The economic costs of domestic violence can be categorized as two types — direct costs and indirect costs. Direct costs consist of the value of the goods and services used in treating or preventing domestic violence; indirect costs consist of the value of goods and services lost because of domestic violence.
Direct Costs
The Costs of Domestic Violence Project focused on the direct costs of domestic violence in the following areas:
· Health Care, including emergency room care, hospitalization, initial or follow-up care at clinic or doctor’s office, nursing home care, dental care, mental health care, costs of treatment for sexually transmitted diseases, pregnancy complications and birth defects, and alcohol and drug abuse treatment;
· Child well-being, including child protective services, foster care, counseling, special education, teen pregnancy, and positive toxicology infants;
· Housing, including emergency shelters for homeless and battered women, supported housing such as transitional, Section 8, or public housing, and foreclosure and eviction;
· Criminal Justice and the Legal System, including police time for arrests and responses to telephone calls, prison and detention costs, probation and parole costs, prosecution, criminal court, civil or family court, custody litigation, child support enforcement, and juvenile court;
· Social Services, including domestic violence prevention/education, counseling, job training, advocacy program costs, training costs for police, doctors, etc.; and
· Other Costs, for example, property damage.
Direct costs can be calculated by multiplying the prevalence of domestic violence by the cost of the services used as a result of the violence. This is a useful method for determining the cost-effectiveness of intervention strategies because once a baseline cost is established, any change in the cost (either from a decline in prevalence or a decline in cost) from one year to the next can be evaluated after the implementation of a new intervention. Of course, not all interventions are successful in preventing future domestic violence.
Table 1 includes data on the prevalence of domestic violence in various services (”usage”) and their costs. These data should be considered only as illustrative of how the cost model might be applied; costs vary in different regions of the country and services also vary widely. Further review is necessary before reliable total cost figures can be calculated.
Table 1. Examples of Direct Costs of Domestic Violence
Service Usage Costs
HEALTH CARE: Emergency room care 1.5 million women seek medical treatment for injuries related to abuse (AMA, 1992). A study at Rush Medical Center in Chicago estimated an average charge for medical services to abused women, children, and older people as $1,633 per person per year, excluding psychological or follow-up costs (Meyer, 1992).
CHILD WELL-BEING: Foster care Of the 256,000 children in foster care (1995 est.), an estimated 50% are victims of child abuse (Committee on Ways & Means, 1994). In 45-59% of child abuse cases the mother is also being abused (McKibben, De Vos, & Newberger: 1989; Stark & Flitcraft: 1988). The percentage of child abuse or foster care cases that result from domestic violence is unknown. $2.5 billion Federal foster care expenditures under Title IV-E in 1993 (Committee on Ways & Means, 1994). New York spends $13,600 per child per year in foster care benefits, excluding protective services (Zorza: 1994).
HOMELESSNESS: Emergency shelters 41% of homeless women in family shelters report that they had been battered (Bassuk & Rosenberg, 1988). The Women Against Abuse Center in Philadelphia reported an annual budget of $2.5 million, or $68 per person per day for housing and services (Working Woman, 1994).
CRIMINAL JUSTICE: Prison and detention costs of batterers 20,170 male prisoners were incarcerated for harming an intimate in 1991 (U.S. DOJ, 1994). Average annual operating expenditures per inmate for all State and Federal correctional facilities (nationwide) in 1990 were $15,513 (U.S. DOJ, 1992).
* For a more complete description of the full range of indirect costs, see the full report.
Health Care
Within the health care area, relatively reliable usage and cost data appear to be available for certain services, including hospitalization and emergency room care. On the other hand, more specific data on the number or percent of battered women who use health services such as treatment for AIDS/HIV and other STDs are needed. It is estimated that there are 12 million cases of STDs among women in the United States each year and that treatment costs $5 billion annually; however, national data on battered women and STDs are lacking (Center for Disease Control, 1995). Because women in violent relationships are often unable to negotiate condom use, they may face a higher risk of AIDS/HIV and STDs, along with a higher risk of unwanted pregnancy.
