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HOUSING
AND REFUGE
PROTECTIVE
INTERVENTIONS
PSYCHO-
SOCIAL
COUNSELING
LEGAL
SERVICES
PRODUCTIVITY
LOSS
COSTS OF SERVICE
PROVISION AND
OTHER WELFARE
PROGRAMMES
HEALTH SERVICES
FOREGONE
INCOME
OUT-OF-POCKET COSTS
SOCIAL SERVICES
MACRO OPPORTUNITY COSTS
REPLACEMENT
OF PROPERTY
FOREGONE
INCOME
REPLACEMENT
OF PROPERTY
PROTECTIVE
INTERVENTIONS
REHABILITATION SERVICES
REDUCED
EARNED
INCOME
MEDICAL COSTS
IMPACT ON
CHILDREN CRIMINAL JUSTICE
Government
allocations
Service
provision
Household
losses
Guidelines
to Cost
Guidelines to Estimate the Economic Cost
of Domestic Violence in the Arab Region
iii
Acknowledgements
These guidelines are the product of the collaboration between the United Nations Economic and Social
Commission for Western Asia (ESCWA) and the United Nations Population Fund (UNFPA) Arab States
Regional Office.
They would not have been possible without the efforts of several people: the lead authors, Nata Duvvury,
Director of the Centre for Global Women’s Studies at National University of Ireland Galway and Caroline
Forde, postdoctoral researcher at the Centre.
Mehrinaz El Awady, Director of ESCWA Centre for Women, was involved since the inception phase,
provided substantive input and guidance and contributed to the development of the document.
Thanks to the team of the ESCWA Centre for Women, namely Nada Darwazeh, Sukaina Al Nasrawi
and Hala Attieh for their contributions. Thanks goes to Enshrah Ahmed from UNFPA regional office for her
contribution and support to the entire process.
Thanks also to the international consultants who participated in an expert group meeting in Beirut, from
which these guidelines have evolved. Please see annex 8 for a list of participants in the expert group meeting.
iv
v
Executive Summary
Domestic Violence (DV) is a pervasive problem worldwide. In the Eastern Mediterranean region, 37
per cent of women have experienced physical and/or sexual violence by a male spouse or fiancé. In addition
to being a human rights violation and public health issue, DV has asignificant economic impact on individuals,
the community and the wider society. As such, governments need to take a comprehensive response that takes
into consideration the full spectrum of measures to address DV. Estimating the costs of DV to society as a
whole can be a powerful tool in directing this response.
The economic costs of DV are both direct and indirect, tangible and intangible, and range from health-
care and criminal justice service costs to lost productivity for both the survivor and perpetrator. Having an
estimation of these costs provides an evidence base from which the systemic impact of DV on a country’s
economic potential can be clearly demonstrated to government planners. The undertaking of such studies is
gaining momentum, particularly in the Global North.
The findings have been employed to highlight the importance of addressing DV holistically by
informing policy and increasing the resources dedicated to DV prevention and response. For example, in Viet
Nam, the Government agreed to develop and deliver a minimum package of services based on the cost data
produced.
While data on DV in the Arab region is available to a certain extent in some countries, the understanding
of its economic impact is limited. Estimating the costs of DV will address this gap in knowledge and provide
a potentially important opportunity to positively influence the budget decision makers in the Arab states.
These guidelines are intended for government officials, programme managers and researchers intending
to estimate the costs of DV in the Arab region. They are designed to enable users to understand the purpose of
costing studies and the steps required to undertake a costing exercise in the users’ country.
The guidelines are divided into three parts. Part 1 details the purpose and importance of costing DV,
with a focus on the Arab region, as well as the recommended steps to take when conducting a costing study.
Part 2 outlines how to translate the research findings into concrete actions to ensure impact. In Part 3, four case
studies from a selection of countries which have successfully undertaken or are in the process of undertaking
costing studies are presented.
vi
vii
CONTENTS
Page
Acknowledgements ....................................................................................................................... iii
Executive Summary ....................................................................................................................... v
Chapter
PART ONE: GENERAL GUIDELINES .................................................................................. 1
I. THE PURPOSE OF COSTING DOMESTIC VIOLENCE .......................................... 1
II. WHY COST DOMESTIC VIOLENCE IN THE ARAB REGION?:
A TOOL TO INFLUENCE POLICY REFORM ........................................................... 2
III. COSTING DOMESTIC VIOLENCE: DECIDING THE SCOPE OF
THE STUDY ...................................................................................................................... 4
A. Typology ...................................................................................................................... 4
B. Impacts of DV ............................................................................................................. 5
IV. PROPOSED STEPS TO COST DV IN THE ARAB REGION .................................... 6
A. Preparatory Phase ........................................................................................................ 7
B. National Consultation Phase ........................................................................................ 8
C. Implementation Phase.................................................................................................. 8
V. CAPACITY DEVELOPMENT – AN ONGOING PROCESS ...................................... 24
PART TWO: FROM DATA TO ACTION ............................................................................... 25
PART THREE: CASE STUDIES .............................................................................................. 29
A. Case study one: Egypt ................................................................................................. 29
B. Case study two: The United Kingdom ........................................................................ 36
C. Case study three: Viet Nam ......................................................................................... 46
D. Case study four: State of Palestine .............................................................................. 52
LESSONS LEARNED FROM CASE STUDIES ...................................................................... 57
ANNEXES
1. Case study interviewees ...................................................................................................... 60
2. Internationally recognized definitions ................................................................................. 62
3. Key informant interview questions ..................................................................................... 64
4. Illustrative example of mapping help seeking behaviour - the case of Nicaragua .............. 65
5. Help-seeking by women after experiencing DV ................................................................. 66
6. Estimating lost productivity ................................................................................................ 69
7. Sample household questionnaire Case study of women in national shelter
(Peace House in Hanoi) ....................................................................................................... 72
8. List of participants in the Expert Group Meeting ................................................................ 79
9. Questions on costing DV ..................................................................................................... 80
viii
CONTENTS (continued)
Page
LIST OF TABLES
1. Governance options ............................................................................................................. 8
2. Type of costs incurred by households ................................................................................. 12
3. Key sectors, issues to consider and provider survey questions ........................................... 16
4. Cost of domestic violence based on data from 2001 and 2008 ........................................... 41
LIST OF FIGURES
1. Typology of violence .......................................................................................................... 4
2. Typology of violence (ESCWA and UN Women 2017) ..................................................... 5
3. Estimating costs of DV in the Arab region ......................................................................... 6
4. Proposed project phases of costing DV ............................................................................... 7
5. Calculating direct costs for the company ............................................................................ 21
PART ONE: GENERAL GUIDELINES
I. THE PURPOSE OF COSTING DOMESTIC VIOLENCE
Violence against women (VAW), and specifically domestic violence (DV) against women,
1
is a global
pandemic and a violation of an individual’s human rights. Research has found that one in every three women
worldwide has experienced physical and/or sexual violence, and the rate is slightly higher at 37 per cent in the
Eastern Mediterranean region.
2
This indicates the widespread nature of DV and the urgent need for a
comprehensive response by governments across the globe.
The economic, social and health costs of violence against women, while largely undocumented and
unrecognized, are considered by researchers, programme practitioners and advocates to be enormous. There is
currently growing interest in estimating the costs of DV, particularly the costs of inaction,
3
to provide
governments evidence of the scale of financial losses. Sustainable human development will continue to be
directly and negatively affected until the cycle of violence against women is broken. Demonstrating the economic
and other costs to households, communities and the economy at large is one way to help break this cycle.
Estimating the economic impacts of DV is important to illustrate in clear terms to government planners
the systemic loss to a country’s economic potential. In terms of the logic of economic planning, the estimate
of leakage from the system also provides the basis for understanding the potential gain from increased
investment in policies and programmes to reduce DV. Framing the issue in terms of its economic consequences
redefines it as a matter of public welfare, rather than a private concern within families. Working from the
assumption that the fundamental objective of government is to promote a vibrant and growing economy, this
economic analysis also provides an evidence base to redirect budget allocations to ensure a sufficiently funded,
comprehensive and ultimately effective response to DV. In addition, it contributes to increasing the efficiency
and transparency of budget allocations, especially for countries that have a limited budget for gender equality,
which is the case in most Arab countries. Furthermore, by accounting for inflation, the expected increase in
use of services in response to DV and the population growth rate, governments can project costs of service
provision.
4
Nearly 60 studies, largely from countries in the Global North, have attempted to provide cost estimates of
DV
5
at the individual, household and community levels. Many of these studies provide only selective estimates
of costs of violence; their findings are approximations based on partial information and with many assumptions
for aggregation. In general, these studies have aimed to document and quantify the economic impacts of violence
upon individual household economies and to assess the following: loss of family earnings due to repeated
physical injuries or emotional abuse; work days lost by both women and men and related health costs (including
the costs of accessing services); and the impact of spousal violence on children and their education.
Countries that have focused on estimating the economic costs of DV have used the evidence to raise the
priority given to the phenomenon in national policies and programmes, as well as to increase the resources
available to programmes for prevention of violence, treatment and care for survivors and for prosecution
of perpetrators of violence. For example, in Egypt, the findings of a national costing study conducted in
1
Domestic violence encompasses violence perpetrated by family members against other family members. These guidelines
focus on domestic violence against women, namely, violence perpetrated against women by family members. Marital violence is a
subset of DV and focuses on violence against women by a husband or partner.
2
WHO and others, Global and Regional Estimates of Violence Against Women: Prevalence and Health Effects of Intimate
Partner Violence and Non-Partner Sexual Violence (Geneva, World Health Organization, 2013).
3
Costs incurred as a result of governments failing to adequately address the problem of DV.
4
Nata Duvvury and Sinead Ashe, “A costing tool for action: estimating the resource requirements for a minimum package
of essential services for women experiencing violence” (New York, UN Women, 2016).
5
Many of these studies have a limited focus on marital or intimate partner violence.
2
2015 have contributed considerably to proposed legislation on VAW. The findings are also being used by
non-governmental organizations (NGOs) and the National Council for Women (NCW) to raise awareness and
put pressure on policymakers. In Viet Nam, the government agreed to develop and deliver a minimum package
of services based on the results of its costing study. Fokupers, an NGO in Timor-Leste, was also able to increase
the budget allocated to combat DV through advocacy based on the findings of their costing exercise.
6
In
Peru, estimates of the costs for the private sector has led to some companies developing and implementing a
business model to address violence against women. The studies conducted in Egypt and Viet Nam are detailed
in Part 3.
Nata Duvvury, an expert on the subject and lead contributor to these guidelines, designed a rigourous
costing model for the Arab States to calculate estimates of the costs of marital violence experienced by women
at the household and community level.
7
With slight modifications, this model can be applied to estimate the
costs of DV against women which includes violence by family members, other than husbands, in addition to
marital violence. The model is based on mapping both direct and indirect costs. Direct costs include provision
of services (law enforcement, court hearings, health care, housing, refuge and other social services, etc.).
Indirect costs include lost earnings due to job loss, productivity losses, education losses (such as the impact on
children’s learning and completion of school) and health losses (for example, the impact on women’s and
children’s well-being).
It is important to recognize that data limitations present methodological challenges in developing an
effective model to cost VAW. For example, estimating direct costs at the community level requires rigourous
data on DV prevalence and information on utilization of services as a result of violence. New data collection
efforts will help overcome some of these challenges. Several countries in the Arab region have conducted or
are beginning to undertake national prevalence studies on VAW, including in Egypt (case study 1), the State
of Palestine (case study 4) and Tunisia. However, there are very few household surveys that estimate either
the income loss to households or indirect losses.
Despite the challenges involved, costing the impact of violence is an important step towards galvanizing
countries to actively address violence, develop realistic strategies and ensure allocation of adequate resources.
It also reduces the need for donor funding in the sector and enables better utilization of such funding. Thus,
research on the social and economic costs of DV is urgently needed. This guide will provide an overview of
what is involved in conducting a costing study, including sample questions to be included in a survey as well
as a sample survey.
II. WHY COST DOMESTIC VIOLENCE IN THE ARAB REGION?:
A TOOL TO INFLUENCE POLICY REFORM
In the Arab region, DV has been widely recognized as a critical human rights violation requiring political
commitment and leadership to prevent it from happening and, when it does, to mitigate its consequences and
prosecute its perpetrators. While some data is available in some countries, the understanding of the economic
impacts and financial consequences of DV is limited. Costing DV in the Arab region will fill a gap in knowledge
on its prevalence and its economic impacts. A focus on the economic costs can offer a potential entry point to
positively influence budget decision makers in Arab States and, most importantly, to introduce policy reform.
Costing DV will help Arab States coordinate their efforts on a national level, as efforts thus far have
been fragmented. This is evident in the disconnect of the international and national legal frameworks from the
actual policy frameworks implemented and services established.
8
Costing DV will assist Arab States to
6
See http://asiapacific.unwomen.org/en/news-and-events/stories/2016/06/un-women-costing-tools-have-led-to-improved-
essential-services.
7
E/ESCWA/ECW/2017/Technical Paper.4.
8
E/ESCWA/ECW/2017/2.
3
implement due diligence and to meet their international commitments and obligations, such as the Beijing
Platform of Action,the Convention on the Elimination of all Forms of Discrimination Against Women
(CEDAW) and the relevant goals and targets in the Sustainable Development Goals. Analysing the cost of DV
will also enable Arab States to fully assume their role as duty bearers, confirming the severity of the problem
as a matter of public, not private, concern.
The recent costing study in Egypt, examined here in case study one, was conducted to address the dearth
of information on the prevalence of gender-based violence (GBV) and its economic impact.
9
The study
confirmed a high rate of violence perpetrated against women. The total cost for women and families due to
this violence was approximately 2.17 billion Egyptian pounds (LE) in 2015. The findings led to enhanced
awareness and the development of VAW services, among other significant advances.
While these types of findings can have a significant impact, criticisms have been raised. For example, a
main criticism of the costing approach is whether an estimation of financial costs can capture the full
ramifications of survivors’ suffering. Another is to what extent cost estimates assume the link between level
of violence, degree of development and magnitude of costs. Related to this is whether or not cost studies
assume that the impact of the perpetrator’s behaviour is limited only to the woman assaulted? Given these
concerns, it is therefore important to outline some key considerations and highlight the limitations of costing
studies when communicating study findings to policymakers. Based on its experience of consultations with
national policymakers in the region, ESCWA have outlined the following key considerations and principles
for costing studies.
10
Main principles for costing violence against women in the Arab region
1. Since VAW is a social phenomenon with serious economic implications, costing necessitates that the human
and social dimensions serve as the basis of the economic aspect.
2. The prevalence of VAW causes serious socioeconomic problems on the macro and micro levels.
3. There is a negative correlation between delayed development and the incidence and rates of specific forms of
VAW.
4. In costing the impact of VAW, women must be the primary stakeholders, followed by society and then the
State. This hierarchy should be reflected in the costing indicators.
5. Formulating sustainable policies of costing VAW is a valid approach to underscore the importance of ending
the serious harm done to women which, at the same time, enables measuring the related developmental losses.
That said, it is not a meant to shift the economic burdens from the State.
6. The harm caused by VAW is not restricted to the women assaulted but extends to the larger society and
subsequent generations, so the losses in development are felt across families and social structures. In this sense,
VAW can be considered comparable to a crime which causes gross public damage and loss of funds.
7. In addition to the tangible forms of VAW, there are numerous intangible forms that have been traditionally
overlooked in the discipline and which require more effort in discerning and calculating the cost of their impact.
8. The nature of specific norms of VAW in a country is a determining factor in defining the nature and specificity
of the relevant VAW policies.
9. Even where VAW costs as a percentage of GDP are the same, the developmental status of the countries in
question mandates the type of State intervention, approaches and policies for the elimination of VAW.
9
The Egyptian study had an expanded focus to capture violence experienced by women from the spouse, family members
and in the public spaces.
10
While the principles developed by ESCWA have not been vetted, they are included here to highlight the type of reservations
that are often raised in national consultations regarding the costing of DV.
4
III. COSTING DOMESTIC VIOLENCE: DECIDING THE
SCOPE OF THE STUDY
A. TYPOLOGY
VAW is a broad continuum comprising the complex and interlinked forms of interpersonal violence
women experience, such as harassment, assault, abuse and rape.
11
VAW can occur within the household, in
the public sphere and/or at the community level (see figure 1). It can include child abuse, violence against an
adult or violence against an elderly person, and the perpetrator can be a family member or a stranger.
As the most widespread form of violence globally, DV
against women manifests in a number of different ways. The most
common forms include emotional, sexual, physical and verbal
abuse perpetrated in households. Likewise, there are many
definitions of the different types of violence.
As such, a fundamental aspect of the research design involves
determining which form of VAW and what definition will be used in
the costing study. For example, the research team can choose to focus
on DV or a combination of DV and VAW in public spaces (see the
case studies presented in Part 3) with the understanding of the pros
and cons of each option.
When deciding upon the scope of a country’s costing study,
it is important to draw on relevant internationally recognized and
operational definitions. A selection of internationally recognized
definitions is provided in annex 2. The operational definition
employed in the costing study should take into consideration the
breadth and width of the different types of families (nuclear and
extended) in the region.
The brief overview of VAW in figure 1 highlights that it encompasses violence perpetrated by multiple
actors, as well as different types of behaviours that are basically economic, psychological, physical or sexual
in nature.
Figure 1. Typology of violence
Source: WHO 2012.
11
Liz Kelly, Surviving Sexual Violence (Minneapolis, Minnesota, University of Minnesota Press, 1988).
Good Practice: Egypt
While it is possible to estimate the
costs of DV and violence in public
spaces in a single household survey
(see the Egypt case study), it is
recommended to assess different types
of violence in separate surveys.
A number of difficulties were
highlighted by the Egyptian national
stakeholders. These included the length
of time required to complete surveys for
the numerous types of violence
occurring within the family and in
public spaces as well as the emotional
burden placed on respondents. Due to
these data considerations, costing DV is
more relevant for the Arab region and
will ensure greater accuracy.
5
The global typology of VAW is very relevant to the Arab region. ESCWA and UN Women have adopted
the same typology (see figure 2), which highlights that VAW occurs in both public and private spaces.
Figure 2. Typology of violence (ESCWA and UN Women 2017)
B. IMPACTS OF DV
When formulating the scope of the study, it is also important to consider the numerous consequences of
DV for individuals, families, communities and the wider society. As shown in figure 3, DV has multiple
impacts on women’s health, education and work opportunities. Overall, women’s ability to take advantage of
employment opportunities and their work performance are impeded, leading to productivity losses that affect
the national economy. Women’s subordinate status is reinforced, which can fuel further violence. Additionally,
DV has long-term effects on children’s health and education, potentially limiting their future economic
participation. Taken together, there are significant costs for the national economy. As such, increased
investment in prevention, protection, prosecution and compensation would, in fact, result in significant savings
for governments.
6
Figure 3. Estimating costs of DV in the Arab region
Source: E/ESCWA/ECW/2017/2, p. 10.
IV. PROPOSED STEPS TO COST DV IN THE ARAB REGION
Building on the the ESCWA experience in supporting Arab States in costing DV, ESCWA established
a number of practical steps to initiate and complete a national costing exercise for DV. These steps take into
consideration the specificity of the region and the need to build consensus and ensure ownership. They also
account for the data limitations of the region while putting in place actions to ensure adequate data collection
and management. As shown in figure 4, this project model involves three overarching phases: (1) the
Preparatory Phase, (2) the National Consultation Phase and (3) the Implementation Phase.
In the Preparatory Phase, it is important to clearly define the purpose of the study, as this will determine
the scope of the exercise, the most appropriate methodology and the types of costs to be estimated. Next, the
National Consultation Phase involves establishing partnerships with and among stakeholders. This ensures that
the stakeholders involved understand the exercise and commit to using the findings to influence policy reform.
