the monetary – but not all – types of violence that girls and women suffer through their lives. costs of intimate partner violence as 2. The use of current versus lifetime violence the ‘costs of violence’ since it Public Disclosure Authorized prevalence to estimate costs: Duvvury, excludes the costs of all the other Grown and Redner (2004) note that types of violence that women and lifetime prevalence rates are flawed girls face throughout their lives. because of recall problems. Thus, where survey data are available, estimates for recent (typically 12 months prior to the survey) violence should be used. Where surveys are not available, however, researchers have attempted several data collection methods to get estimates of current or recent experiences of violence. For example, Stanko et al. (1998) conducted a postal survey, records searches, a waiting room survey of women, case studies, and meetings with service providers. However, such estimates of violence – and the estimates of associated costs – are typically not comparable across studies. 3. Separating out service costs between violence survivors or sufferers and others who seek the same services: Another challenge is that of disentangling costs incurred for services to violence survivors versus by the population in general, for a range of institutional or Public Disclosure Authorized formal services such as health care, court system services, police services, or housing. For example, a recent costing exercise in Bangladesh found that in the court system, information related to violence against women is not separately maintained and thus data on court-related expenses to redress violence cases is impossible to separate out from court-related expenses to address other concerns brought to a court (Siddique 2011). 1 4. Inability to take into account the quality of service provision: In many estimates of service provision costs, individual women who suffer violence form the unit of analysis. As Yodanis and Godenzi (1999) point out, this assumes that women actually receive satisfactory services, or that all women using a service receive an equivalent level of service, even though many studies report inadequacies and inefficiencies in service provision. 5. Large informal sector: Many developing countries, including large parts of South Asian countries, have large informal sectors with limited data on labor and wages. Thus, estimating the costs of violence in terms of labor participation and productivity loss is not always possible. Rather, such estimates may be biased towards the costs incurred by urban women working in the formal sector who have suffered violence, and not represent costs incurred by violence survivors in urban non-formal and rural, unpaid agricultural or household labor. Methodological Challenges DEFINING DIRECT AND INDIRECT COSTS Direct costs are defined in slightly varying ways by different researchers. According to KPMG (1994), direct costs of violence are “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.” The United States Centers for Disease Control and Prevention (2003) define direct costs as “the actual dollar expenditure related to violence against women.” Buvinic, Morrison, and Shifter (1999) define direct costs as “the value of goods and services used in treating or preventing domestic violence.” Indirect costs cover the gamut of all other ‘costs’, such as the emotional, physical and intergenerational consequences of violence for women, their children, their families and communities. Definitions vary possibly more than is the case for direct costs because of the larger range of such ‘costs’ (Duvvury, Grown and Redner 2004; Laing 2001; Laurence and Spalter-Roth 1996). Duvvury, Grown and Redner (2004) argue that indirect costs are larger and more important than direct costs, yet very few studies have attempted to estimate indirect costs, since these types of costs are “notoriously difficult” to calculate (Duvvury, Grown and Redner 2004: 16). Day, McKenna and Bowlus (2005) propose the division of costs into two main groups: tangible versus intangible costs and direct versus indirect costs. A violence survivor is aware of tangible costs, but does not directly perceive intangible costs. Both tangible and intangible costs can be divided into direct costs, which are realized costs with a monetary value, and indirect costs, which are opportunity costs or the loss of potential,1 where the monetary values must be estimated. Examples of direct tangible costs include out-of-pocket expenses, such as a survivor’s medical bills or legal fees; direct intangible costs include services provided by the government or NGOs. Examples of indirect tangible costs include a survivor’s income loss due to missed workdays. Examples of indirect intangible costs include a firm’s loss of profit because of the low performance of employees who are violence survivors, or the impact of violence on the children of survivors. 1 According to KPMG (1994), 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.” 2 Table L.1 provides examples of some of the most commonly measured categories of direct and indirect costs for women and their families, their communities, and incurred by service providers. Table L.1: Illustrative direct and indirect costs of violence: women, community, providers Direct costs Indirect costs triggered by violence Individual Out-of-pocket expenses Value of goods and services forgone in the form of and family for services income lost through job loss or increased Income loss due to absenteeism, decreased productivity in the missing workdays workplace, and decreased labor force participation Loss of household Increased mortality and morbidity work Pain, suffering, and lost quality of life Increased drug and alcohol use Intergenerational transmission of violence Behavioral problems of children Reduced educational performance Other measures of children’s social health Community Costs of providing Increased demand for public services, which may services to survivors mean additional costs for other users Businesses Costs of provision for: Loss of output and profit due to: Medical services Reduced productivity and/or lower earnings Criminal justice Increased absenteeism Housing Withdrawal from the labor market Legal services Social services Sources: Duvvury, Grown and Redner 2004; Buvinic, Morrison and Shifter 1999. CALCULATING DIRECT COSTS According to Laurence and Spalter-Roth (1996), calculations of the direct cost of domestic violence require data on the number of affected people (prevalence rate), how many are using services as a result of domestic violence, how much of each service is used (service utilization rate), and the unit cost of these services. They propose the following general model of direct cost estimation: where the cost of service i ( ) is multiplied by the proportion of those who use service i because of violence ( ). The accuracy of this estimation model depends on the correct specification of both and . For example, if only those who have suffered violence request a service, then the whole cost of that service should be considered as ; otherwise, only the difference between what sufferers and non-sufferers pay for that service should be included. Alternatively, when the unit cost of services is not available, estimates can use the actual budget that an institution