Child Well-Being
Although research documents the risks that domestic violence poses to the physical and mental health of children living in that environment, there are very limited data on the prevalence and costs of children’s services. Straus (1992) estimated that 10 million teenagers are at risk for exposure to domestic violence each year, suggesting the need to collect more information on the impact and the resulting demand on services. Edleson (1997a and 1997b) provides an overview of studies documenting the overlap between child maltreatment and women battering as well as the development problems children who witness domestic violence experience. All researchers found that at least 20 percent of men who were violent toward women partners had physically abused a child — in some studies, the estimates were 50 to 75 percent.
In estimating prevalence of child abuse related to spousal abuse, experts should consider research evidence that half of all children in foster care are victims of child abuse, and that in about half of child abuse cases, the mother is also being abused; moreover, the majority of children living in homes where there is domestic violence are also abused (Bowker, 1988; see Table 1).
In some instances, child abuse occurs in a home where there is no spousal abuse and vice versa; in other homes, there is child abuse and spousal abuse that have the same cause; in other situations, domestic violence may actually cause child abuse and neglect. For example, a child may be physically harmed when he or she tries to defend the mother, or a child may be emotionally harmed or neglected because of the violence in the home. In order to develop a model for calculating the direct and indirect costs of domestic violence, it is appropriate to include the costs related to a child living in an environment of domestic violence, but if child abuse occurs that is not related to the domestic violence, those costs should not be included. It is difficult to make this distinction, because there are no national data on what percentage of child abuse or neglect is caused by or related to domestic violence. The cost of medical care and social services, including foster care placement, for abused and neglected children would be a direct cost of domestic violence if the domestic violence caused the child abuse or neglect. Since child abuse and neglect are the major causes of foster care placement, foster care could be a substantial direct cost of domestic violence.
Homelessness
Research has produced a wide range of estimates of the percentage of abused women in emergency homeless shelters and in publicly subsidized housing. Bassuk and Rosenberg (1988) found that 41 percent of homeless women in family shelters reported that they had been battered. However, we were unable to obtain nationally representative cost figures for shelters, and located only local cost figures (see Table 1).
Criminal Justice
Much of the available data on the costs of domestic violence to the criminal justice system is not at the national level. There are very limited data on arrests by police, 911 calls, and protective orders, making it impossible to construct a national cost estimate. Because the data on the use of criminal and civil courts are based on reports from a significant number of states, they are more reliable (Table 1 shows some national data on incarcerations).
Indirect Costs
In determining the indirect economic costs of domestic violence, the Costs of Domestic Violence Project focused on the following areas:
· Lost Productivity, such as job loss and unemployment, productivity lost due to women prevented from working by partner, coming in late or inability to concentrate due to violence at home, disruption at the work place by the batterer, lost productivity at work for medical reasons, lost productivity at work for court appearances or other appointments, lost promotion/advancement, lost productivity due to incarceration, and lost productivity at home for medical or other reasons;
· Mortality, including the death of the battered women and, less frequently, the death of the batterer or their children.
· Social and Psychological Costs, such as losses to women, communities and society in terms of quality of life and restraints on human potential and activities. Indicators for measuring such costs are in their infancy and are therefore excluded from the indirect economic costs model in the Costs of Domestic Violence Project. However, some of the potential indirect social and psychological costs are discussed below.
Lost Productivity and Mortality
In determining the indirect economic cost of domestic violence, researchers need to consider two kinds of values: 1) the cost of lost productivity (e.g., from illness, court appearances, or incarceration), and 2) the cost of mortality. Much of the data on productivity losses is based on small scale studies and data on the prevalence of domestic violence among working women are not available. Nevertheless, preliminary calculations for losses due to domestic violence can be made. Table 2 demonstrates how we can integrate the finding that 30 percent of abused working women lose their jobs with information on women’s earnings by age to yield estimates of the cost of lost productivity.