This is followed by the Implementation Phase, where the research strategy is put into action. To further ensure
ownership and institutionalization, capacity-building is an ongoing component of the costing exercise. Each
of these phases is outlined in figure 4 and further detailed in the sections that follow.
7
Figure 4. Proposed project phases of costing DV
A. PREPARATORY PHASE
Contextual Analysis
It is important to initiate the costing study using a participatory options exercise.
12
The essential elements
that must be considered in any costing exercise are: existence and type of legislation on DV; existence and
type of policy framework; the corresponding services that either respond toor prevent DV; existence and type
of data, and other information in the country.
An analysis of the legal framework and operating procedures in the country will enable the research team
to gain a better understanding of the national context. Stakeholder mapping is a useful tool to identify potential
partners, as well as the primary and secondary audience. In addition, this analysis should look at stakeholders’
roles and responsibilities to identify gaps. It is also important for the analysis to document unmet needs, such as
lack of human and financial resources, and absence of services in isolated regions and rural areas.
The contextual analysis defines the scope of the costing exercise, specifically the type of costs that can
be estimated and the definitions to be employed. Both these elements influence the methodology and methods
that will be chosen. There are a number of factors to take into account, such as the intended audience, the
response mechanisms and the legal framework available in the country. An additional consideration is whether
or not the team working on this project will be able to access and review national budget documents.
12
UN Women, Manual for Costing a Multidisciplinary Package of Response Services for Women and Girls Subjected to
Violence. (Bangkok, 2013).
8
Key informant interviews should also be conducted with all relevant national stakeholders (see
annex 3 for interview questions) in ministries such as social affairs, finance, interior, education, health,
statistics, etc. In addition, interviews should be conducted with relevant NGOs, especially service
providers. It is important to complement this fieldwork with a literature review of VAW costing studies.
This should result in a short contextual analysis report detailing the results and providing
recommendations for the next steps to be taken.
B. NATIONAL CONSULTATION PHASE
The national consultation phase is a key aspect of the
costing project. It is important to involve government at the
highest level possible, especially the offices involved in the
preparatory phase. It is also important to establish a national high-
level platform to ensure a commitment to sharing existing
information. In terms of governance of the costing project, there
are three options: government-led, NGO-led or National Women’s
Machinery-led (see table 1 for international examples).
Table 1. Governance options
United Kingdom 2004: Government-led Project
The United Kingdom’s Government Equalities Office
commissioned Professor Sylvia Walby in 2003 to address gaps
in the existing data on DV (see case study 2). International
experts contributed research assistance and the Home Office
Economics and Resource Analysis Unit personnel provided
expert advice. Data on the extent and nature of DV was taken
from the report on the 2001 British Crime Survey
Ukraine 2008: NGO-led Project
The NGO La Strada-Ukraine initiated a
costing exercise and conducted it in
partnership with the Institute for Social
Studies and the Ministry of Interior
(International Women’s Rights Center “La
Strada – Ukraine” 2008).
Egypt 2016: National Women’s Machinery-led Project
Under the leadership of the National Council for Women, UNFPA coordinated the study in Egypt, which was
conducted in partnership with the Central Agency for Public Mobilization and Statistics (CAPMAS) (see case study
(1). A National Advisory Committee was established to manage this nationwide project, which enlisted an
international and a national economics expert. Consultations were also conducted with relevant ministries and
institutions providing protection and response services to survivors.
The study estimated the cost of the problem for women and households could cost Egypt as much as LE 6.15 billion
or about $769 million (based on an exchange rate of LE 8 to the $1) if the rates of violence are maintained.a
a. Costing studies are an expensive undertaking. In the case of Egypt, where the study cost approximately LE 350,000, it is important
to note that CAPMAS was a key part of this study. If the employees of the national statistics office do not conduct the analysis of
quantitative data, outside researchers will need to be hired, increasing the cost of the study.
C. IMPLEMENTATION PHASE
There are two main ways to cost DV–costing the problem and costing the solution.
13
Costing the problem
involves estimating the economic and social costs of DV, from out-of-pocket expenses incurred by individuals
and households to the macroeconomic impact on society at large. In contrast, costing the solution entails
estimating the cost of resources needed to prevent, treat and mitigate the effects of violence. In both ways,
household surveys are useful tools, but in the latter gender-responsive budgeting can be used as a tool for
calculating the cost of the solution (prevention, provision of support and prosecution).
13
E/ESCWA/ECW/2017/TECHNICAL PAPER.4, p. 3.
Good Practice
To ensure ownership and
implementation of the research
findings, a multi- or interagency project
that is led by the government is
recommended. NGOs can play a useful
role in advocating for the government
to undertake a costing study.
9
1. Issues to consider when costing DV
(a) Ethical guidelines
Conducting this type of research involves significant ethical considerations. To minimize harm to
survivors and researchers, the protocol devised by WHO
14
must permeate the design, implementation and
dissemination of the research. Throughout the study, the emotional and physical safety of survivors must be
taken into consideration above all. It is also important to be aware of the time needed to receive approval from
the relevant research ethics board.
(b) Site selection
A costing study can be undertaken at various levels - household, community, national - with specific
advantages, drawbacks and uses of each. A study at the local authority level (for example, a city or
municipality), will focus on estimating costs at the household and community level. A more comprehensive
option, such as an estimate of the nationwide costs of DV, will require a nationally representative survey of
households and service providers.
While several factors determine which kind of study is most
appropriate, the level of information available is a key factor. For
example, in the United Kingdom, the first costing studies were
undertaken at city level since researchers were able to work with
service providers in the city to collect the required information
through administrative records and interviews with service users
with expert interviews conducted to fill any gaps. The resources
available for undertaking a costing study is also a significant
determining factor, as smaller, regionally focused studies will be
less expensive.
Another factor that could influence at which level a study
is undertaken is the subregional variation in the extent of
violence or in situations where the type and extent of services
vary considerably. If particular subregions in the country are known to have significantly higher levels of
DV, it is possible that survivors bear higher associated costs. Additionally, where DV is not perceived as
a problem by policymakers, using an aggregation of estimates across various regions may be more
effective than national costs. However, aggregate national costs run the risk of lacking empirical rigour,
which can be used to undermine the validity of the estimates. Estimating costs at specific regional levels
could therefore be an option.
(c) Data availability
The quality and robustness of data sources are of central importance to ensure that the cost of DV
estimates are not underestimated, overestimated or inaccurate. Costing errors could undermine the prevention
of VAW and gender equality policy and programmes, as well as potentially reduce the appropriate
prioritization and allocation of resources. Additionally, a concise and recognized definition of DV is necessary
for the proposed costing exercise, firstly, so it is clear what is included and excluded in the study and, secondly,
to inform the range of data necessary to fulfill cost estimations.
Which items to cover in the costing exercise is dependent on the availability of robust data on both
the extent of the violence and its direct impact for women individually. Compiling a checklist of the
14
WHO, “Putting women first: ethical and safety recommendations for research on domestic violence against women”
(Geneva: World Health Organization, 2001).
Good Practice
Given the arguments presented,
it is recommended that a multi-site
costing exercise be undertaken in
representative subregions and/or
localities.
Indicators for determining
national representation of regions
should include, in addition to the
usual demographic and economic
variables, norms of acceptability of
DV and level of response to DV, as
discussed in this paper.
10
administrative data that could be used (such as age, sex, national patient registry, number of days in jail) is
an important first step. If robust, high-quality data is not available, an alternative approach would be to draw
on estimates from other reputable costing studies. Such an approach would entail adopting item cost
estimates produced in similar contexts.
To give an example, in a situation in which States have similar health-care systems (service provision,
funding and access): State A has high-quality data available to produce a reasonable unit cost estimate but
other States in the region with similar contexts do not. State A’s robust unit cost data could be justifiably used
by the other States. If contextually similar States have insufficient high-quality data to produce an item cost
estimate, the next step would be to draw on item cost estimates undertaken in other regions and appraising
whether it would be reasonable to employ them in
respect of contextual similarities and differences. If
not possible, rather than producing error-laden
estimates, it is advisable not to include the item
while clearly indicating that it is missing from the
overall cost estimation.
One of the challenges for costing DV across
several states within a region, such as the Arab
region, is the issue of comparability. If data sources
are not equivalent or comparable, the estimates of
costs cannot be compared. For costs to be
comparable across a region, differences between
States must represent something measurable about
the extent of the violence and/or its impacts rather
than a difference in accuracy or quality of
underpinning data sources. Though not robust, the
GBV Information Management System (IMS) data
available in some countries are a good place to begin
and this tool could be employed in countries that do
not have statistics on GBV. Walby and Olive
(2014)
15
and Walby and others (2017)
16
recommend
basic data quality criteria that are a good starting point to assess the available data.
(d) Methodology and type of costs
The use of mixed methods (household surveys, service provider interviews) enables triangulation of
findings. However, as noted above, the availability of data will inform the method(s) chosen. Also, any gaps
identified in the context analysis should feed into survey development.
There are a variety of economic and social costs that can be estimated in a DV costing study. These
costs can be delineated into four main categories: direct tangible, indirect tangible, direct intangible, indirect
intangible. Direct and indirect tangible costs have a monetary value, while direct and indirect intangible costs
do not. These costs will be discussed in detail below.
Another goal of the study could be to project potential costs of the available services when fully utilized,
since only a relatively small group of women actually report DV when accessing services. If the costs per
15
Sylvia Walby and Philippa Olive, “Estimating the costs of gender-based violence in the European Union” (Luxembourg,
European Union, 2014).
16
Sylvia Walby and others, “The concept and measurement of violence against women and men” (Bristol, Policy Press, 2017).
General data quality criteria
• Comprehensiveness of data coverage
• Robustness
• Specificity
• Replicability
Violence specific criteria for administrative data
• Record of the violence
• Actions (and intentions) and harms
• Variations by type of violence
• Temporality of the violence
Record of gender dimensions of violence
• Sex of the survivor
• Sex of the perpetrator
• Relationship between perpetrator and survivor
• Whether there was a sexual aspect to the violence
• Whether there was gender motivation
11
person for delivering a specific service, the prevalence rate of
DV among women and the incidence rate of DV are known,
then the potential demand for services can be estimated.
To calculate the per person costs of service provision, it
is important to consider both variable costs (which increase
with number of persons being provided the service) and fixed
costs or sunk costs (which do not vary with number of
individuals provided with the service). For example, the cost
of radio campaigns does not change as more or less people
listen, but the cost of housing and bedding would fluctuate
dramatically with an increase in numbers.
2. Estimating costs of DV at the household level
(a) Mapping help-seeking behaviour
An important first step in estimating the household level
costs of DV, particularly in settings where data is lacking, is
to map the help-seeking behaviour of women experiencing violence, as well as the type and extent of public
or private services that are or should be made available. This step is important to understand which services
should be included to estimate the out-of-pocket costs of women experiencing violence.
The tree branch model is a useful tool that can be applied in mapping help seeking behaviour. In
annex 4, we present tree branch models for different categories of services generally considered in estimating
the cost of Interpersonal Violence (IPV):
17
health services, criminal justice, civil legal services, housing and
refuge and social services. The starting point is a woman going to some sort of provider such as a health clinic,
police station, legal aid cell or shelter.
However, in most countries of the Global South, a majority of women will not take this initial step,
especially with respect to police stations, legal aid or shelters. This lack of utilization of services is partly
driven by the norms of acceptability of DV. It equally reflects the lack of services available due to the
inadequate policy attention paid to the needs of women experiencing DV. A mapping of the available services
in the local context would lead to a clear identification of the specific services that need to be considered in
the costing exercise.
There are various approaches and tools that can be explored and adopted when mapping women’s help-
seeking behaviour. One of these approaches is to adopt a participatory process. In this approach, a randomly
or purposively selected group of women is gathered together for a half-day or one-day exercise. An open-
ended narrative of a case of a woman experiencing DV is presented to the group. The group is then asked about
the hypothetical actions this woman can/will take in that specific community, with questions about the people
and organizations at her disposal, and so forth. The responses and discussion are recorded in a Venn or circular
diagram. Also known as a chapati diagram, the Venn diagram is useful for analyzing social distance,
organizational structures or institutional relationships (see annex 4 for an illustrative example and more detail
about the implementation of this approach).
Whenever possible, the input of survivors of violence is another source of information for mapping help-
seeking behaviour. Since women may contact more than one service provider, this should be noted in the
discussion to understand their pattern of referrals.
17
The branch model for IPV can be applied to DV.
Good Practice
If a prevalence study has been
conducted in the previous year, employ the
data generated from it.
Where possible, advocate for the
integration of specific questions on
experiences of DV and service use in
existing national prevalence surveys (the
National Health Service surveys,
demographic health surveys, multiple
indicator cluster surveys), rather than
conducting a stand-alone survey.
If this is not possible and funds are
available, a national survey of the
prevalence and costs of DV, can be
conducted, as was the case in Egypt (case
study one).
12
(b) Household out-of-pocket direct costs
The mapping of help-seeking behaviour by women who experience DV is necessary to calculate out-of-pocket
costs households incur due to DV. The mapping exercise enables a country to take advantage of the findings
from existing studies on the types of services women access and refine them to reflect the local context. With
this information, the study can now be informed about the type of services the household may use and can
focus on estimating these costs. Based on the main services and cost items identified in existing studies, the
following are the types of costs that are frequently incurred by households:
Table 2. Type of costs incurred by households
Health-care costs
Criminal justice
Housing and refuge
Emergency room care
Incarceration
Shelters for survivors
Hospitalization
Prosecutors
Rented accommodation (hotels etc.)
Outpatient visits
Emergency protection order
Residing with family/friends
Nursing home care
Temporary restraining order
Dental care
Mental health care
Medication
Ambulatory services
Surgery
Legal services
Social services
Mediation
Counselling
Divorce
Rehabilitation
Legal counsel
Probation
Emergency protection order
Temporary restraining order
The questionnaire for those seeking assistance is the main tool for obtaining information regarding these
costs. This questionnaire can include a section that explores women’s experiences of violence by family
members to establish prevalence and incidence of DV in the form of economic, psychological, physical and
sexual violence within the household. It can contain follow-up questions regarding the injuries sustained and
services sought after each incident reported in the last 12 months. The essential out-of-pocket costs for
accessing services are classified as service fees (such as doctor’s fees, filing fees at the police station),
medicines, transportation costs, communication costs and food expenses. In addition to these expenses,
survivors and households also incur costs for replacing property (dishes, household appliances, furniture,
mobiles, vehicles, etc.).
(c) Household indirect costs
Besides the direct out-of-pocket costs that arise due to DV, in many instances what transpires to be a
more substantial cost is the reduced income and productivity not only of survivors, but also of other members
of the household including the perpetrator. The estimation of indirect costs presents several challenges,
particularly in relation to subsistence and unpaid work.
In the Arab region, there are four principal types of work that women might be involved in. The
following are the types of questions that can be covered for each type:
18
18
Douaa Mahmoud and May Gadallah, “Imputing monetary value to Egyptian females: unpaid domestic and care work”,
Journal of Development and Economic Policies, vol. 13, No. 1 (2011), pp. 31-56.
13
Waged worker, by the market definition
In this case, clear questions regarding the number of daily working hours, number of days per week and
number of weeks per month should be asked. In addition, data on wage per hour/day/week is required and a
daily wage should be computed in order to calculate the opportunity cost of missing a working day or even a
fraction of a working day. Data also needs to be collected about the job characteristics in order to impute any
missing data using the multiple regression technique (statistical analysis), which will provide a replacement
value for the wage using available data for
individuals with the same characteristics.
Employer/self-employed
Questions regarding the average earnings per
day should be asked. Information about the number
of days missed due to DV and/or the loss of
productivity due to DV, with an estimate of the loss
compared to a normal day.
Unpaid worker for the family (or non-
family)
By market definition, this type of worker is
considered as part of the labour force. Data on the job
characteristics (occupation, sector, economic
activity, stability and in/out of an establishment) is
required. By employing multiple regression
techniques with the demographic variables as well as
the job characteristics, the earnings can be imputed
using the estimated wage of a waged female worker
with the same characteristics.
Domestic and care work
This type of labour is not considered work by
the labour market definition. In order to provide a
monetary value for this type of work, there are
several approaches that can be used. A time use
survey (questionnaire) is needed, in addition to an
estimated hourly wage, if the generalized
replacement approach will be used (see section on
measuring unpaid work below).
The following factors need to be considered in the Arab region:
(a) Extent and type of female participation in the labour market
According to modelled International Labour Organization (ILO) data, the Arab regional average rate of
participation of women in the formal labour force reached 20.9 per cent in 2017, which is less than one third
of the rate for men in the region (75 per cent)
19
and extremely low compared to the world average of 48.7 per
cent. Female participation in the formal sector is predominantly characterized by governmental work and low
19
E/ESCWA/ECW/2017/Technical Paper.6.
Good Practice
The methods for calculating lost productivity for
waged and unpaid work are detailed in annex 5. The
choice of method (accounting methodology,
econometric, propensity score matching) depends on
the extent of available data and the degree of rigour
desired. The accounting methodology is the simplest
to use if the basic data on days lost and mean earnings
are known from survey data and other secondary
sources. However, this method assumes that all lost
days can be attributed solely to violence. Moreover,
while the extent of absenteeism can be estimated,
productivity loss is more difficult to estimate using the
accounting methodology. By contrast, both the
econometric or propensity score matching methods
would more rigorously establish loss of productivity
attributable to DV.
In principle, the accounting method is
recommended to establish missed work and missed
care work. However, it is important to note that, while
this is the most straightforward method, it requires
data that is not available in the Demographic and
Health Surveys (DHS), which is data on population
and health collected by USAID from more than 400
surveys in over 90 countries. As such, the
econometric or propensity score matching methods
are recommended for estimating productivity loss.
In terms of calculating unpaid work, the output method
measures the value of goods produced, while the input
method measures the burden (which is the major concern
in unpaid work). Thus, input measures are commonly
used in the valuation of unpaid work for household
production of domestic and personal services for one’s
own consumption.
14
wages. While female participation in the labour market increases with higher education, disclosing DV
decreases in parallel with higher levels of education among women.
(b) Breadth of the definition of female labour market participation
Female labour market participation (FLP) increases if subsistence work is considered (using the
extended labour market definition). For example, in Egypt in 2012, the FLP of around increases if the
extended definition that includes subsistence work is used.
20
Since subsistence work is greater in rural
areas and among less educated women in almost all Arab countries, adding several specific questions to
the questionnaire is essential for computing the missing working days and
(c) Accounting for unpaid domestic work
Unpaid domestic work is the most significant type of work that can be missed due to DV. Therefore, as
previously noted, the questionnaire must include sound and accurate time use questions. The next section
outlines how to estimate the costs of DV due to lost productivity in relation to this kind of work.
Valuing unpaid work. Unpaid work can be understood to include all productive activities outside the
official labour market done by individuals for their own households or for others, such as housework, care for
children and for sick and old people, voluntary community work, subsistence agriculture, helping in family
businesses, building the family house, maintenance work, transport services, etc. All of these activities have
one thing in common ─ they could, at least in theory, be replaced by market goods and paid services.
21
The volume of unpaid work could be in terms of the output units or time units spent in producing the
output. Similarly, the wage rate (price for a unit of work) could be in terms of the wage paid by output units
or by time spent. The measurement depends upon the prevailing practices in the economy of a country. The
common approaches used in the valuation are the output approach and the input approach.
22
3. Community-level costs of DV
The community-level costs associated with DV are also both direct and indirect. The expenditure
for providing services to survivors of violence is understood as a direct cost, which is the bulk of DV
costs for a community or country. The indirect costs involve the effect of dealing with DV on service
providers’ productivity. These indirect costs have been comparatively underexplored and will not be
considered in the proposed costing studies in the region, largely due to limited availability of data. For
the purpose of the present model, the major cost at the community level is therefore considered to be the
direct cost of service provision.
(a) Mapping of services available at the community level
At the community level, there are normally a number of institutions and organizations providing services
to survivors of DV either exclusively or non-exclusively, with substantial associated costs. In calculating these
costs, the initial step is to identify institutions (which could be government, civil society, NGOs and
international NGOs) that deal with issues related to DV and then map all the services available to survivors.
Although the resulting map is likely to overlap significantly with the information obtained from women, there
could also be possible divergences, as this exercise will capture the supply side rather than the demand side.
20
Rana Hendy, “A quarter century of changes in labor force participation,” Working Paper No. 973 (Cairo, Economic
Research Forum, 2015).
21
Joke Swiebel, “Unpaid work and policy-making towards a broader prospective of work and employment”, Discussion
Paper, Department of Economic and Social Affairs”, DESA Discussion Paper No. 4 (New York, United Nations, 1999).
22
Nancy Folbre, “Valuing non-market work” (New York, United Nations Development Programme, 2015).
15
Nevertheless, conducting two separate mapping exercises will provide the research team with the means to
cross-validate information.
There are several tools and approaches that can be used in a mapping of services provided at the
community level:
• Focus group discussions with key stakeholders including community leaders, service providers,
health-care workers and other key players. This is an appropriate method to gauge the main areas of
service provision. The sources used in these meetings and group discussions should be consulted
regularly, not just at the beginning stages, to ensure field workers have an accurate assessment of
service provision;
• Key informant interviews with personnel from institutions that are likely to come into contact with
survivors of DV, such as the police, hospitals, childcare services, etc.;
• Day-long workshops with community leaders, service providers and NGO representatives working
on DV to conduct a participatory mapping exercise;
• Provider questionnaire to establish the services offered to survivors of DV, both specialized and
general service provision (there may be no way of knowing the exact proportion of general services
provided to survivors, but an estimate can be derived from DV prevalence data, injury data and
number of injuries treated, for example).
(b) Provider survey: volume and cost of services provided
The main tool for collecting information on the use and
cost of available services in the community is a provider
questionnaire. Such provider questionnaires need to be sector-
specific and focused to include key domains of information that
are required for cost calculations.
These key domains include the following: type of
services provided; level of record-keeping and administration,
utilization of services (by survivors, if not specialized); referrals; operating budgets; source(s) I changed the
text box format from rounded edges to sharp one to stay in harmony with the other boxes
of funding; systematic information on operating costs (fixed costs and recurrent costs, such as personnel
time, infrastructure and material resources).
Most of the costs to be estimated will be the same across the
different services/sectors, but service/sector-specific considerations
and questions will also be needed to establish costs. In addition, the
challenges that arise in terms of obtaining reliable and robust data
will vary by sector.
In table 3, a selection of the main sectors and key areas to be
considered are outlined. This is followed by a selection of questions
to be included in the service provider survey, which can be tailored
to specific services. An example of the steps involved in estimating service provision costs is then detailed.
The steps outlined can be applied to each type of service.
Good Practice
Depending on the level of
richness, specificity and reliability
of data obtained from the provider
questionnaires, secondary data
sources may need to be used to
complement the collected
information.
Cost questions in service provider
surveys
A key issue to keep in mind when
developing and implementing the
provider questionnaire is to ensure the
cost/price questions are concisely worded.
This is important to avoid double
counting.
16
Table 3. Key sectors, issues to consider and provider survey questions
Sector
Service/Activity
Considerations to assess volume
Health-care
system
• Emergency room treatment
• Doctor’s visit
• Hospitalization
• Rehabilitation
• Trauma centre
• Hospitals
• Small clinics/local practices
• Pharmacy
1. Which health care services are provided by national and local
government, NGOs, private businesses and organizations and
volunteers?
2. In cases where doctors do not screen for DV, are other
indicators such as bruises, broken bones, pelvic and
gynaecological problems recorded?
3. Is it possible to gauge the cost and length of hospitalization or
the number of medications prescribed?
4. Are general practitioners able to estimate the percentage of
their time spent with DV survivors? Women in general?
Criminal
justice system
• Police force
• Women’s police stations
• Family courts
• Civil court
• Prosecutor’s office
1. Are there DV units within the police force?
2. Are police units able to estimate the amount of staff time and
resources dedicated to DV incidents?
3. If police forces keep adequate records of investigations, are
there specific codes for DV incidents? What are other codes
that DV might fall under?
4. Can discrepancies between reported incidents, follow-up
investigations and arrests or final decisions be detected?
5. Are there indications either from records or police interviews
that other offenses, such as assault, rape, breaking and
entering, child abuse, etc., are related to DV?
6. If the costs of responding to DV incidents are not calculable,
are there other related cost estimates that the police force are
able to better estimate, such as assault?
Civil legal
services
• Lawyers
• Legal counselling
• Mediators
1. Are there lawyers’ associations or organizations that can
estimate the costs of an injunction and other related costs of
legal proceedings?
2. How many divorces or khula were granted during the period?
Is there an indication of whether the divorce stemmed from
DV?
3. Of the legal cases and proceedings, how many of the cases
were defended by the State versus privately?
Social services
• Transitional housing
• Legal advice
• Therapy
• Hotlines
• Social service support
• Service advertisement
• Radio and television campaigns
on DV
• Additional outreach activities
(speaking to groups about DV,
fundraising for service
provision, etc.)
1. What percentage of each organization’s service activities is
related to DV? Does the organization only work with
survivors of violence or does it work with other vulnerable
populations?
2. What are the resources that have been allocated to the service,
such as government subsidized shelters, volunteers, food,
clothing, etc.
Housing and
refuge
• Shelters
• Hotels
• Refuge with family or friends
• Housing referrals by service
providers
1. What is the process for applying for housing? Which parties
are involved?
2. What is the budget of staff working on re-housing and what is
the percentage of time dedicated to the task?
3. How many women do shelters turn away and is there an
indication of where they go if the shelter is full?
17
Suggested Questions for Provider Survey
What are the unit costs of service provision to survivors of DV?
What are the unit costs of personnel training on DV?
What are the unit costs of awareness-raising events?
What are the administrative costs?
Where applicable, what are the unit costs of preparing housing for new tenants?
Illustrative example: basic model for costing shelters
23
1. Establish a list of unit costs associated with the establishment/provision of shelters/fee paid for the
service – calculate the number of shelters in each Arab country (for example, Egypt n=9, UAE n=3), or
if the exercise is at the national level, include the number of shelters in each governorate/district or
community; estimate the cost of providing shelter per woman per year, with trend data of past five years,
to show increasing costs for temporary and long-term refuge/housing, hotel vouchers, vocational
training; establish the fee(s) paid by survivors to access the service.
2. Establish the utilization rate either through administrative data for individual shelters or a regional
survey of all shelters (for example, Egypt was 1.8 per cent of women 18-64) - per cent of women
experiencing violence using the service, administrative data in one year and trend over past five years.
3. Collect data on the unit costs: macro (such as ministry budgets, international NGO or donor budgets,
administrative data, etc.), meso (data from studies) and micro (interviews with experts).
4. Establish a meta-table of data collected for each unit cost.
5. Document the calculation for each unit cost, describing the calculation in detail, including how client
user fees are accounted for to prevent double counting.
6. Determine a lower and an upper estimate for each cost.
7. Create a software template that adds up all unit costs, including lower and upper estimates.
8. Use an “estimate of an estimate” and include a discussion on the limitations of the data and
recommendations for improving the methodology.
Add out-of-pocket expenditure incurred by women clients for transport to and from the shelter.
4. Gender-responsive budgeting
Gender-responsive budgeting (GRB) is a holistic approach that looks at all the DV services being
provided (by government, civil society, NGOs and INGOs), as well as the budgets for each. At the outset, it is
vital to know what you are seeking to cost and where you will obtain the data. A GRB approach can be
undertaken wherever public budget and resources are being dedicated to DV prevention and/or response. It
involves “following the money” allocated and then spent (or not). GRB should be conducted hand-in-hand
with household surveys, with no time gap, by a national institution and international consultant together. This
23
First, use the basic model of costing VAW shelters. Once this method has been shown to be a valid, reliable and efficient
methodology, then a social cost benefit analysis can be considered in the future (see Chanley S., Chanley J. and Campbell (2001)
“Providing refuge-the value of domestic violence shelter services” American Review of Public Administration, 31(4), 393-413). As it
is a common phenomenon that victims in the Arab region leave their homes and stay with parents or friends, rather than in a public or
private shelter, this needs to be considered in the survey and in imputing its cost. The costing study conducted in Egypt estimated the
opportunity cost of shelters (see Case Study 1). An alternative approach is to collect data on the invisible cost to parents and friends,
as was the case with a smaller-scale costing study conducted in Ireland (Duvvury, Forde and Gleeson, forthcoming). Finally, it is
difficult to make a case for funding shelters when the cost is very low. In this case, it is important to highlight unmet need and how a
small investment would make a big difference.
18
combination will allow building government capacity and institutionalizing the practice, as well as ensuring
ownership of the costing study findings.
This approach has been proven effective and has many elements of an in-depth evaluation of existing
DV policies and services. GRB identifies budgetary efforts (by government and other actors) to implement
services to victims and survivors; gaps in resources to properly implement services; weaknesses or absence of
referral systems and/or protocols needed for better management of specialized and general public and private
services that survivors might access. It also informs future rounds of consultation for national plans and/or
strategies (mainly through an approximation of the time used by public employees on DV related cases).
This methodology does not aim to arrive at total monetary costs, but rather offers a clearer picture and
analysis of the current budgetary situation with regards to DV services. It provides valuable information to
improve effectiveness and efficiency of policy implementation. In sum, it requires knowledge at different
levels of intervention, from the legislative and police to budgeting and services.
24
It is useful to delimit the
scope of the analysis, as it can only be carried out by examining governmental efforts to prevent and address
DV (that means the financial efforts of NGOs must be excluded).
25
The GRB methodology considers
1. Gaps in DV laws and policies;
2. The amount of resources allocated to different DV-related services;
3. Sources of funding;
4. Whether the resources are adequate or not;
5. Whether the money is getting to survivors or not.
GRB also engages NGOs with expertise in DV that may or may not receive funding either from the
national government or other donors. It is important to establish whether NGOs are receiving money from the
government or from international donors. NGO overdependence on foreign aid must be considered and is
important to demonstrate to governments. In addition, GRB should be conducted hand-in-hand with the
household and service provider surveys.
This methodology requires full knowledge of
1. The types, extent and context of DV in the country;
2. Existing DV laws and policies;
3. The legislation and administrative structure of the country pertaining to the different services that may
be accessed by survivors; decentralization and how it affects the funding of, and access to, services is a
key element of the analysis;
4. Which DV-related services are planned and available, as reflected in current legislation or national
action plans;
5. The national budgeting process, including processes of decentralization;
6. Relevant budgetary allocations;
7. The State budgeting cycle;
24
UN Women, Manual for Costing a Multidisciplinary Package of Response Services.
25
In most countries NGOs delivering services to victims ranging from legal to medical and psychological support and
employment are financed either through private contributions or contributions by national government or foreign governments through
their development cooperation efforts.
19
8. The different aspects of expenditure and sources of revenue related to measures and services.
It is also necessary that the following data/information be available. This is not an exhaustive list,
but a reasonable quantity and quality of information that is necessary for this type of study to include
1. Legislative documents for advancing a multidisciplinary or holistic approach to preventing and/or
combating DV such as:
• Laws related to DV, including legislation on DV, if it is part of the penal code or a standalone law
on DV or VAW in general;
• Civil law (with regard to rights and obligations of married couples, parents and extended family, if
relevant);
• Criminal law (with regard to perpetrators of DV);
• Administrative law or by-law (with regard to the rights to services that are specified in the legislation
on DV or other legislation addressing other aspects of DV, if they exist). This includes services
provided by local level or regional authorities per the legislation in your country (for example: local
police, housing, health, education, social services, etc.);
• National action plan or strategy for addressing DV or VAW;
• Other national strategies that might include specific mention of victims of DV as beneficiaries of
specific actions/benefits, such as the national strategy on gender equality and/or the empowerment
of women;
• International commitments to which a country is a signatory (CEDAW, Beijing Platform for Action,
other relevant regional agreements or conventions) and the latest reports and/or recommendations;
• Other relevant legislation (for example, reproductive law, family law, gender equality law, sharia
law or tribal law).
2. Public and private budget documents. The following main public budget documents should be analysed in
order to understand the macroeconomic environment in which the Ministry of Finance (MoF) works and
how it negotiates with each ministry or sector:
26
• Budget circular;
• Medium-term expenditure framework (MTEF);
• Budget statement or budget law;
• Handbooks/guidelines on preparation of the budget;
• Any technical and/or political documents accompanying the budget;
• Annual work/action plans of the ministries submitted to the MoF;
• Any working methods to track/monitor/evaluate budget outcomes or impacts.
3. Indicators:
• Prevalence rate of DV (incidence and severity if possible);
• Number of incidents reported via police, social services, courts, hotline, etc.;
• Number of survivors accessing available services (shelters, health education, employment, legal aid,
etc.);
26
Note that this is a general review focused on understanding the main political economy of the government and is not meant
to carry out a gender audit of the documents. The usual tools for GRB can be used as guidance, but in this case, the budget is being
examined with a very particular goal in mind: determining the cost of the different services that make multidisciplinary/sectoral delivery
possible, as reflected in the budget for these services. In addition, the general political economy of the budget itself (such as a focus on
economic growth or on fiscal discipline) will also guide the conclusions as it affects services for victims of DV.
20
• Demographics of survivors and perpetrators (very important to account for diversity in the female
and male population of the country).
As this methodology focuses on examining
national, ministerial or other facilities’ budgets, two
approaches can be used: top-down or bottom-up. The
top-down approach focuses on reviewing national
and ministerial budgets to establish the allocations to
the key services identified in the National Action
Plans (NAPs) or national strategies to address DV.
The bottom-up approach, by contrast, focuses on the
administrative records and service-level budgets to
estimate the resources allocated. The bottom-up
approach requires a representative selection of
services to ensure that reliable aggregate estimates
can be made.
If national budgets are difficult to access, an
alternative is to collect information directly from civil
servants and any other available sources. Possible
interviews could include: (1) in-depth interview with
the MoF to establish the origins of the funds of the
NAP (recurrent and/or development budget),
including asking questions about decentralization of
these funds to local authorities; (2) in-depth interview
with the national women’s machinery (Ministry of
Women, etc., to collect information about the NAP
and its budget); and (3) interviews with the gender
focal points and the budget officers in each ministry
with a responsibility under the NAP.
The sole critical drawback in employing a
GRB approach in a costing exercise is that it may not
always come up with a final figure. This is because
the exercise will depend on publicly available information on public budgets and the level of detail in which
these are elaborated and monitored. However, there are many advantages to carrying out a GRB approach
costing exercise. First and foremost is the direct engagement with the main public finance decision makers in
the different government departments (at any level) who have a role in addressing or preventing DV. This
raises the political level at which DV is discussed.
The key results across the countries where this methodology has been implemented can be summarised
as follows: (a) Identification of gaps in legislation and policy, in particular regarding basic and other services;
(b) Identification of the money allocated to, and spent on, existing services; (c) Sources of funding for existing
services (in some cases high dependency on foreign support); (d) Situation of referrals and protocols in
the system (itineraries for survivors of the available services); (e) Situation of adequacy of existing resources;
(f) The services sought by the victim versus the services provided (in other words, disconnect between what is
planned and what actually happens).
5. Cost to business
Extending beyond the individual and community, DV also has a significant economic impact at the
business level due to reduced labour productivity. Though this is an area that has received little research
attention to date, studies illustrating the impact of DV on both female and male employees, as survivors and
Good Practice
To estimate community-level costs of DV, it is
recommended that service provider surveys be
undertaken to provide a comprehensive estimate of
the cost of service provision. However, a factor to
consider is whether service providers will have
detailed information available and, if not,
stakeholders should identify other possible methods
to fill data gaps.
GRB (completed by interviews within ministries)
is an important option, though it risks providing
estimates that are less reflective of reality on the
ground, as it is a top-down approach. However, it can
be used in the first instance to identify gaps that would
have to be addressed before a service provider survey
can be reasonably implemented.
It is important, where possible, to conduct a
“sister” study on value for money in terms of
improving existing services and using this data to
argue for improved allocations. It is also useful to
learn from the experience of a recent costing project
that employed GRB in another area, such as the
environment and apply this learning to costing
violence.
Note: Value for money is an assessment that examines
whether public resources are being utilized to ensure they
maximize public value in terms of the populations’ well-
being.
21
perpetrators respectively, are beginning to gain momentum.
27
,
28
Estimating the costs of DV for businesses
enables one to better capture the wider impact of this violence in terms of individuals’ employment. Businesses
have the resources to address DV and, once informed of the benefits, they can design and implement the
relevant policy and procedures.
(a) Costing the impacts of GBV to business: a practical tool
The majority of methods to estimate the cost of DV to business are
deductive or top-down in nature; rely on national datasets (and therefore are
patchy); highly technical and cost-intensive; and focused on individuals.
The available methods for business are similar to those used for calculating
household costs: econometric method, propensity score matching,
willingness-to-pay principle, and disability-adjusted life year
(DALY)/quality-adjusted life year (QALY) accounting method (see section
3B). The type of costs calculated include staff time lost due to DV; services
provided by businesses to address the violence experienced by women; and financial support provided to
women to access other services.
29
Figure 5. Calculating direct costs for the company
To complement the data collected and provide a robust estimate of costs, a company needs to collect
additional contextual data, which can be obtained through formative research (desk review, interviews,
27
Aristedes Alfredo Vara Horna, “Violence against women and its financial consequences for businesses in Peru”
(Lima, GIZ, 2013), p.13.
28
Aristedes Alfredo Vara Horna, “Violence against women and its financial consequences for businesses in Bolivia
(La Paz, GIZ, 2015), p.14.
29
David Walker and Nata Duvvury, “Costing the impacts of gender-based violence (GBV) to business: a practical tool”
(London, Overseas Development Institute, 2016).
Good Practice
The accounting method
is the recommended method
for estimating the cost of DV
for businesses.
22
pre-study, etc.) on the following areas: help-seeking behaviours; different forms of DV (local terms
and concepts); and the types of services used to respond to DV within firms themselves (counselling,
hotlines, etc.).
(b) Quality of data for calculating the costs to business
Costing the impact of DV on business can be a time-intensive exercise. It requires mapping data quality,
quantity and gaps that exist in the business’s accounts. Errors can occur due to memory loss (in a 6- to 12-
month window) and confronting complex incidents requires skilled survey design and implementation. Semi-
structured interviews with managers can elicit information about staff numbers, salaries, leave and
absenteeism, turnover, recruitment costs, training costs and services offered.
(c) Application and implementation
To obtain firm participation in both the short and medium term, given the inherent disincentive from a
business perspective, the process needs to ensure a critical mass of resources required to start or maintain a
venture, stakeholder engagement in business platforms and provision of strong internal or external credibility
of implementing parties.
Definitional challenges should be accounted for in the form and function of studies (for example, is
the definition limited to women or are girls in included?). Choosing the study scale/level of focus - micro
(firm level), meso (subsector level) or macro (sector or industry level) has significant implications for
investment, findings and advocacy utility. It is important to add value for money (VfM) evaluations into
discussions to counter-balance overall costs. The next section outlines the considerations relevant to
choosing a reliable sample.
6. Sampling
Quantitative research relies on random sampling of informants regardless of the level at which the
costing study is undertaken. Random sampling involves employing specific techniques to ensure that every
individual who meets certain eligibility criteria has an equal probability of being included in the study. Failure
to adhere to these techniques can introduce error or bias into the sample, which may reduce the validity of the
study. It is important to ensure the national statistics office is involved.
While quantitative research involving a representative sample is ideal for estimating costs at the
household level, qualitative research is better for mapping services and collecting data on service provision
costs. In addition, the context is important, as it depends on what the costing study is seeking to achieve.
Variation sampling,
30
which involves selecting case studies, is also an option. This strategy enables the range
of differences in relation to services provided to be captured. To ensure the sample is representative, care is
required when choosing regions (for example, the DHS can be used).