Table 2. Examples of Indirect Costs *
Cause Number Affected Loss
Job loss of victim 24% – 30% abused working women reported losing their jobs (Shepard & Pence, 1988; Stanley, 1992). U.S. Bureau of the Census, 1993, provides data on women s earning scales, by age.**
Poor work habits 64% of battered women arrive at work an hour late 5 times per month (Stanley, 1992). U.S. Bureau of the Census, 1993, provides data on women s earning scales, by age.**
Disruption at work place 75% of victims harassed at work by abuser (Friedman & Couper, 1987). U.S. Bureau of the Census, 1993, provides data on women s earning scales, by age.**
Lost Productivity Due to Premature Mortality 29% of female homicide victims are murdered by an intimate or other relative (Bachman & Saltzman, 1995). U.S. Bureau of the Census, 1993, provides data on women s earning scales, by age.**
* For a more complete description of the full range of indirect costs, see the full report.
** Data on the “number affected” can be combined with information on women s earnings by age to yield estimates of the cost of lost productivity.
Indirect Social and Psychological Costs
Indirect social and psychological costs of domestic violence include the decrease in quality of life experienced by women, communities, and society as a result of domestic violence and the increase in restraints on battered women’s human potential and activities resulting from the violence. These costs are documented in many descriptive studies of battered women (Commonwealth Fund, 1995; Estes, 1993; Miller, Cohen, and Wiersema, 1995; and Russell and Megaard, 1988). For example, participants in a focus group run by Victim Services told of losing control of joint resources or custody of their children, constantly relocating in order to avoid their batterers, being forced to sever social relations with neighbors, friends, and family, being embarrassed by visible injuries in public situations, feeling unable to protect their children, having their clothing hidden from them, and therefore being unable to leave home, hiding out with family or friends until they became an unacceptable burden, and staying in shelters in remote locations so they could not be tracked.
The psychological effects of domestic violence that have been evaluated include depression, suicide, chronic anxiety, and sleep deprivation (Raphael and Tolman, 1997). Indicators for measuring indirect social and psychological costs are still being developed; once completed, researchers would have to attach a dollar estimate to them in order to calculate indirect costs.
DOMESTIC VIOLENCE AND WELFARE
For many battered women, welfare is the only income source which allows them to immediately free themselves from financial dependence on their abusers. Three recent studies on domestic violence show that between 57 and 65 percent of women receiving welfare have ever experienced domestic abuse, and between 15 and 32 percent are current victims of physical abuse (Raphael and Tolman, 1997). This has important implications for the effectiveness of training and education programs and the impact of welfare reform.
Welfare reform, depending on how it is implemented in a given state, may have positive or negative effects on the direct and indirect costs of domestic violence. States that are responsive to the needs of victims of domestic violence within their training and employment programs face higher direct costs through the provision of support services and other assistance. However, assuming that their interventions are effective, the long-term indirect costs will be lower as women are able to increase their earning capacity and productivity. Conversely, in states that do not incorporate the additional support services, domestic violence results in the loss of higher earnings that battered women on welfare could have received had they completed their job training or education programs.
Similarly, the imposition of sanctions against women on welfare for noncompliance with work or other requirements will have direct and indirect costs. Some states have chosen to pass the Family Violence Option, which excludes battered women from work requirements, and other requirements if participating will put her at risk. Allowing these women to continue to receive benefits will increase direct costs in the short-term; however, it may decrease the long-term economic costs of the abuse. Those states that do not have the Family Violence Option may see an immediate drop in expenditures as women are taken off the welfare roles. However, these cutbacks in welfare payments could lead to increased domestic violence as women, seeing no financial alternative, remain with their batterers. Those who do not return to husbands or male partners may turn to homeless shelters or see their children placed in foster care, thus increasing the costs of domestic violence.
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