When deciding upon your target sample, be careful not to approach individuals or groups who have
participated in many studies already, as they may be less willing to participate. It is recommended that sampling
guidelines be shared with the statistical expert in the country’s statistics office, who can devise the target
sample and sampling strategy.
30
Charles Teddlie and Fen Yu, mixed methods sampling: a typology with examples, Journal of Mixed Methods Research,
vol. 1, No.1 (2007), pp. 77-100.
23
The following is a set of questions that guide decisions regarding sampling
• What is the purpose of the research? The purpose of the
research is linked to the level of rigour required. As highlighted
above, if the purpose of the study is to influence policy
decisions, it might be necessary to provide estimates that are
statistically significant based on an adequate sample size.
• What are the characteristics of the study population? The
degree of heterogeneity of the study population would also
affect the sample size to ensure that critical differences in the
study population are reflected in the sample population.
• How large a sample is needed? The size of the sample depends
on the degree of rigour required for the estimates derived from
the survey data and the complexity of analysis involved. A
representative sample is also dependent on the extent of the
problem being studied – for example if violence is understood
to affect a majority of the population the sample can be small
as the likelihood a selected respondent would be affected by
the problem is high. If the problem is rarer then the sample has
to be significantly larger to ensure that a sufficient number of
respondents affected by the problem are selected to derive
estimates of interest. A smaller sample size is acceptable for
smaller geographic locations with a smaller population.
• What kind of statistical analysis will be used? If complex
econometric techniques will be used to determine productivity
loss, for example, such regressions would require sufficient
observations to ensure results are meaningful.
• What kind of sampling strategy will be used? The choice of sampling strategy depends on the
context and the information sought. For example, employing a quantitative approach to estimate
costs at the household level requires a random sample.
• How precise must the conclusions be? If the study is a pilot, it might be satisfactory to provide
indicative estimates that suggest the dimension of the problem. However, if the purpose is to provide
a rigorous appraisal that can be used as an input to policymaking it might be necessary to reach a
high level of confidence in the conclusions, thereby requiring a larger sample size to be adequate.
Issues around sampling and
implementation – an illustrative
example
If a household survey on
violence is only conducted
during the day, then it is most
likely that the respondents
included in the study will be
women who work at home;
women who work outside the
home would be less likely to be
interviewed. Since women
working outside the home may
have different experiences of
violence, the study results
would be biased towards
women who work at home. One
way to reduce this particular
bias would be to return to
homes at night or on weekends
to increase the likelihood of
reaching all women.
Source: Mary Ellsberg and
Lori Heise, “Researching Violence
Against Women: a practical guide
for researchers and activists”
(Washington, D.C., WHO and
PATH, 2005) p. 179.
24
V. CAPACITY DEVELOPMENT – AN ONGOING PROCESS
It is recommended to
have a multidisciplinary research
team consisting of individuals
with a broad range of relevant
methodological expertise. To
ensure institutionalisation of
systems so that the governments
can and will undertake such work
in the future, it is also important
to ensure building its capacity, as
well as that of civil society. This
must be an ongoing component
of the project. An advocacy
campaign can help to encourage
countries to combine prevalence
surveys with costing estimations,
and to link these to the
Sustainable Development Goals
(SDGs) and other international
frameworks. Due to turnover in
ministers, external expertise,
though costly, is also needed.
The data collection process
is also an opportunity to
encourage organizations to begin
monitoring and recording DV
incidents if they are not already
doing so. Information sheets on
the definition of DV, indications
of DV and suggestions for ways
to monitor and track incidents
should be distributed to relevant
parties whenever possible.
Capacity development for gender-responsive budgeting: Kosovo
In Kosovo, various actors worked with institutions to develop their
capacity to conduct GRB, as part of a strategy that focused on integrating a
gender perspective in government planning and budgeting. These capacity-
building efforts were not related solely to costing of DV. Rather, they
focused on the capacities of all budget organizations in ministries and
municipalities to better assess individuals’ needs and the extent to which
government-funded programmes were addressing their needs.
First, a simple approach to GRB was developed that was consistent
with Kosovo’s national legal framework and budget cycle. An easy-to-
use handbook was developed for officials at local and central levels.
Second, international organizations (Organisation for Security and Co-
operation in Europe, the German development agency GIZ, Swiss
Helvetas) cooperated with experts from the Kosovo Women’s Network
(KWN), a local civil society organization, to roll out a two-day training
for hundreds of finance officers, officials involved in programming,
gender equality officers and elected officials throughout the country.
Afterward, the government-run Kosovo Institute for Public
Administration adopted the curricula and handbook, to ensure sustainable
training for new public servants in the future. Third, as training was
insufficient in itself, KWN worked with several ministries individually
(labour and social welfare, education, trade and industry, environment,
agriculture), supporting finance and programme officers within these
ministries to conduct gender analyses of prior expenditures and
beneficiaries, and then to use these analyses to inform budget planning
for future years. This longer-term hands-on approach contributed further
to building the capacities of public servants to carry out GRB.
Institutionalizing the practice by furthering the capacities of officials to
do gender budgeting themselves can contribute to local ownership, as well
as to sustaining gender-budgeting as an approach to ensuring that public
budgets better meet the needs of citizens. Officials can thus employ studies
on DV to inform their budget planning in the future.
For KWN, see: https://womensnetwork.org.
25
PART TWO: FROM DATA TO ACTION
An important objective of undertaking costing studies is to translate the findings of the research into
practical and implementable recommendations that inform policy, practice and resource allocation in relation
to DV. This section details examples of good practices from a selection of countries in the Arab region and the
Global North. A step-by-step guide to evidence-based actions for sustainable change is also provided.
Detailed accounts of the studies conducted in Egypt, the United Kingdom and Viet Nam as well as
examples from Peru and Timor-Leste,
31
have been chosen to showcase how the findings of costing studies can
be successfully employed to increase awareness, enhance the response to VAW and sensitize the legal and
policy framework. Capacity-building for the institutions involved in conducting the costing exercises has
also been an added benefit. The following list outlines a number of achievements resulting from
complementary actions related to costing the impact of DV:
Dissemination of the findings among relevant government entities
Egypt
• The Ministry of Planning increased the budget for VAW-related activities;
• The Ministry of Interior increased the number of female police officers and integrated a lecture for
combating VAW into the police academy curriculum provided by the NCW;
• The new draft law on VAW currently under consideration by parliament was strongly informed by
the prevalence data and cost findings;
• Governorate-level action plans and their alignment with the national strategy on VAW was based
on the findings of the costing study.
Viet Nam
• UNFPA and Ministry of Labour, Invalids and Social Affairs (MOLISA) undertook a joint
dissemination activity with members of the National Assembly, particularly with women members,
to build momentum around recommendations emerging from the costing study;
• The government agreed to develop and deliver a minimum package of services based on the results
of the costing study;
• The police and wider criminal justice system have been working on enhancing their services to
survivors of DV and women are more inclined to report their experiences;
• The General Statistics Office of Viet Nam has committed to building a national database on the cost
of violence against women by including cost questions in the second national survey of women’s
experiences of violence, 2018-2019. This will enable the Government of Viet Nam and other
interested actors to assess changes over time.
The U.K
• A series of costing studies (2004, 2009, 2014) have enabled the United Kingdom to monitor trends
over time;
• The first study conducted in 2004 led the Home Office to assess the resources allocated to DV
services;
31
Aristides Alfredo Vara Horna, “Violence against women and its financial consequences for businesses in Peru”, p. 13.
26
• The estimates have been utilized by Government Institutions (National Institute for Health and Care
Excellence; National Health Service) and local government (for example Safer Portsmouth
Partnerships; Devon County Council).
Dissemination of the findings among United Nations agencies
Egypt
• The importance of improving DV services by supporting the NCW, particularly the complaints
office, became clear to all relevant UN agencies.
Viet Nam
• UN Women and UNFPA have supported the Government in piloting the Minimum Services Package
for Women and Girls Subject to Violence, which includes health care, protection and a referral
system, over the past five years;
• UN agencies advocated with donors (particularly the Australian Department of Foreign Assistance
and Trade) to convince the Government of Viet Nam of the need to have a robust database on
prevalence of violence, the costs of inaction and the costs of action to develop a comprehensive,
integrated and effective response to violence against women.
Dissemination of findings among NGOs working on VAW
The United Kingdom
• Women’s Aid and Refuge: Living Without Abuse employed the findings to advocate for increased
funding (see case study 2).
Timor-Leste
• The NGO Fokupers used the findings from their costing exercise to obtain increased budgetary
allocations.
Dissemination of findings to the media
Egypt
• The media began discussing and highlighting the issue of DV, which was previously a taboo subject.
Viet Nam
• The findings have been reported in the media and have raised awareness among the public of the
magnitude of the problem.
Expertise resulting from conducting the study
Viet Nam
• Training provided by the international expert has increased the expertise among government
personnel and researchers working on DV, which would enable another costing exercise to be
undertaken with greater ease;
27
• As part of the 2018-2019 study being currently undertaken by the General Statistics Office (GSO)
in coordination with UNFPA, GSO staff have taken the lead in training their field staff, equipping
them with a good understanding of costs and how they are estimated.
The United Kingdom
• A Leeds-based NGO used the estimates to calculate costs at the local authority level across the
United Kingdom, helping local NGOs to advocate for greater resources (see case study 2). The
research introduced a new debate around DV in terms of the economic aspects of the problem. The
findings have also been used to underpin cost effectiveness studies of DV intervention
programmes.
32
• Another impact of the study involves its usefulness in explicating the different costing
methodologies and methods available, as well as providing/supporting the impetus for other studies
to be undertaken (momentum evident across the world).
Peru
• The Peru study provided a basis for replication of business studies in other Latin American countries.
• The study also provided a framework to estimate productivity impacts in other sectors, such as
educational institutions. A new study on impacts of IPV among university students in Peru has been
recently completed (currently only available in Spanish).
• Estimates of the costs for the private sector led to some companies developing and implementing a
business model to address VAW.
STEPS TO ACHIEVE IMPACT
From the outset, research that aims to achieve change needs to have a clear dissemination plan that lays
out the broad messages to be communicated, the specific audiences to be reached, the types of products to be
produced and the different types of events/activities that need to be delivered. Furthermore, stakeholder buy-
in and input from the beginning is key to ensure that stakeholders take ownership of the data and commit to
using the findings. It is for this reason that setting up a national consultation group or steering committee that
comprises government, civil society, business, academia and media is essential. A key task of the group could
be to provide input and an overview of the dissemination strategy/plan for the study.
Advocacy to influence policy and practice requires a range of products that can effectively communicate
key findings to different actors. Apart from research reports, useful products include policy briefs, flyers,
infographics, brochures and social media campaigns. It is important to have a blend of quantitative and
qualitative data to move beyond statistics. Equally important is to have media outreach to print and
audiovisual media. News stories and opinion pieces often play a key role in influencing other opinion makers.
A strategy that works well is to have key recognized stakeholders publish opinion pieces (or op-eds), in
addition to encouraging regular news stories on the topic. Depending on the context, targeting specific
radio/television programmes that have a wide reach can be equally effective. To the extent possible, it is
more effective to get in-depth interviews rather than simple headlines. If resources are available, short videos
that can be materials for a broader campaign can be produced.
32
Estela Capelas Barbosa and others, “Cost-effectiveness of a domestic violence and abuse training and support programme
in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study”
(London, BMJ Open 2018).
28
Events to disseminate the study findings must also include
a range of activities in addition to the standard dissemination
meeting/workshop. For example, debates or policy dialogues
allow for discussion that is deeper than a usual research
dissemination activity. The key idea is to have events that allow
for a more in-depth conversation that moves beyond
communication of key findings. It is also strategic to organize
multiple dissemination events with different government
ministries to ensure that the findings reach key officials that are
involved in drafting policies or designing programmes. The more
targeted the dissemination, the more likely the message will
reach those who may actually consider the information as an input
into their decision-making.
Examples from Viet Nam
Campaign:
https://www.youtube.com/watch?v=d2Ao
hHhvrqY&feature=youtu.be
Reporting of the campaign 2013:
https://www.youtube.com/watch?v=nvN0
YWGwo8k&list=UUbDl_UWDVsXbWV
aG3_scGyQ
29
PART THREE: CASE STUDIES
In this section, four case studies are presented from Egypt, the United Kingdom, Viet Nam and the State
of Palestine. The costing studies conducted in Egypt, the United Kingdom and Viet Nam have been very
influential globally. The Viet Nam model is being followed in countries of the Global South and the framework
underpinning the United Kingdom studies is being employed in some European Union (EU) countries. Egypt
has been a model for other Arab countries. For example, the State of Palestine is currently in the process of
undertaking a case study, the design of which has been strongly influenced by the costing exercise in Egypt.
This model is also being followed by Saudi Arabia.
These case studies are based on in-depth interviews with key informants in the selected countries.
Interviewees included senior government officials, lead consultants and staff involved in the costing projects
either from National Women Machineries, national statistics bureaux, NGOs and subject matter experts (see
annex 1 – List of interviewees). The case studies also benefited from an expert group meeting that was held
by ESCWA in Beirut from 20-21 September 2018. The meeting was attended by official representatives from
Arab States as well as international experts who have experience in costing VAW (annex 8 – List of
participants in the expert group meeting).
A. CASE STUDY ONE: EGYPT
1. Background and context
(a) National strategy and legal framework
Until recently, DV was not considered a problem in Egypt. Just prior to the costing study, the National
Council for Women (NCW) developed the first National Strategy for Combating Violence against Women
2015-2020. The national strategy was developed in a participatory manner that included interviews with
relevant stakeholders (ministries, national research institutes, NGOs, religious institutes, etc.). These
discussions revealed the lack of accurate data on VAW and shed light on the importance of commissioning a
prevalence study that would include a costing component.
The national strategy on VAW includes a detailed workplan and budget to cover the activities outlined,
highlighting the importance of investment in GBV prevention and response. As such, it was not difficult to
convince the stakeholders of the importance of costing VAW. However, according to the NCW, a gap in the
legal framework on marital violence persists because it continues to be seen as a private/family issue. Women
experiencing violence usually seek divorce but do not make a criminal case against their husbands because
there is no law criminalizing marital violence.
(b) Service provision
In 2013, UNFPA began working with the Government of Egypt to improve service provision and
address the existing gaps in prevention and response. This process is ongoing, with some sectors requiring
more strengthening than others. For example, the Ministry of Health has been providing training to doctors
in hospitals, though not in all governorates, on understanding GBV, including how to recognize survivors
and their right to report severe violence to the police. In addition, the Ministry of Interior has established a
unit to combat VAW, with dedicated female police officers. There were approximately nine shelters in Egypt
at the time of study. NCW complaint officers provide legal and psychosocial support to women victims of
violence throughout the country. However, there is still a lack of uptake in the use of these services by
women and gaps in terms of the police and health system response, including an inadequate referral system,
continue to be an issue.
Fear, stigma and a belief that the issue is private mean that women who experience GBV in Egypt
generally do not report the incident(s). While they access other services, such as health care, they do not
30
disclose that the injury received was a result of violence perpetrated by their husbands/fiancés. In Egypt, health
services are generally available free of charge, including psychological support for women experiencing
violence. At times, women request legal advice or psychological support from the NCW, who also refer them
to a shelter when necessary. The number of shelters in Egypt is small, and most are not suitable for children
and have set regulations for women staying there. Even so, Egyptian women generally do not seek this solution,
either because they are not aware or they prefer an alternative solution, such as staying with their parents or
friends. The national strategy on VAW includes a plan to improve the accessibility of shelters.
2. Rationale for costing study
(a) Initiation and study team
The costing study was undertaken by the UNFPA Country Office in Egypt which, in partnership with
NCW and CAPMAS, formed a multidisciplinary team. To support and oversee the team, a National Advisory
Committee was created in early 2014 and consultations with the relevant ministries and institutions providing
protection and response services to victims were conducted. UNFPA advised the team to conduct a national
survey on GBV that included a calculation of its economic and social costs.
UNFPA coordinated the research, providing financial and technical support, and an agreement was
established between NCW and CAPMAS to govern the work on the study.
33
CAPMAS was responsible for
the technical issues related to the survey and NCW provided support in an advisory capacity. Discussions,
including how much the study would cost, were led by the leaders of NCW and CAPMAS. UNFPA and the
international consultant explained the purpose of the costing exercise to the concerned ministries, such as the
Ministries of Health, Social Solidarity, Interior and Justice, and trained the researchers on GBV. The success
of this research was underpinned by a robust multisectoral team. Each partner shared an understanding of the
problem and the aim of the research.
NCW welcomed the formation of a multidisciplinary project team and the clear division of labour/skill
areas: (1) CAPMAS had the legal authority and expertise to conduct the large-scale surveys, as well as analyse
the complex quantitative data; (2) the international expert had the knowledge of GBV and VAW costing
research, as well as experience in implementing the methodologies and methods employed; and (3) NCW had
a deep understanding of GBV, especially in relation to the type of questions to be asked in the questionnaire
and how to conduct research with Egyptian women who have experienced violence.
(b) Motivation for the study
The 2014 Demographic Health Survey showed a significant increase in VAW in Egypt, with DV,
sexual harassment and female genital mutilation (FGM) being, at once, the most common and the most
underreported forms. The 2015 study was conducted to address the paucity of research on prevalence rates
of violence against women and girls (VAWG) and its effects on the Egyptian society and economy. This
research was timely, as Egypt was taking concrete steps to eradicate all forms of VAWG. According to
Duvvury and others, “adding the economic perspective of the problem provided “a new, quite powerful,
angle to view the legal, health and other consequences of violence against women and to advocate for action
to be taken.”
34
The Economic Cost of Gender-based Violence Survey (ECGBVS) was thus designed as the
first nationally representative study to collect comprehensive data on the various types and forms of GBV
and to estimate their economic costs.
33
Nata Duvvury and others, “The Egypt Economic Cost of Gender-based Violence Survey” (Cairo, UNFPA, 2015).
34
Ibid., p. 5.
31
3. Methodology
(a) Objectives of the study
The objectives of the study were as follows: (1) to establish and provide accurate nationally
representative data on GBV and its associated economic costs and (2), to help policymakers and planners
formulate evidence-based interventions to combat GBV.
The survey aimed to measure: (1) prevalence and incidence of different types of GBV; (2) impact of
violence on women’s health, reproductive health and general well-being; and (3) consequences of violence
against women and their associated economic costs.
(b) Intended audience
The research was intended for a variety of national stakeholders, policymakers in government
institutions having a role in the prevention and/or response to GBV and groups affected by GBV:
• Society – to raise awareness of the negative consequences of VAW;
• Relevant ministries and policymakers – to raise awareness of the greater cost of inaction compared
to the cost of response; to address GBV by investing in prevention and response services and to take
steps toward eradicating poverty;
• Religious institutions – to highlight their role in combating GBV;
• Media – to highlight their role in combating GBV.
(c) Scope of the study
The multidisciplinary team working on the project sought to emulate the Danish model on costing
violence. While Danish researchers supported the process, the necessary administrative data regarding
investments in GBV services by the government was not available. The Egyptian governmental budget is not
delineated in a way that provides this information and it was not possible to gather data on the cost of service
provision in relation to the time consumed by personnel in addressing GBV from hospitals and police stations.
In addition, the service costs varied, particularly between public and private providers.
According to CAPMAS and NCW, hospitals do not record whether or not injuries occur as a result of
violence and women tend not to disclose the cause of injuries. Additionally, since hospitals do not register
identification numbers for patients, there are no records, for example, of previous injuries so that trends could
be identified. Moreover, it would have been difficult to obtain data on the salaries of the specialist police
officers and the costs of service provision and training. As such, the study estimated the cost of the problem
only to the extent possible, that is, for the woman and the household.
The costing study focused on violence perpetrated by the fiancé or spouse since, according to the
Egyptian culture, these two categories constitute the intimate partner relationship. Indeed, examining violence
perpetrated by the fiancé was a new area of investigation, as well as a new area of intervention for the team,
as it had not been examined in earlier studies.
The study was designed to capture all forms of GBV in the household and public spaces, with due
consideration of how the Egyptian culture functions. The study used the 1993 United Nations definition of
GBV to refer to the physical, sexual and psychological violence occurring in the family, within the general
community and/or perpetrated or condoned by the state. The study estimated the annual economic cost of
violence perpetrated against women by the husband, fiancé, relatives within the immediate or extended family,
other individuals within the close surroundings (anyone present in the home) and violence perpetrated in public
spaces. However, the cost of economic violence, such as financial controlling behaviours, was not included.
32
The role of the national and international experts was instrumental in this study as they determined
which costs were to be estimated and then discussed these costs with the team. The 2005 United Nations
definitions of costs – direct tangible, indirect tangible, direct intangible, indirect intangible – were employed.
The study included all feasible costs for the most severe incident in the previous year, as it was considered this
would produce the most accurate estimates. This was based on the complexities associated with accounting
for inflation and recall. The survey focused on estimating (to the extent possible) direct and indirect tangible
costs. These costs were calculated primarily from the ECGBVS data.
• Direct costs borne by women, such as expenditure associated with seeking services for injuries
(physical and psychological), medical care, medicine, shelter, local community services, legal and
judicial litigation (police), including transportation as well as consumption costs related to the
replacement of property;
• Indirect costs such as income loss due to missed work by the woman and the perpetrator (where
applicable), loss of domestic work, children’s school absence (missed days);
• Indirect intangible costs and consequences that the woman and children faced due to the incident;
• National estimates of out-of-pocket expenditures, lost earnings and value of missed domestic work;
• Costs calculated for the national level based on data from the sample.
(d) Method and cost calculation
Data collection took place between April and June 2015 through a survey framed as a questionnaire on
the “Status of Egyptian Women”. Further information on the exact nature of the questionnaire was provided
as part of the consent process when the interviewer and respondent were alone. Two questionnaires, one for
individual women and one for the household, were employed face-to-face by women researchers, following a
devised criterion. The questionnaire designs were based on the United Nations 2013 Guidelines for producing
statistics on VAW, ESCWA tools adapted for measuring VAW in Arab countries and the experiences of other
countries who conducted similar surveys (after being adapted to fit Egyptian cultural context). Each
questionnaire was finalized by a validation committee comprised of local experts.
The household questionnaire gathered data on demographics (which also served to identify eligible
women); housing characteristics and ownership of a variety of consumer goods (which served to identify the
household wealth index, assessing the long-term standard of living in the household). The individual
questionnaire focused on the characteristics of respondents and the district in which they resided; employment
and income; general and reproductive health, including harmful traditional practices such as FGM, forced
marriage and child marriage; violence perpetrated by husband/fiancé (including financial control); violence
perpetrated by family members/persons ofclose relation and strangers within the surrounding environment;
violence in public spaces (workplace, educational institutions, street and public transport).
The sample was designed to be representative at the governorate level (95 per cent confidence level),
with urban and rural areas separated out, for five regions: urban governorates (for administrative purposes,
Egypt is divided into 27 governorates), urban Lower Egypt, rural Lower Egypt, urban Upper Egypt and rural
Upper Egypt. Frontier governorates were excluded from the sample as their population constitutes less than 1
per cent of Egypt’s total population and accordingly does not affect national estimates. A two-stage cluster
sampling strategy was employed: 21,448 households (almost the sample of the DHS) were selected and women
aged 18-64 years (regardless of marital status) who were residents or present in the household for a month or
more before the survey were eligible. Only one eligible woman in each household was selected at random for
the interview using the Kish Grid, which had been incorporated into the household questionnaire. Sample
weighting was used to ensure representativeness. The household response rate was 97.3 per cent, and the
individual response rate was 99.2 per cent.
33
The study primarily employed the accounting methodology. Multiple regressions were used if a woman
could not remember specific costs, such as health costs which were then estimated based on type of injury,
service accessed and health provider variables. In cases where women were subjected to severe DV and had
to leave their marital homes, the costs of local community services were calculated based on the costs of
existing shelters and alternative housing. The study took into consideration the fact that Egyptian women are
less likely to access public shelters. This was accounted for as an opportunity cost: calculating what the woman
would have spent had she used another form of shelter and was estimated by examining the average daily cost
of shelter (for those who paid). The total shelter cost was thus the total number of days spent outside the home
multiplied by the average daily cost of a shelter.
The ECGBVS did not provide information to calculate lost productivity. However, the survey did
include questions pertaining to the absence of the victim or spouse from work. The survey also collected
information on the daily wages of female waged workers, whether as regular or irregular workers, as well as
current spouses and fiancés (the daily wage was calculated based on the assumption of five working days per
week, 10 in two weeks, 21 for the month, with no data collected on the number of working hours). Women
were also not asked about their earnings or whether they were employed/self-employed. Data related to the
spouse was more difficult to estimate as the women provided this information (16 per cent missing data).
A multiple regression model was employed to: (1) estimate missing data of wages for waged female
workers by regressing the wages on the job characteristics in addition to the age, the educational level and
place of residency of the waged worker; and, (2) estimate the missing wage values of the spouses/fiancés by
regressing the daily reported wages on the occupation, economic activity, age and educational level of the
spouse/fiancé. In the private sector, individuals who miss days of work are not paid. In the governmental sector,
people have 27 paid days off work and a day taken as a result of violence is not counted as a “day off”.
The opportunity cost approach was employed to estimate the daily earnings for self-employed women,
employers and unpaid female workers by regressing the daily reported wages on the job characteristics
(excluding the contract), age, education and place of residency. The cost was calculated as the number of lost
working days multiplied by the daily wage for both the victim and the perpetrator. A small time use survey
was also part of the questionnaire, with all women asked about the hours they and their spouses spent on
different domestic activities during the previous week. Women who reported violence were asked about the
number of days they were unable to conduct these domestic activities due to the incident. Some domestic
activities are usually performed simultaneously, such as caregiving for children and the elderly, which
complicated some of the calculations.
To estimate the monetary value of domestic work, some assumptions were made to address extreme
values and simultaneous activities - the maximum number of domestic working hours per day was set at 14
hours in order to leave time for sleeping/eating/and personal care,
35
and the maximum number of hours
dedicated for child care or elderly care was set at four hours per day (for other extreme values, values above
the 95th percentile took the value of the 95th percentile). A generalized replacement approach was employed to
provide monetary value to domestic work by assuming that the work can be done by a working woman in the
occupation of caregiver who earns an average daily wage of LE 14.7 (using the Annual Report of Wages and
Salaries of 2014, CAPMAS). The calculation for each activity was based on the number of missed days for
this activity multiplied by the average daily hours spent on this activity multiplied by the hourly wage. Then it
was added for all activities to get the total.
The cost of missed school days for children, which parents bear in educational costs, was calculated by
multiplying the number of missed days by the average daily fees of the school. For the 2014/2015 academic
year, the total number of school days was considered as 201 days and the daily fee was computed by dividing
35
Douaa Mahmoud and May Gadallah, “Imputing monetary value to Egyptian females: unpaid domestic and care work”.
34
the total annual fee by the number of days. As the questionnaire did not clarify the number of children who
missed school or the school fees for each child, the estimate is for each family.
The cost of lost time for women forced to change their route due to harassment or violence in public
spaces, was evaluated using the opportunity cost approach. This was calculated by multiplying the extra hours
per day by the hourly wage (14.7),
36
multiplied by the number of days. The cost of extra time for a companion
was also calculated by multiplying the extra hours per day by the hourly wage (12.5), multiplied by the number
of days. As the survey did not provide the number of days a companion was required or the number of days
the route was changed, it was assumed to be 100 days for studying women and 110 otherwise.
37
Though the questionnaire included health-related questions, the causal relationship between violence
and trauma was inconclusive. Also, the data collected did not allow for an estimation of costs associated
with the impact of psychological distress on work performance and productivity, domestic work or
the development of a psychological condition. The survey included questions concerning emotional distress
for women based on the 20-item self-reporting questionnaire (SRQ-20) (see study for further details).
38
A
direct, simple measuring index was computed (the index is the percentage of the total number of problems
reported by the woman divided by 18, the total number of problems investigated in the survey). Mothers
were also asked about the effect of spousal violence on their children, whether in the last year or throughout
their lifetime.
The total cost of violence perpetrated by husband/ fiancé is considered to be an underestimation of the
real total cost, as it is based only on one incident in the year (the incident rate for spousal violence per 100
women is estimated to be 133 incidents). If all these incidents were considered, the total cost would have been
considerably higher.
4. Challenges
(a) Data
The lack of service, budgetary or employer data presented a challenge for the research team. Though
the data obtained also presented challenges, these challenges were addressed by using proxies, such as using
lost wages to calculate lost productivity. As noted previously, multiple regression models were also used to
calculate missing data, such as wages, and assumptions were made to account for extreme values and
simultaneous domestic activities when calculating missed work days.
(b) Questionnaire design
The team took the time needed to extensively discuss the different viewpoints regarding issues such as
the age range and reach a consensus on the final questionnaire.
(c) Accuracy of the estimates
The study provides only estimates of the costs of violence, which represent the minimum cost rather than
the exact cost.
36
Though wages are the same in the public sector, they are different in the private sector. LE 14.7 is the average hourly wage
for a working woman in the occupation of caregiver, and LE 12.5 is the average hourly wage of a working person in the occupation of
caregiver (since the gender of the companion is not available in the data). The comparison wage is lower as a man doing care work
usually earns less than a woman.
37
The number of days is based on the assumption that the incident happened in the middle of the previous year: half of school
days is 100 and half of working days is 110.
38
Duvvury and others, “The Egypt Economic Cost of Gender-based Violence Survey”.
35
5. Key findings
DV
• The majority of respondents, (79 per cent), all of whom were women, were currently married.
• The majority of women (79 per cent) had no income from work or other sources.
• Approximately 7.888 million women suffered from all forms of violence annually, whether
perpetrated by spouse/fiancé, individuals close to her or strangers in public places.
• Approximately 2.288 million women suffered emotionally due to their exposure to violence (all
forms) yearly.
• Approximately 5.6 million women were exposed to violence perpetrated by husband/fiancé
annually.
• The total cost for women and families due to violence was approximately LE 2.17 billion in the
past year, based only on the cost of the most recent severe incident.
• The total cost is projected to reach LE 6.15 billion if the injury rate for all incidents perpetrated by
husband/fiancé in the last year were to continue at the current rate.
• Women and their households incurred a cost of 1.49 billion LE due to violence perpetrated by
their husband/fiancé, comprised of 831.236 million LE in direct costs and 661.565 million LE in
indirect costs.
• Approximately 58 per cent of currently employed women paid in cash were covered by social
security insurance through their work and a similar proportion were covered by health insurance.
Some had both.
• Approximately 2.4 million women experienced one or more type of injuries resulting from
violence perpetrated by spouse or fiancé.
Direct/indir
ect costs of
DV
• Approximately 1 million married women leave their homes annually due to IPV yearly.
• The cost of alternative housing/shelter for women who leave their home due to IPV is
approximately 585 million LE annually.
• Women exposed to violence are more likely than women who have not experienced violence to
have a miscarriage (or stillbirth), 40.1 per cent compared to 36.6 per cent, and are more likely to
have an underweight child, 7.3 per cent compared to 5.3 per cent.
• Approximately 200,000 women are exposed to pregnancy-related complications due to IPV
yearly.
• About 4.7 per cent of women reported being forbidden from working by their husbands throughout
their lives.
• The children of 113,000 families are absent from school yearly due to DV perpetrated by the
husband amounting to loss of approximately 90,000 school days annually.
• The children of 300,000 families suffered nightmares and fear due to violence perpetrated by the
husband during the previous year.
Violence in
public
spaces
• Approximately 139,600 women, 3.7 per cent of working women, were exposed to violence in the
workplace during the previous year.
• Approximately 16,000 girls aged 18 and over were exposed to sexual harassment in educational
institutions in one year alone.
• More than 1.7 million women suffer from various forms of sexual harassment on public transport.
• Working women and female students are more likely to face harassment and violence in public
spaces (approximately 39.4 per cent of girls who were studying at the time of the survey were
victims of such violence).
• VAW in public spaces is estimated to cost 571 million LE yearly.
• Women and their families incur a cost of 548 million LE annually for changing their route and
method of transport or by having to travel with a road companion due to violence in public spaces.
Additional
costs
• Of the 2.6 million women who reported injuries resulting from DV or violence perpetrated by
others, 2.29 million women reported psychological problems due to these incidents during the past
year, representing about 8.8 per cent of the entire sample.
36
See the study for tables concerning: estimates of direct costs and number of women by type of service
due to husband/fiancé violence in last 12 months; cost of violence perpetrated by individuals in close
surroundings and strangers; cost of violence in public spaces in the last 12 months; and estimates of indirect
costs and number of women/lost days, due to husband/fiancé violence in the last 12 months.
6. Study impact
(a) Increased awareness
As a result of the dissemination of the study findings to concerned minsters and senior officials,
policymakers recognized the impact of VAW on the entire economy and the importance of investing in the
implementation of the National VAW Strategy. The media began discussing and highlighting the issue of
DV, which was previously treated as a taboo subject. The study represents an important first step in
combating GBV.
The findings were also used by NGOs and NCW to raise awareness of GBV among policymakers and
at the grassroots level. The importance of supporting NCW to improve their services, particularly the
complaints office, became very clear to all relevant UN agencies. NCW is currently considering
commissioning a national study on violence perpetrated against women with disabilities.
(b) Enhanced response
NGOs started utilizing the findings of the study to advocate for a comprehensive response to VAW,
including increased funding. The Ministry of Planning subsequently increased the budget for VAW-related
activities.
The Ministry of Interior also increased the number of female police officers and integrated a lecture
on combating VAW into the police academy programmes provided by NCW. This is expected to increase
the reporting of VAW and women’s access to services.
Following the completion of the study, each of the partners further engaged in a number of activities
to enhance the national response to GBV. The costing exercise highlighted the fact that more work needs
to be undertaken and better coordination among the various stakeholders, particularly in relation to advocacy
and policies for sector-specific needs, such as in educational institutions is required. Also, further awareness-
raising is needed in terms of improving access to support services which are not available, not known about
or the need for them is marked by stigma.
(c) Enhancing the legal and policy framework
Female parliamentarians began paying attention to the issue of GBV and realized the importance of
strengthening the legal framework. Both the prevalence rate and cost findings were the main source of data
informing the development of the new draft law on VAW currently under consideration by parliament. This
data was also utilized by each governorate to develop action plans in line with the national strategy on VAW.
B. CASE STUDY TWO: THE UNITED KINGDOM
Realizing the multifarious and lasting impacts of GBV on survivors, as well as on society and the
economy at large, the Government of the United Kingdom commissioned a costing study in 2004. This was
followed by an update in 2009. Then in 2014, the EU commissioned United Kingdom researchers to conduct
an EU costing exercise, which produced a case study focused on the United Kingdom.The findings of these
sequential costing exercises have enabled the United Kingdom to monitor cost trends over time.
37
1. Background and context
(a) National strategy and legal framework
The Domestic Violence, Crime and Victims Act came into legislation in 2004. This law, which focused
on IPV, amended the 1996 Family Law Act and was seminal in terms of setting out several legal rights for
women. For instance, the definition of a couple was extended to include same-sex partnerships, and a provision
was made for the establishment and implementation of domestic homicide reviews. In 2012, the United
Kingdom Government also published guidance on controlling or coercive behaviour to assist prosecutors to
better understand the nature and features of this type of abuse. This was followed in 2017 by the introduction
of the Controlling or Coercive Behaviour in an Intimate or Family Relationship Legal Guidance. This guidance
addresses “controlling or coercive behaviour in an intimate or family relationship which causes someone to
fear that violence will be used against them on at least two occasions; or causes them serious alarm or distress
which has a substantial adverse effect on their usual day-to-day activities”.
39
The Strategy to end violence
against women and girls: 2016 to 2020, was also published in 2016.
(b) Service provision
In global terms, the United Kingdom has demonstrated an excellent interdepartmental government
response in relation to service provision since 2000, when independent DV and sexual violence advocates were
introduced. To operationalize this response, the Government invested approximately £57 million in housing-
related support services for DV survivors through the Supporting People programme for 2003-2004. They also
invested £18.9 million in establishing and developing refuges (shelters) across the nation. However, the
Minister for Women and Equalities acknowledged that despite the considerable size of investment, it was still
insufficient to fully address the problem. A key challenge to GBV service provision has been the underfunding
of DV and sexual violence advocates, in spite of their success. Recognizing their importance, the central
Government agreed to fund these services on the basis that they would then be funded locally once their
usefulness was established. This, however, did not materialize.
In 2014, there were approximately 200 DV organizations in England and Wales providing a range of
services: refuge accommodation, community outreach, independent advocacy services, single point of access
services, culturally-specific services, child support workers and a free 24-hour national DV helpline run in
partnership with Women’s Aid, a grassroots organization. The helpline provides women and children with
access to emergency refuge accommodation, an information service, safety planning and translation facilities.
This service targets women, as the predominant victims of DV, but it also caters for individuals calling on
behalf of women experiencing DV, such as friends, family or other agencies. Men seeking help are referred to
an appropriate service. In addition, a forced marriage unit was established to lead on the Government’s forced
marriage policy, outreach and case work. As a joint unit with the Foreign and Commonwealth Office and the
Home Office, it provides support to individuals in the country, as well as aiding British nationals living
overseas.
However, while the United Kingdom has been one of the European countries most actively engaged in
providing services for survivors of violence, the existing level of service provision does not meet the standards
set out in the Istanbul Convention on preventing and combating violence against women and domestic
violence. In addition, only 47 per cent of DV incidents were reported to the police in the year 2008/2009. This
low reporting rate has been attributed to several reasons, such as varying levels in police response, how reports
of DV are recorded, the fact that there are approximately 41 police services operating independently of each
other at the time and the onerous nature of the juridical system. Another challenge undermining the provision
of services is related to the central government’s devolving of responsibility for these services to local
authorities. While the refuges could count on the Supporting People progamme (a central government
programme) for core stable funding, the amount allocated was insufficient. In addition, immigrant women with
39
See https://www.cps.gov.uk/legal-guidance/controlling-or-coercive-behaviour-intimate-or-family-relationship.
38
insecure status or those fleeing their local area to access another refuge and who were experiencing a delay in
transference of their claim had no access to public funds. This was particularly an issue for disabled women.
This created cash flow problems for the refuges which needed to seek charitable funding to make up the deficit
and this situation continues to the current day.
The 2008 financial crisis led to additional funding cuts, which affected the level of service provision
throughout the United Kingdom. Over the past ten years, DV services have been pressured to reduce their costs
in tandem with a big push by central government to get local authorities to undertake competitive tendering to
contract out services. Janet Veitch
40
described the claim that this approach was partly driven by the EU
Procurement Directive as simply an excuse, as the directive allows for exemptions. Over time, many local
shelters lost their contracts as they were undercut by large national housing providers (which have lower unit
costs than small community-based organizations), and minority-led organizations were affected the most.
Indeed, research conducted in 2008 mapped the gaps,
41
highlighting disparities in DV and sexual
violence service provision across England and Wales. It revealed that one third of authorities did not have
services in their area and were thus in breach of their public sector equality duty. The particular issues that
emerged included the long distances some women had to travel to access services and discrepancies between
the range of services and the response of these services to disclosures of violence (unless the case involved
child protection). At this time, the focus was also placed on high risk groups (those at risk of homicide). While
this is understandable, individuals considered lower risk potentially did not get the help they needed to prevent
further violence in their lives. Given the limited number of refuge spaces, there was also a lack of understanding
of the potential for women to become homeless, as well as the time required to source new accommodation.
The 2008 study also included the development of a costing methodology for an average VAW service,
number of refuges for n size of population over a lifetime, for example. As the Home Office considered the
costs unfeasible, a ready reckoner with lists of tables of standard costs was instead developed and made
available on the Home Office website for local authorities to calculate costs.
(c) Data
According to Philippa Olive of Lancaster University, even though the way the data is collected does not
capture the full extent of the problem, the United Kingdom has had reasonably good data on the prevalence
and incidence of DV and GBV since 1996.
2. Rationale for costing studies in the United Kingdom
(a) Initiation and study team
Given the lack of information on DV in the last decade, the Women and Equality Unit commissioned
the first costing study in 2004 using data from 2001.
42
Sylvia Walby, a professor at the University of Leeds,
was contracted to undertake the study.
43
In 2009,
44
the study was updated using estimates based on 2008 data.
40
Janet Veitch is an Associate Gender Adviser at the British Council.
41
Maddy Coy and Liz Kelly, “Map of gaps: the postcode lottery of violence against women support services in Britain”
(2008). (unpublished report).
42
Sylvia Walby, “The cost of domestic violence” (London, Women and Equality Unit, 2004). Available at
http://webarchive.nationalarchives.gov.uk/20060715143031/http://www.policyhub.gov.uk/news_item/domestic_violence_weu.asp).
43
The research team was led by Professor Sylvia Walby (Lancaster University), June Greenwell, Purna Sen and Jennifer
Turner; Sam Brand and Jamie Thorns from the Home Office Economics and Resource Analysis Unit provided expert advice.
44
Sylvia Walby, “The cost of domestic violence: up-date 2009” (Lancaster, Lancaster University, 2009).
39
Then in 2014, another study was commissioned by the European Institute for Gender Equality (EIGE),
45
which built on the 2004 report. This study was conducted by Sylvia Walby and Philippa Olive, and coordinated
by the EIGE GBV team. EIGE oversaw the strategic governance, while acknowledging the expertise of the
research team. The team held numerous consultations with third sector organizations to estimate the costs.
Walby, along with her colleagues Jude Towers and Brian Frances, had been developing a methodology to
analyse the British Crime Survey (BCS) data on prevalence and severity of GBV. Walby and Olive reported
to and discussed directly with EIGE, who had an internal team working on the project. The next section
provides an overview of each of the three studies.
(b) Motivation for costing studies
The 2004 study sought to better understand the full cost of DV as the basis for action within the financial
policy framework. The United Kingdom undertook the costing study to complement the existing legal and
policy frameworks which were based on fairness and justice, and to address the gaps in the existing data. The
rationale behind the 2009 update was the realization that there were several reasons for changes to the costs: a
reduction in the rate of DV; the development of public services led to their greater use by survivors of DV;
and technical adjustments due to inflation and to growth in GDP. The 2014 study was then initiated in response
to the push towards gender neutrality across the EU, to meet Goal 5 of the SDGs on VAW and to establish an
evidence base to argue for increased funding to the sector.
3. 2004 United Kingdom costing study
(a) Methodology
Objectives
The objectives of the study were as follows: (1) to translate DV into monetary terms, so that its costs
would be given the appropriate significance; and (2) to inform policy and enable discussions within the Finance
Department, where funding of DV posed an issue.
(b) Intended audience
• Government – to raise awareness that the cost of response is much less than the cost of inaction and
to address DV by investing in prevention and response services;
• Society - to raise awareness of the seriousness of the problem and to create space for public debate.
(c) Scope of the study
This research estimated the costs for a range of individuals (both women and men) and social
institutions in relation to DV - physical force, sexual violence and threats that cause fear, alarm and distress,
often amounting to patterns of coercive control, including stalking. While some definitions of DV include
violence perpetrated by other family members, the definition used followed Home Office practice by
restricting the inquiry to intimates, namely a current or former husband/wife, current or former partner, or
current or former girl/boyfriend. While most of the violence reported was perpetrated in the home shared
with the abuser, some of the violence was experienced after the relationship ended. The Home Office defines
domestic violence as: “Any violence between current and former partners in an intimate relationship,
wherever and whenever the violence occurs. The violence may include physical, sexual, emotional and
financial abuse.”
46
45
Sylvia Walby and Philippa Olive, “Estimating the Costs of Gender-based Violence in the European Union”.
46
Home Department, “Safety and justice: the Government’s proposals on domestic violence”, Report presented to Parliament
(London, 2003) p. 6.
40
The costs calculated were for England and Wales in 2001. Direct and indirect costs were estimated in
the following areas: (1) services largely funded by government including the criminal justice and health care
systems (including mental health); (2) social services; (3) housing, civil legal services; (3) lost economic output
as a result of disruption of employment, sustained by employers and employees; and (4) human and emotional
costs borne by the individual victim/survivor.
(d) Methods and cost calculation
The methodology employed was based on the Home Office framework for costing crime as noted by
Brand and Price (2000). This framework was developed to include the specific costs that result from DV,
including mental health care, emergency housing and refuge, social services and civil legal costs. These were
derived from a review of international literature on costing studies of DV and of crime. The study also built
on the programme of research in the Department of Transport to estimate the full cost of injuries sustained in
road traffic accidents, which provides the basic estimates for health care, lost economic output and human
costs in the Home Office research and in the study.
Three key types of data are needed to cost DV: (1) the extent and nature of DV, including both the
number of victims and the number of incidents; (2) the extent and nature of the impact of DV on victims’ lives
and society, including the extent to which it leads to the use of services, disrupts employment and causes pain
and suffering; (3) the cost of service provision, lost economic output and the public’s willingness to pay to
avoid the human costs of pain and suffering.
Data on the extent and nature of DV was taken from four sources – the 2001 BCS IPV self-completion
module on Inter-Personal Violence (BCS IPV, Walby & Allen 2004), the Criminal Statistics for homicides,
reports from agencies and a review of previous research. The self-completion module on interpersonal violence
provides data on DV, rape, sexual assault and stalking by intimates in terms of the number of victims and
incidents, the extent of injuries and some information on the use of services. NGO reports were also used to
enhance the understanding of the extent to which DV led to service use, while the evidence from previous
research was employed where there were gaps in the main data sources.
Cost estimates were generally rounded to the nearest thousand, except for estimated costs per incident
or where more precise figures were available from administrative records. According to the study,
“whenever there was doubt or choice regarding the costs, the more conservative assumptions were
employed”.
47
The criminal justice system, health care, social services, housing and refuges and civil legal
services were identified as key areas and within each domain a number of specific institutions were identified
for more detailed investigation. Though complex, the extent to which people use potential services (as not
all survivors seek help) was also estimated. As the level of service use reported in the BCS for IPV was very
low (only helpful for a few major services) and service providers collect little data routinely on the extent
to which their services are accessed as a consequence of DV, important sources of data included ad hoc
instances of data collection, specialist studies of service use and research on the extent of service use for
injuries from incidents other than DV. In particular, the study drew on research from the Department of
Transport on the implications of different types of physical injuries sustained in road traffic accidents (use
and cost of medical services, lost employment and economic output, public’s willingness-to-pay to avoid
such pain and suffering) and used them as a barometer for similar damage within DV.
The BCS is a nationally representative survey of 40,000 people conducted annually. While most of the
questions in this survey are asked by the interviewer face-to-face, the questions concerning DV, sexual assault
and stalking are answered by the participant reading the questions from a computer screen and entering their
responses directly onto a laptop. This method substantially increases both confidentiality and disclosures of
DV which were approximately five times more compared to the face-to-face part of the survey.
48
47
Sylvia Walby, “The cost of domestic violence” (2004), p. 15.
48
Sylvia Walby and Philippa Olive, “Estimating the Costs of Gender-based Violence in the European Union”.
41
4. Key findings
• Total cost of DV to society was approximately £23 billion, of which £3.1 billion was borne by the
state (criminal justice system, health system, social services, social housing and legal aid bills to
support victims). This amounts to over £5.7 billion per year;
• Lost economic output (cost of time off work due to injuries) was estimated at £2.7 billion, over half
of which was borne by employers;
• The cost of domestic violence to the criminal justice system (CJS) was approximately £1 billion a
year. This is nearly one quarter of the CJS budget for violent crime. The largest single component
is that of the police;
• The cost to the National Health Service (NHS) for physical injuries was around £1.2 billion a year.
This includes general practitioners and hospitals. Physical injuries accounted for most of the NHS
costs, while mental health care was estimated at an additional £176 million;
• The annual cost to Social Services was nearly £250 million - overwhelmingly for children rather
than for adults, especially those experiencing the co-occurrence of DV and child abuse;
• Expenditure on emergency housing (local housing authorities and housing associations for those
homeless because of DV; housing benefits for such emergency housing; and refuges) amounted to
£160 million a year;
• Civil legal services cost over £300 billion, equally divided between legal aid and the individual. This
includes both specialist legal actions such as injunctions to restrain or expel a violent partner, as well
as divorce and child custody;
• The cost of pain and suffering amounted to over £17 billion a year.
Employing the data generated in the 2009 update of this study, the table below provides a comparison
of costs between 2001 and 2008. It shows that there has been a reduction in the cost of lost economic output
due to the decrease in the rate of DV.
Table 4. Cost of domestic violence based on data from 2001 and 2008
Costs 2001 £m
Costs 2008 £m
Services
3111
3856
Economic Output
2672
1920
Human and emotional costs
17,086
9954
Total
22,869
15,730
5. 2014 United Kingdom costing study
(a) Methodology
Objectives of the study
EIGE sought to illustrate the extent of collection of administrative data across the different sectors in
EU member states. Their specific objectives were as follows:
• Explore the range of costing methodologies available;
• Review how other studies were conducted to identify the most robust approach that could be
employed using a range of sectors costed and methodologies;
• Explore how the field had advanced to seek innovations.
42
(b) Intended audience
EIGE wanted to collate information on GBV and costing methodologies that could be shared with all
EU member States. In addition to society and the government, as was the case in 2004, the research was
intended to provide a tool for EU member States to calculate GBV service costs.
(c) Scope of the study
To ensure that the study did not produce an overestimation of the costs that would undermine their
credibility, the team included any costs for which they could obtain robust data. The focus was placed on the
extent to which EU countries spend money on specialized services, as opposed to criminal justice and health care,
and the cost for society so as to reinforce GBV as a public problem rather an individual one. The EIGE costing
exercise includes a case study on the United Kingdom, which calculated costs for intimate partner violence
(physical and sexual violence perpetrated by a current or former partner) against women. It also estimated the
broader category of GBV (physical and sexual violence perpetrated by either an intimate partner or other family
member, and sexual violence by any perpetrator). The study included women and men survivors.
In addition to including the costs estimated in 2004, the 2014 study estimated: (1) some costs specific
to victims of DV; and (2) a small fraction of out-of-pocket expenses. The latter included the cost of setting up
a new home and a calculation of self-funded civil legal expenses, which were likely an underestimation of the
full personal, out-of-pocket costs. The following costs were not included at all or were not costed sufficiently
due to the absence of robust quantitative data: long-term health; mental health (mental health impacts are
included in health sector costs and the cost of pain and suffering, although only partially); long-term effects
on children; reduced productivity and the increased likelihood to rely on social welfare (requires data on prior
history of DV alongside welfare payment information, which is not available in the United Kingdom);
additional costs of income support for households that descend into poverty as a result of fleeing DV; specialist
government costs (such as prevention efforts, national action plans, data, research, reports, conferences,
education, training and information materials).
(d) Methods and cost calculation
The methodology involved the following steps:
• Review of studies costing gender-based violence in EU and Organisation of Economic Co-operation
and Development (OECD) countries;
• Evaluation of methodologies employed (comprehensiveness, robustness, replicability, simplicity,
feasibility);
• Identification of preferred methodology;
• A case study - building on United Kingdom example and extrapolated to EU.
It was possible to apply a state-of-the-art costing
methodology uncovered through the literature review because the
United Kingdom has one of the most highly developed statistics
systems and cost-benefit methodologies. The governmental cost-
benefit methodology includes benchmarks for some costs and
established practices for adjustments over time and space. The
country is unique in having annual survey data on the number of
incidents of violence by crime classification, by injury, by the
gender of the victim and by relationship with the perpetrator. Employing the Home Office methodology, a
tailored analysis was performed on the data from the BCS IPV face-to-face survey to produce the best estimates
of the incidents by frequency, severity, gender of victim and relationship with the perpetrator. The findings
The EU (2014) report on costing
is useful for higher and middle-income
countries. It also serves as a good
reference for the Arab region to learn
about the different methodologies
available.
43
were taken over an average of six years, increasing the sample and thereby ensuring robust disaggregation and
more detail than what is routinely available in normal government statistics.
The tailored analysis involved examining the differences between the face-to-face survey data and the
computer-assisted survey data and multiplying the face-to-face data by 3.8, based on rate of disclosures across
a number of years (to ensure the year examined was not an outlier). In addition, data limitations made it
necessary to aggregate some crime categories (“serious and other wounding” were put together under
“wounding”; “rape and sexual assault” became “sexual violence”) to avoid small numbers. A proportionate
adjustment was made for Scotland and Northern Ireland based on population size to provide estimates
extrapolated to the United Kingdom level.
The United Kingdom case study was based on the data from 2012. The study did not adjust previous
valuations for changes to GDP so that a consistent method for updating costs was applied across cost items.
Also, in the intervening period (2003–2012), economies had both grown and shrunk. Monetary valuations
established for the years before 2012 were adjusted to present day prices using the Bank of England Inflation
Calculator. No adjustments were made in relation to “discount rates”, following the practice in the “global
burden of disease” methodology. The United Kingdom costs were initially calculated in pounds sterling and
then translated into euros using the European Commission’s calculator.
The unit cost approach was employed to estimate the cost of each incident by adding the estimated unit
costs in each crime type of lost economic output, utilization of the health and criminal justice systems and an
estimation of the value that the public places on avoiding such injury. Established Home Office estimates were
employed based on average United Kingdom daily output per head of lost economic output from incapacity to
work for each type of violent crime. The emotional and physical impact of each type of crime was formulated
from simulated statistical probability modelling of the prevalence of physical health injuries reported to the
Crime Survey for England and Wales (CSEW) and prevalence of psychological health injuries identified in
the research literature. To apply this methodology to GBV, the unit cost was multiplied by the number of
incidents of each type of violence.
In relation to health-care costs, the United Kingdom health system records information on the extent and
cost of the treatment provided on average to address each of the types of health outcomes that typically result
from specific injuries were employed. Estimates were based on the level of injury and the estimated proportion
of survivors seeking help. This method, modelled on the prevalence of injuries per category of violent crime
reported to the CSEW, provides an assumed average health treatment cost for each category of crime.
49
The
average unit cost for the criminal justice system was formulated per incident of crime reported in the crime
survey. As such, it was weighted according to the probability that an incident would be reported, recorded,
investigated and prosecuted. Employing an updated version of Walby’s 2004 method and data from 43 local
police forces reported by HM Inspectorate of Constabulary and Local Authority Expenditures (HMIC 2012),
estimates were produced for: (1) the total costs and (2) cost of no-crime domestic incidents by the proportion
estimated to be GBV and IPV perpetrated against women and men.
While most of the relevant civil legal costs are borne by the State through various legal aid schemes,
some are borne by the victim/survivor. Both types of costs were estimated using 2012 data on divorces and
Walby’s 2004 methodology. The health-loss grounded approach recommended by the Home Office was also
employed to calculate the public’s willingness to pay. This methodology produces a cost of the physical and
emotional impact on victims for each type of crime based on the burden of disease methodology, which
measures health loss by functional/capacity loss. Specialized civil legal service (such as protection orders) and
specialized victim service (such as refuges/shelters) costs were also calculated using Walby’s methodology,
which is widely paralleled in other studies.
49
Ibid.
44
6. Key Findings
IPV
• The total cost was €33million/£26 billion per year
• The cost of IPV against women was €13.8 billion
• The cost of IPV against women and men was €15.4 billion
GBV
• The cost of GBV against women was €28.4 billion
• The cost of GBV against women and men was €32.6 billion
• The cost of lost economic output due to GBV was €4.2 billion
Services/Personal
• The cost of health care was €1.9 billion
• The cost to the criminal justice system was €4.7 billion
• The cost for civil legal services was €405 million to the State and €230 million self-
funded
• The cost to social welfare was €1.3 billion
• The cost for specialist services was €210 million
• The cost for physical and emotional impact was €18.9 billion
• Personal costs came to €840 billion
Total EU Cost
• Based on extrapolation, GBV costs the EU €258 billion each year
7. Challenges: 2004 and 2014 studies
(a) Data
For the 2014 study, finding the relevant sources of information across the range of costs and examining
the methodologies employed was time consuming, which raised concerns regarding the robustness of the
findings and presented a challenge. Reviewing the literature was likewise time consuming because much is
“grey literature” or unpublished reports and reports that are not available in academic journals. A careful
iterative process was thus employed to source the relevant literature to the extent that was possible.
Synthesizing the complex web of data sources was also difficult.
In addition, it was difficult to address missing data, which is why other EU countries were encouraged
to extrapolate their cost findings from the United Kingdom case study.
(b) Scope
The focus of each of the studies was on physical and sexual violence, rather than coercive control, as
there was limited awareness of this issue at the time. In addition, the main challenges of costing GBV in the
United Kingdom context for the 2014 study were: (1) the ability to measure the extent of violence (severity
and frequency) disaggregated by sex and by relationship with perpetrator; (2) how to identify the extent
of employment losses; (3) the measurement of the extent of service use; and (4) the measurement of the
public valuation of the physical and emotional impact of GBV. Though the BCS is world-leading in quality,
findings from the survey that provide data at the level of disaggregation required by severity, frequency, sex
and relationship with perpetrator are not routinely available. These challenges were addressed by performing
a customized analysis of the raw survey data. Data on the extent of violence is not available in most countries
at the required level of disaggregation. In addition, though the United Kingdom has established governmental
calculations of some aspects of lost employment and of services used, these were not sufficient for the purpose
of the study. As GBV and IPV survivors use services beyond those accessed for other crimes, additional
estimates for civil legal services, social welfare and specialized services (such as shelters and refuges) were
required. Even in the United Kingdom, many major services either cannot or have great difficulty in measuring
the extent of service use by survivors of GBV and IPV. The estimates provided in the study thus required time-
consuming searches for such data, as well as complex calculations.
45
Ideally, the EU wanted a system or formula where member States could input their numbers and
calculate costs. However, this was not possible due to the discrepancies in the rates of violence across EU
countries, as identified in the 2014 European Agency for Fundamental Rights EU-wide survey
(methodological, rather than differences in violence).
50
As member states do not have the disaggregated data
required, extrapolation was deemed the only reasonable solution. Finally, recognising the limits of the quality-
adjusted life year (QALY) method to estimate health impact (focused on physical health and an able-
bodied perspective, the scale used involves hypothetical questions and lacks mental health indicators), the team
had hoped to explore alternative options. However, the tight timeline precluded this and QALYs are backed
by WHO and the Home Office. An additional limitation of the study is that only high-income countries were
included because the team felt their methodologies were more appropriate for the EU.
8. Impact of the Costing Studies
(a) Raised awareness
According to Jacqui Smith, the Minister for Women and Equalities at that time, “Professor Walby’s
ground-breaking research findings send out a powerful message that although domestic violence occurs behind
closed doors, it is everyone’s problem and we all have a part to play in eradicating it”.
51
The 2004 report
concluded with a review of the data needed to improve DV cost estimates and to monitor the impact of policy
development more effectively. In addition, the 2014 study contributed to a vibrant engagement from civil
society, academia and the Government.
(b) Enhanced response
The cost estimates of violence produced led the Home Office to assess the resources allocated to IPV
services. Costing exercises have also been used by civil society and businesses to determine resources.
Furthermore, a Leeds-based NGO used the estimates to calculate costs at the local authority level across the
United Kingdom, helping local NGOs to advocate for greater resources. In 2014, DV organizations used
Walby’s 2004 study and the 2009 update to justify why it was worth investing in their services. Indeed, the
estimates have been utilized by government institutions (National Institute for Health and Care Excellence;
NHS), local government (Safer Portsmouth Partnerships; Devon County Council) and NGOs (Women’s Aid;
Refuge: Living Without Abuse).
The 2014 study was also a very useful means of explaining the economic impact of DV on a large
scale. All of the Walby costing studies were employed by DV organizations to help advocate for funding.
While they currently receive less resources, it has helped them to minimize funding cuts. The findings also
raised awareness among some politicians who increasingly see DV as more than an issue affecting solely
women. Furthermore, the research introduced a new language around DV in terms of the economic aspect
of the problem. Indeed, due to financial cutbacks, there is an added benefit in being able to produce headline
figures that get the attention of the government and can be used to influence allocation of resources.
(c) Wider reach
EIGE have shared the findings widely in their reports to articulate the importance of allocating adequate
resources to address the problem. These findings have also been used to underpin cost effectiveness studies of
DV intervention programmes.
52
Another impact is how the study has been useful in explicating the different
costing methodologies and methods available, as well as providing/supporting the impetus for other studies to
50
European Agency for Fundamental Rights, “Violence against women: an EU-wide survey” (Luxemburg, Publications
Office of the European Union, 2014).
51
Sylvia Walby, “The cost of domestic violence” (2004), p. 8.
52
See Estela Capelas Barbosa and others, “Cost-effectiveness of a domestic violence and abuse training”.
46
be undertaken with momentum being seen across the world. This leads to capacity-building and development
in the field. In addition, the study has been cited in 13 academic papers and numerous costing studies and has
been read more than 100 times on the academic platform, ResearchGate. However, while the findings were
reported in the media which is positive, the impact has been diluted because of the media’s problematic
reporting on and representation of victims and perpetrators of VAW.
There are some important issues to bear in mind. According to the former director of Women’s Aid,
Hilary Fisher, the United Kingdom views itself at the forefront of addressing DV and Aid, and indeed, in some
ways, the country is very progressive. However, gaps in understanding and problems regarding service
provision remain, particularly in relation to competitive tendering. As noted by Janet Veitch more recently,
generic service providers underbid and then request additional funding to ensure service delivery after the
contract has been awarded. As a result of this trend, DV services have suffered and this situation has worsened
over time. Moreover, while there has been a probable decrease in violent crime for some time, there has not
been a comparable decrease in DV.
The Government of the United Kingdom has declared addressing DV a high priority, yet the sector has
been weathering the impact of funding cuts since the 2008 financial crisis. As local authorities do not have the
full financial resources required, it makes demonstrating the good value of investment over time almost
impossible, according to Fisher. Veitch maintained that some areas have good serviced in place, with support
provided predominantly in relation to the criminal justice system, as the success of many of these services is
measured against judicial criteria. In cases where ongoing support has been provided, there has been a
reduction in the rate of women withdrawing DV cases. However, increasing caseloads and a limited number
of services across the nation have made it almost impossible to meet demand. Additionally, according to
Veitch, health-care personnel do not feel they have the capacity nor the resources to treat a DV victim and do
not consider it in their remit. Olive has expressed concern over health service resources for women getting
lost amidst the focus on children. In other words, child protection driving and taking priority over the needs of
the woman. Finally, even though women who become homeless as a result of DV are considered the highest
priority, there are still too few refuge spaces, resulting in the serious risk of these women becoming homeless.
C. CASE STUDY THREE: VIET NAM
1. Background and context
(a) Legal and policy framework
Viet Nam is a deeply patriarchal society with ingrained traditional gender norms, which revere men and
devalue women. However, as a result of the economic reforms introduced in 1986, there was a significant
increase in women’s labour force participation and a slight shift in gender relations within the family. In 1992,
the Vietnamese Government adopted a revised constitution recognizing the equal rights of women across the
public and private domain. This was followed by the adoption of several ordinances on the Conclusion and
Implementation of International Treaties by the Standing Committee of the Vietnamese National Assembly in
1998. These were regarded as an “organic part of Vietnamese law”. The Law on Gender Equality and the Law
on Domestic Violence Prevention and Control (DVPC) were then introduced in 2006 and 2007, respectively.
Several instruments such as action plans were also developed to guide the implementation of this legislation.
Though the legal framework is strong, there are gaps in the implementation of these laws, and they do not
explicitly define GBV or IPV as a violation of human rights.
The first national study of the prevalence of DV perpetrated against women was conducted in 2009 by
the General Statistics Office
53
to address the gap in data frequently raised by the United Nations. UNFPA
coordinated this research to ensure that relevant stakeholders took ownership of the findings and committed
53
Viet Nam, General Statistics Office, “Keeping silent is dying: results from the national study on domestic violence against
women in Viet Nam” (Hanoi, 2010).
47
to implementing the recommendations. Publication of this landmark study led to increased pressure to
strengthen the response to DV, particularly in relation to IPV. A national orientation workshop on DV
intervention was held one week after the launch of the study. This was followed by a series of advocacy events
during 2011-2012 with the relevant government ministries and NGOs.
This momentum led to increased awareness among parliamentarians, the communist party and
government representatives, local leaders, development partners and donors on the issue. Subsequently, UN
Women worked with the Government to develop the National Strategy on Gender Equality (2011-2020) and
the National Programme on Gender Equality (2011-2015). VAW was identified as a key indicator in the
national strategy and became part of GBV interventions included in government action plans and programmes,
such as One Plan.
54
Given the focus on addressing DV, the UNFPA country office supported the Government
of Viet Nam in its efforts, while advocating for the scope to encompass other forms of GBV. In addition, DV
continues to be broadly understood as a “culturally sensitive issue” and a “family affair”.
(b) Service Provision
DV service provision for women in Viet Nam is primarily provided by the government agencies
responsible for the legislation: Ministry of Labour, Invalids and Social Affairs (MOLISA) and Ministry of
Culture, Sport and Tourism (MOCST), as well as the Viet Nam Women’s Union. Prior to conducting the national
prevalence study, the services were fragmented and lacked any capacity development programmes for specialist
training. The study addressed this gap as it was able to influence national efforts related to service provision. DV
prevention and response training models were developed in selected provinces for nationwide application. The
government also formulated a protocol for the health sector response and issued new orders to facilitate access
to services. These included allowing abused women to receive medical treatment without having health insurance
and waiving legal fees for court cases. In addition, the Government supported building a network of “safe
addresses” where women could seek temporary shelter within their communities. It also increased the funding of
the national shelter network and expanded its outreach by establishing regional shelters.
Run by the Women’s Union, the national shelter, Peace House,
55
provides refuge and additional services
such as legal aid, health care, counselling, vocational skills and support for children’s schooling. Of the 10
shelters for women in all of Viet Nam, only two are for DV survivors and their children.
56
A second model is
implemented by the Centre for Studies and Applied Sciences in Gender, Family, Women and Adolescents
(CSAGA), a national NGO which operates a hotline and provides legal aid and counselling, temporary shelter
and a referral system to government shelter in serious cases. The third shelter model involves a list of “safe
addresses” in Thai Binh, Phu Tho and Hai Doung provinces which are used by women to manage smaller
incidents involving minor injuries. Given the difficulties of accessing support from family or friends who do
not live in the same area, these local shelters help women to leave their children in the home, while staying
connected with them.
As part of the Seventh Country Programme 2006-2010, the Vietnamese Government piloted a
comprehensive intervention model to prevent and respond to domestic violence in Phu Tho and Ben Tre
provinces.
57
However, aside from such programmes, the health sector response remained fragmented and
women continue to be reluctant to report IPV. In addition, the police response was notably slow and unfocused,
reflecting the view that DV is a family matter.
54
The government of Viet Nam signed One Plan with the UN, which constitutes a common programmatic framework,
including one budget and one results matrix to ensure the coherence of work and its alignment with all national strategies.
55
See http://www.cwd.vn/en/index.php?option=com_content&view=article&id=113&Itemid=208.
56
Diane Gardsbane and others, “Gender-based violence: issue paper” (Hanoi, United Nations Viet Nam, 2010), p. 41.
57
United Nations Population Fund, “Domestic violence prevention and response in Viet Nam: lessons learned from the
intervention model in Phu Tho and Ben Tre provinces” (Hanoi, 2012).
48
2. Rationale for costing study
(a) Initiation and study team
Following a recommendation emerging from the 2010 national prevalence research, the 2012 economic
costing study conducted by Duvvury and others
58
was initiated by UN Women and funded by AusAID. Several
UN agencies in Viet Nam provided support, in particular UN Women and the Gender-Based Violence Working
Group chaired by UNFPA. The Ministry of Family, Ministry of Culture, Sports and Tourism and the Women’s
Union also provided support in the design and implementation of the study. The core team consisted of Dr.
Nata Duvvury as an international consultant from National University of Ireland (NUIG), Dr. Nguyen Huu
Minh, a national principal investigator and research staff from the Institute for Family and Gender Studies
(IFGS). IFGS took the lead in the fieldwork and data entry, while NUIG oversaw responsibility for data
management and analysis. Regular communication was maintained between the consultants to review progress
and provide quality control.
(b) Motivation to undertake the study
The 2010 prevalence study confirmed that IPV is a serious problem in the Vietnamese society and has
an impact on women’s ability to work. Building on this data, Duvvury and others (2012) undertook the first
economic costing study of DV in the Vietnamese context to address the dearth of information on the costs of
IPV, particularly its costs to the economy. An assessment of the costs of inaction was essential to underscore
the urgency of expanding government investment to address DV. It was also hoped that the cost of inaction
would provide a basis for an estimation of the adequate level of resources required for an effective response.
A study was designed to estimate the social and economic costs with the aim of informing policy and practice
in relation to DV.
3. Methodology
(a) Objectives of the study
The overarching aim of the study was to provide a reliable estimate of the economic cost of domestic
violence perpetrated against women by an intimate partner in Viet Nam. The specific objectives are as follows:
1. To estimate the annual economic cost of DV against women by an intimate partner at the household level
including:
Estimate of annual direct costs for household-related incidents of intimate partner violence,
including costs associated with seeking medical care (physical and mental), shelter, mediation
(NGOs, local resolution), and judicial resolution as well as consumption costs related to the
replacement of property;
Estimate of indirect costs, including income loss due to missed work, loss of reproductive labour
such as child care, children’s health and school performance (including missed days, poor marks
and failing).
59
2. To estimate the annual service provision costs across sectors including health, police, judicial and social
(namely the Women’s Union).
58
Nata Duvvury, Patricia Carney and Nguyen Huu Minh, “Estimating the costs of domestic violence against women in
Viet Nam” (Hanoi, UN Women, 2012).
59
The costs incurred by other family members (such as parents, in-laws and siblings) after an incident of violence were not
captured directly. Women were only asked about the impacts on themselves, their spouses and children.
49
3. To develop macroestimates of:
Aggregate costs for national economy;
Cost of service provision;
Cost due to productivity loss.
(b) Intended audience
The study aimed to enhance awareness of the full cost of inaction with regard to addressing DV, as well
as the seriousness of the problem, among:
• Policymakers and political leaders - to address GBV by investing in prevention and response
services;
• NGOs – to provide evidence enabling them to advocate for increased budgets;
• Communities and families - to raise awareness of the negative consequences of VAW.
(c) Scope of the study
Viet Nam is a middle-income country, yet it has a large informal economy. Women perform a significant
amount of paid and unpaid labour, including reproductive work, subsistence work and community production.
This makes it difficult to estimate lost and reduced output/ productivity as a result of violence. Given these
challenges, the 2004 operational framework developed by Duvvury and others was employed, as it is specific
to this context. The study focused on providing an estimate of the opportunity costs of DV to households and
the community. These costs were then extrapolated to the national economy, including service provision and
prevention services, and the economic cost to businesses due to absenteeism as a result of IPV. This enabled a
preliminary national estimate of the costs of IPV incurred by the economy as a whole. The costs of violence
at the household level are borne by the woman and family member/friends, the perpetrator and the children.
The following are the specific costs that were estimated
• Direct out-of-pocket expenditures by household for utilization of formal and informal services;
• Indirect household costs such as income loss due to missed work and household work by members
of the household; loss of productivity for the household enterprise; missed school days;
• Community level costs including provision of response services and prevention services.
(d) Method and Cost Calculation
The costing study focused on IPV, defined as the violence experienced by women and perpetrated by
husbands/partners within the family setting. The 2001 definition of DV by Ellsberg and others
60
and
administered in the National Study of Domestic Violence, was employed. Data collection involved a mixed-
methods approach:
1. In depth qualitative interviews with 10 women who had experienced DV and accessed services in relation
to their help-seeking behaviour. The costs borne by these women to provide an illustrative picture of the
maximum costs associated with IPV, as they have left their homes and have begun the recovery process.
2. A household survey was conducted with a sample of 1,053 women (based on the National Study prevalence
rate over the last year of 10.9 per cent), aged between 18 and 49, across four provinces and three major
60
Mary Ellsberg and others, “Researching domestic violence against women: methodological and ethical considerations”,
Studies in Family Planning vol. 32, No. 1 (2001), p. 5.
50
cities. The selected provinces and cities represent the seven regions surveyed in the National Study of
Domestic Violence. The total sample was evenly divided between rural and urban areas.
3. A survey was conducted with 79 service providers within the government system, including a primary
health care centre, police station, legal office, local shelter, a Women’s Union committee and a local court
in selected wards/communes to gather data on service utilization and costs of service delivery.
Supplemental information was collected from province-, district- and city-level hospitals, police stations,
courts and Women’s Union groups to verify local level costs. Interviews were also conducted with the
national shelter and the national NGO, CSAGA.
A household was defined as a unit consisting of people sharing the same kitchen, independent of the
number of adults and children living in the household. One eligible woman per household was interviewed to
obtain detailed information on their experience of IPV and the associated costs in the 12 months prior to the
survey. Only women who were married at the time of the survey or those whose marriage ended due to death
or divorce in the past 15 months were eligible. Data was collected for the past 15 months to ensure an adequate
number of data points for estimating the average cost per incident.
Demographic information was recorded. In addition, a wealth index was constructed using income,
water and sanitation status, number of rooms, construction materials of the roof and walls, cooking material,
and ownership of consumer durables, such as a radio or motorbike, and principal component analysis (PCA)
was employed. To estimate missed paid work and household work, daily earnings were calculated. Finally, the
opportunity cost approach was used for the calculation of macroestimates. Productivity loss was estimated
using an ordinary least squares (OLS) regression. Refer to the study for further details of the equations and
calculations employed.
The household survey was adopted from the questionnaires used for the 2010 National Study on DV
and the 2009 International Centre for Research on Women (ICRW) study on the costs of DV, revised
accordingly. Separate service provider questionnaires, also adapted from the 2009 ICRW study, were
developed for each sector of service provision. The fieldwork took place from 17 April to 21 June 2012.
4. Challenges
(a) Data
Several difficulties limited the study results. For example, the impact on children in terms of missing
school days due to IPV could not be established as an extremely small proportion of the women reported this
as an effect. Another cost that could not be calculated was the annual cost of service provision to address and
prevent DV, as service providers were unable to provide robust budget data to estimate the cost of provision
of specific services.
Three significant challenges emerged from the service provider survey. Firstly, the data provided was
extremely fragmented, which meant that producing a robust estimate on a yearly basis was unfeasible. Another
critical problem encountered was the lack of systematic record keeping by the various service providers as a
result of their lack of awareness of DV issues. It was extremely concerning that the health and police sectors
had not recorded cases of DV and were unable to provide systematic information on the costs involved in cases
of reported violence. The final challenge was the virtual absence of information on referrals between the
service providers or to programmes for financial support, vocational skills, legal aid or counselling. In addition,
as the definition of DV was very broad, it was difficult to estimate its exact prevalence and costs.
(b) Time
As this was the first time a costing study was undertaken in Viet Nam, the process was lengthy and
involved many discussions, decisions and training for stakeholders and fieldworkers. Regular consultations were
51
held with the government stakeholders at both national and local levels to ensure the full understanding of the
importance of the study and provide important collaboration at the local level. For example, the household survey
was carried out at the commune (the administrative level between a district and a ward) headquarters to ensure
privacy and confidentiality that could be problematic when interviewing women in their homes.
5. Key Findings
Demographic
Information
• The majority of the women in the sample were married (92.5 per cent), 6 per cent were
separated or divorced and 1 per cent widowed. While approximately 20 per cent of the women
had completed secondary schooling, only 5 per cent of participants had university-level
education.
Economic status
• The majority (93.8 per cent) of respondents were engaged in some form of work (only 65
respondents did not reply to the question on employment, indicating they were full-time
housewives).
• Most of the women (and men) reported incomes below 2,600,000 VND and almost 38 per
cent earned between 1,000,000 VND (minimum monthly salary for those employed in
organizations) and 2,600,000 VND. Some 60 per cent of the sample reported having health
insurance.
Violence
• Approximately 48 per cent of rural women and 38 per cent of urban women reported having
ever experiencing physical violence, with more than 20 per cent experiencing such violence
in the last 12 months in rural areas and about 14 per cent in urban areas. More than one in
four women reported ever experiencing sexual violence in rural and urban areas. The current
prevalence was lower but still approaching one fifth across the sample (17.6 per cent in rural
and 15.2 per cent in urban).
• The prevalence rates for psychological violence were 38 per cent in rural and 27 per cent in
urban areas.
Impact
• Women who were experiencing violence reported a much higher level of problems in the
previous four weeks across the standard measures of mental well-being. They were one and a
half times more likely to be unable to complete their daily work or enjoy daily activities.
Cost
• The cost for accessing health care, transport and medicines came to an average of 804,000
VND per incident, or about 28.2 per cent of women’s average monthly income.
• Women’s loss of earnings per incident averaged 382,234 VND, or about 13.4 per cent of their
average monthly income.
• The opportunity cost of DV for participants, taking into account the weighted average unit
cost of out of pocket expenditures and lost earnings from paid work, came to 34 per cent of
the average monthly income of women in the sample.
• The potential opportunity cost for the economy, including out of pocket expenditures, lost
earnings and the value of missed housework, was estimated at 1.41 per cent of GDP.
6. Study impact
(a) Enhanced service provision
Following United Nations advocacy based on the findings of the study, the Government of Viet Nam
agreed to develop and deliver a minimum package of services. Over the past five years, UN Women and
UNFPA have supported the Government to pilot the Essential Services Package for Women and Girls Subject
to Violence,
61
which includes health care, protection and a referral system. While progress is slow, the police
and wider criminal justice system have been working on enhancing services to survivors of DV and women
are becoming more inclined to report their experiences.
61
Please see http://www.unwomen.org/en/digital-library/publications/2015/12/essential-services-package-for-women-and-
girls-subject-to-violence.
52
(b) Skill development
The training provided by the international expert has increased the expertise among Government
personnel and researchers working on DV. A future costing exercise could be undertaken with greater ease.
(c) Increased awareness
Thanks to advocacy on the part of the United Nations and the findings being reported in the media,
awareness has been raised in society regarding the magnitude of the problem. UNFPA and UN Women and
some of the government ministries, particularly the Ministry of Labour, worked together in this regard.
(d) Capacity-building
The government has now recognized the importance of establishing cost estimates. Viet Nam is thus
moving ahead to include cost questions within the Second National Survey on Women’s Life and Health
Experiences to obtain nationally representative estimates of the economic impact of violence on women’s work
and productivity. The General Statistical Office is currently training their survey staff who undertake their
statistical surveys on the broader implications of DV against women outside of the health sector.
D. CASE STUDY FOUR: STATE OF PALESTINE
1. Background and context
(a) National strategy and legal framework
Palestine is one of the most complex contexts in the world and, as a territory under occupation for 50
years, has a number of interlinking development and humanitarian needs (UNFPA).
62
VAW is a significant problem in Palestine. A study on the national prevalence rates of violence
published in 2012
63
revealed that approximately 37 per cent of married women had been exposed to at least
one form of violence by their husbands, with a 29.9 per cent rate in the West Bank compared to 51.1 per cent
in the Gaza Strip. However, less than 1 per cent of women reported seeking the help of a social worker, a
shelter, a civil society organization or the police. Following her mission to the State of Palestine in 2016, the
Special Rapporteur on violence against women, its causes and consequences noted the multiple forms of VAW
in Palestinian society, including femicide and child marriage. Much of this violence is a consequence of
entrenched patriarchal gender norms, as well as the fundamental role family honour plays in the Palestinian
society. Poor employment opportunities which entrench poverty and limit women’s freedoms is another
important factor. Women suffer from violence directly and indirectly as a result of the Israeli occupation.
Indeed, the social, cultural and institutional barriers to women's labour market participation are compounded
by Israeli restrictions that impede mobility and perpetuate limited labour opportunities in the formal economy.
Though VAW continues to be a sensitive issue in the State of Palestine, recent efforts to combat and prevent
this problem have made it a little less taboo.
It is relatively recently that the State of Palestine acceded to key human rights instruments, such as
CEDAW. In 2016, the Special Rapporteur on violence against women, its causes and consequences described
the national legal framework as outdated and fragmented. For example, the laws governing gender equality
are a patchwork of problematic and contradictory personal status laws and penal codes. Violence perpetrated
against women or men is illegal and punishable under the gender-neutral Jordanian Penal Code, but DV is not
specifically prohibited by law. However, the Family Protection Bill, which addresses VAW, is in the final
62
UNFPA, “Evaluation of UNFPA support to the prevention, response to and elimination of gender-based violence, and
harmful practices 2012-2017: Palestine case study” (Ramallah, 2017), p. 5.
63
Palestinian Central Bureau of Statistics, “Violence survey in the Palestinian territory, 2011” (Ramallah, 2012), pp. 17-18.
53
stage of review and is expected to be submitted to the President for consultations and endorsement in 2019. In
the meantime, UN Women have supported the Ministry of Women’s Affairs to develop a landmark strategy
to guide interventions to address VAW and to provide protection for survivors. Adopted in 2011, the National
Strategy to Combat Violence against Women 2011-2019 is a comprehensive, multilevel policy framework.
The Palestinian Government, in partnership with several United Nations agencies and donors, recently
launched two joint programmes, Sawasya II and HAYA, focused on eliminating violence against women.
These initiatives support the development of legislation that respects, protects and fulfils human rights and
gender equality, as well as promoting peace and security. UN Women have further supported the development
of VAWG documentation systems in the State of Palestine. Indeed, the Ministry for Women’s Affairs
established the first National Observatory on Violence Against Women in 2017. This important institution
produces and monitors data on VAW, while supporting programming, advocacy and lobbying initiatives to
combat the issue.
(b) Service provision
The Sawasya II joint programme also strives to improve women’s and girls’ access to justice and
security by ensuring accountable service provision to prevent, protect and respond to violence, including their
broader legal needs. For example, specialized teams within key justice and security institutions such as the
Ministry of Interior and Palestinian Civil Police, the Attorney General’s Office, the High Judicial Council and
the Ministry of Justice were prioritized as pivotal to increasing institutional gender responsiveness. A national
referral system has been established, comprising the Ministry of Social Development, the Ministry of Health
and the police, whose main focus is protection of women.
UN Women has been working extensively with the Palestinian Civil Police Family Protection Units
(FPUs) since 2011 to strengthen their capacity to respond to cases involving VAWG. In 2013, the Chief of
Police adopted the first ever Strategy, Regulation and Standard Operating Procedures for dealing with
survivors of violence, including case reporting, risk assessment and case management. Currently, there are 10
units operating in 10 districts of the West Bank. The strategy, which is aligned with international human rights
standards, has led to an increase in the number of survivors of violence accessing services from the FPUs. In
2013, these units dealt with 3,662 cases, an increase of more than 52 per cent from 2011. However, according
to the Ministry for Women’s Affairs, it is still difficult for women experiencing VAW to report their
experiences to the police.
UN Women also provided technical support for the establishment of Mehwar, the first specialized
multipurpose anti-violence centre in the State of Palestine. This centre has been recognized by the Palestinian
Ministry of Social Affairs as a model for homogenizing Palestinian anti-violence services. There are currently
four anti-violence centres/shelters in the Sate: Mehwar Centre in Bethlehem, the Family Defense Society
shelter in Nablus, the Women’s Centre for Legal Aid and Counselling emergency shelter in Jericho and Al-
Hayat Centre in Gaza. Such centres provide numerous services to survivors, including shelter and protection.
However, according to the Ministry for Women’s Affairs, most women who experience DV stay with
family/friends, rather than accessing these shelters due to stigma and fear of reprisal from their husbands. As
part of the Palestine Gender Programme which focuses on strengthening government and civil society capacity
to address GBV, UNFPA also supports clinical and psychosocial support (PSS) services for survivors.
2. Rationale for Study
(a) Initiation and study team
Following a regional consultation organized by ESCWA in partnership with UN Women on the
importance of costing VAW, the Palestinian Ministry of Women’s Affairs expressed interest in piloting the
economic model and undertaking a national study on the topic. ESCWA responded to the technical
assistance request from the Ministry for Women’s Affairs to commission a national prevalence and costing
54
study on DV and formed a partnership with the ministry to govern this relationship. Then a National
Committee was formed to oversee the study, comprising the Ministry of Women’s Affairs, Ministry of
Finance, Ministry of Social Development, Ministry of Culture, Ministry of Labour, Ministry of Justice,
NGOs, UN-Women and ESCWA.
The State of Palestine followed the steps proposed by ESCWA (detailed in figure 4), starting with a
situation analysis, which was conducted through a fieldwork mission by an international consultant to identify
sources of administrative data and budget information for a costing VAW methodology in Palestine. ESCWA
then held national consultation workshops in Jordan
64
with the relevant specialized parties to discuss the
findings of the contextual analysis and to devise the study objectives, scope and methodology. This led to the
formulation of an operational model for the scope of the study in terms of the types of violence to be included
in the exercise; the particular costs of violence that would be feasible to estimate and their relevant sources of
data; the appropriate methodologies and methods for the study; and the partnerships required for the
implementation of the study.
With the support of ESCWA Statistics Division, a follow-up workshop was held in Jordan, to discuss and
finalize the study details and agree on the questions for costing DV which would be integrated in a survey that
the Palestinian government is currently undertaking on the prevalence of VAW (annex 9 – Questions on
costing DV). Integrating a section on costing in the ongoing survey was a very cost-efficient approach that
avoided administrating a stand-alone costing survey.
In parallel to this, UN Women recruited an international consultant to undertake a gender-responsive
budgeting exercise to examine resources allocated for addressing violence against women. The GRB exercise,
which is underway, will integrate “a clear gender perspective within the overall context of the budgetary
process, through the use of special processes and analytical tools, with a view to promoting gender-
responsive policies”.
65
In particular, it will examine the allocation of resources based on (a) reviewing relevant
national policies and laws; (b) examining the budget allocation made to activities undertaken by governmental
and non-governmental members of the National Coordination Committee on how to prevent violence and to
provide services or prosecute perpetrators in areas related to violence against women. The process currently
being implemented is composed of: (a) desk review of existing documents, including policies, laws and
budgets; and (b) interviews with key stakeholders from governmental and non-governmental organisations to
better understand funding sources and adequacy of budgets to deliver the services needed.
(b) Motivation to undertake the study
The study underway aims to address the gap in knowledge regarding the cost of inaction to the State. It
seeks to inform preventative policy development and it is envisaged that the money saved will be redirected
to societal development.
3. Methodology
(a) Objectives of the study
The study aims to establish the prevalence of DV perpetrated by men against their wives (marital
violence) and to estimate its direct and indirect costs for women, households, the community, wider society
and the State.
64
Due to the difficulty associated with visa issuance to United Nations staff and consultants to the State of Palestine, many
events are held in Jordan.
65
Ronnie Downes, Lisa von Trapp and Scherie Nicol, “Gender budgeting in OECD countries”, OECD Journal on Budgeting,
vol. 3 (2016).
55
(b) Intended audience
This study is intended for a variety of individuals/groups affected by DV and those with a role to play
in the prevention and/or response to DV:
• Society – to raise awareness of the magnitude of the problem and of the availability of services;
• Government/budgetary decision makers – to better address DV, and protect women and children, by
targeting funding;
• Government/civil society/researchers – awareness-raising and capacity-building.
Establishing an evidence-base on the costs of DV is seen as crucial to informing policies, as well as to
the development of services addressing VAW. The research partnership plans to hold workshops for the
relevant government Ministries and civil society organizations working on VAW to present and discuss the
findings. This will be complemented by a workshop for the National Committee to plan the development of
policies and procedures to address VAW.
(c) Scope of the study
While the violence women are subjected to as a result of the Israeli occupation is significant, it was
agreed that the research will focus on marital violence perpetrated by men against their wives, as this is the
most prevalent from of VAW in the State of Palestine. Discussions have also explored the link between the
violence experienced by Palestinian men due to the occupation and their perpetration of marital violence. It
was decided to focus on marital violence while acknowledging that the violence perpetrated against men by
the Israeli occupation is a contributing factor to increased violence against their wives. The study will also
explore women’s awareness of the services available and their help-seeking behaviour.
Several factors were considered when devising the scope of the research and the size of the sample, such
as the clarity of the concepts, the availability of indicators and the budget required to implement the project.
The target sample will be representative, comprising 12,400 families across the State. The research team
determined which costs are to be included and the indicators to be employed based on the Egyptian study and
discussions with the ministries and NGOs working on VAW. The study will focus on estimating (to the extent
possible) direct, indirect, tangible and intangible costs.
• Direct costs borne by women, such as expenditure associated with seeking services for injuries
(physical and psychological), general health care, shelter, legal and judicial litigation (police),
transportation, as well as loss of assets and consumption costs related to the replacement of property;
• Indirect costs such as income loss due to missed work by the woman and the perpetrator (where
applicable), loss of domestic/care work, missed days from university, children’s school absence;
• Indirect and intangible costs and consequences that women and children face due to the incident;
• Costs incurred by the woman and/or contributions from family/friends;
• Macroestimates of out-of-pocket expenditures, lost earnings and value of missed domestic
work/care;
• Costs calculated for the national level based on data from the sample;
• Cost of service provision such as health care, legal and judicial litigation (police) and shelter.
56
(d) Method and cost calculation
This study will employ a mixed-methods approach. A household survey will be conducted face-to-face
with one woman per household in the target sample. The Palestinian Central Bureau of Statistics (PCBS) is
currently devising the questionnaire. Building on the 2015 National Household Survey and the advice from
Egypt, the questionnaire will gather data on demographics, work profile of respondents including
earnings/income, prevalence of DV, and the health and economic impacts of violence to estimate the direct
and indirect costs outlined above. PCBS organized a workshop with the National Committee of the Ministry
for Women’s Affairs to discuss and finalize the questionnaire, which was piloted during the summer of 2018
and reviewed according to the findings of the pilot. It is expected that the fieldwork will take place in January
2019 to fully administrate the survey, which will be conducted by approximately 50 women researchers who
were recruited and trained by PCBS.
As was the case in Egypt, the survey data will be primarily analysed using the accounting methodology.
According to the Ministry for Women’s Affairs, the data from the survey will be analysed by PCBS and the
international consultant. This consultant will also analyse the government budget of the Ministries of Finance,
Health, Women’s Affairs and Social Development. In addition, service provider (health care, shelters, police
etc.) and VAW observatory records will be analysed.
4. Challenges
• Lack of national expertise on the costing of DV and the difficulty in choosing the specific target
groups;
• Lack of awareness of the problem has also resulted in a limited understanding among some
national institutions of the importance of the study: some institutions and national experts were
under the impression that costing VAW would underestimate the human rights aspect of the problem
and thus were resistant to the concept;
• Limited understanding among national institutions on the importance of the study: some
institutions and national experts were under the impression that costing VAW will underestimate
the human rights aspect of the problem and thus were resistant to accept the concept;
• Lack of a comprehensive approach to address VAW: National efforts to address VAW had been
fragmented. For example, despite having a national strategy on the issue, the State of Palestine lacks
national legislation on VAW. The lack of a comprehensive approach will be challenging for the
development of preventive policies and procedures that are enhanced if supported by a legal
framework;
• The scope and focus of the study: Due to the unique nature of a country being under occupation,
some stakeholders wanted to broaden the scope of the study to include the cost of violence on women
as a result of the occupation along with marital violence. The economic model used in the State of
Palestine was focused on costing domestic violence and cannot accommodate such a broad scope.
Nonetheless, as a mitigation measure, the questionnaire on costing VAW will include questions
addressing violence by spouse in the context of the Israeli occupation, with an understanding of how
this will be presented - as a risk factor, involving norms of masculinity and conflict. Another
mitigation measure was to include questions on men’s experiences of violence due to the Israeli
occupation;
• The limited financial resources to undertake a costing study: the Palestinian Ministry of
Women’s Affairs and PCBS decided to include a section on the cost of VAW in an ongoing survey
on the prevalence that was budgeted for. This is a cost-effective method to reduce the cost associated
with national surveys.
57
LESSONS LEARNED FROM CASE STUDIES
The following recommendations were shared by those involved in the costing studies presented:
1. Devote enough time to the preparatory phase
• Take the political context into account, particularly in terms of the will to address DV. It is important
to show how much DV impacts the time use of hospitals, physicians and police and that its effects
are wider than just the family unit. This also produces a number of potential allies – for example,
among hospital staff, police, etc. through training. In the Arab Region, securing support from the
business community could be challenging because of the low labour force participation of women.
Also, in some cases, the police consider DV a private issue and thus not their concern or as costing
them time;
• Engage the government from the beginning to ensure its support for the costing exercise, and to
ensure ownership of the findings and a commitment to implement the resulting recommendations.
Provide robust information to stakeholders and highlight the importance of accurate prevalence and
costing data. In addition, partner with/include all relevant parties – such as civil society, academia
(particularly feminist academics) and government;
• Identify the resources and time required for the exercise. In addition, form a multidisciplinary and
skilled team, including good interviewers to ensure women are comfortable answering all the
questions and where participants can seek help and understand their right to live free of violence. It
is important to have the country’s National Statistics Institute as a main partner conducting the
survey to obtain credible data that is recognized by the government and society, with strong
involvement of the Women’s National Machinery;
• Ensure support within wider society by raising awareness of the importance of the issue.
2. Carefully consider the scope of the study
• Be thorough with the definitions employed in terms of what is being included and what is not;
coercive control is really challenging to cost. Although it was a national priority to capture data on
violence perpetrated in public spaces in Egypt, it is better to conduct separate surveys - DV and
violence in public spaces are different in nature and implications and the former may influence
thinking around the latter;
• To address any budget limitations, reduce the scope of the study, exploring the specific costs in
greater detail by having more indicators – first, a smaller sample can be used to produce case studies
of qualitative and quantitative data on specific cost areas which can then be expanded into a larger
survey;
• Take into consideration the pros and cons of focusing on different age cohorts and make an informed
decision on the age range selected. For example, including older women may skew the data because
usually violence takes different forms during early marriage and later in life. Similarly, the sample
for calculating violence in public spaces may skew the results when the number of women working
is very small, as was the case in Egypt. On the other hand, including older women (up to 70 years)
and women with disabilities sheds light on a wider range of issues of violence. Where possible, it is
also recommended to employ percentages regarding age and labour force participation, rather than
choosing a random sample, as older women are usually not working which affects the prevalence of
violence experienced in the workplace and public spaces;
• While it may be a little more difficult for women completing the questionnaire to recall all incidents,
it is recommended to estimate costs of DV per incident, per woman, to produce robust findings. And,
where possible, obtain data from survivors and services to enable the assessment of wider costs;
58
• It is important to (a) map available services for VAW prior to costing service provision and to
confirm that these services are recording the relevant data; (b) map barriers to help-seeking (in other
words, seek the reasons why women stay in abusive relationships); and (c) focus on women’s stories.
3. Employ innovative and participatory approaches
• In the absence of official government figures, employ local polling and local surveys (qualitative
approach). This is how the United Kingdom began producing cost estimates when there was a gap
in the national statistics. For example, a study conducted in the smaller borough of Hackney by
Dr. Elizabeth Stanko was used to make a case for investing in services at the London borough level;
• Where possible, involve survivors in the process, particularly in relation to intangible costs that are
difficult to estimate, and by highlighting costs that are not measurable. Also, complement the cost
estimates with a narrative about the impact of DV on society;
• Include case studies of a particular area or service –as a way to narrow the focus and put a human
face on the problem – as people can relate better to what is happening to an individual than to a
group of people, according to Hilary Fisher (for example, the general practitioner who sees X
number of women every month because of DV, which reduces time spent on other issues).
4. Carefully design the questionnaire
• Ensure that the methodology is culturally appropriate and carefully consider the methodological
approaches and costs to be included. Be comprehensive in covering: (1) the numerous types of
violence, such as financial (for example, when husband takes woman’s salary), physical and
psychological; (2) solid demographic data, such as men’s employment, age, number of children);
(3) questions to help understand why women sought support from family members, NGOs, police, etc;
• Consider looking beyond just the previous month when estimating the cost of alternative transport
for women experiencing harassment – cost will increase significantly and without this expanded
timeframe women who did not experience any incident of violence recently will be excluded. They
may have chosen to use alternative transport because of experiencing harassment or because of
hearing about the harassment faced by others;
• As productivity data is difficult to calculate, it can be measured by the proxies of time and lost
wages: after incident, how many hours of lost focus and change in regular earnings versus earnings
after the incident for self-employed;
• Administer the survey in the morning and evening to ensure working women are included.
5. Produce and disseminate robust estimates
• While all costings are underestimates, they are still huge, especially in terms of health impacts; we
are still scratching at the surface. However, if a robust cost figure cannot be produced, it is best not
to disseminate it as even when the cost is presented as an underestimate, this fact is often not
reported;
• Break down the costs in terms of how they are applied in different sectors. For example, in the
United Kingdom, women reported valuing the specialist NGO services most, yet these services
received the least funding.
6. Develop an advocacy plan and use the findings at the outset
• Visualize the key findings of the study to ensure that the general public understands the message.
Include a component in the advocacy plan targeting key government leaders and decision makers to
address the gaps identified in the study and adopt the recommendations;
59
• Engage the media to maximize dissemination of the findings and to raise awareness among the
public and policymakers on the magnitude of the problem. Set up a press conference, developing a
briefing kit for media to ensure they have comprehensive and accurate information and to avoid
incorrect interpretations or misunderstandings of the findings;
• All advocacy events should be co-chaired by the relevant lead government agency to: (1) enhance
ownership; (2) create a stronger voice and influence; and (3) push commitment for following up
actions. Nonetheless, the government’s key national partner for the project should act as the
coordinating agency to follow up with the government for further actions.
60
61
Annex 1
Case study interviewees
• Naglaa El-Adly, National Council for Women, Egypt.
• Wafaa Maged Ahmed, Central Agency for Public Mobilization and Statistics, Egypt.
• May Gadallah, Cairo University, Egypt.
• Germaine Haddad, UNFPA Cairo Office, Egypt.
• Amin Assi, Ministry of Women’s Affairs, State of Palestine.
• Sylvia Walby, Professor of Sociology, Lancaster University, United Kingdom.
• Phillipa Olive, Lancaster University, United Kingdom.
• Janet Veitch, Associate Gender Adviser at the British Council, U.K.
• Hilary Fisher, Former Director of Women’s Aid, United Kingdom.
• Nguyen Huu Minh, Institute for Family and Gender Studies, Viet Nam.
• Hien Phan, UNFPA Programme Specialist on Gender, Policy and Advocacy, Myanmar.
62
Annex 2
Internationally recognized definitions
The Gender-Based Violence Information Management System (GBVIMS)
66
has a GBV Classification
Tool which standardizes the definitions of GBV incidents using a set of six core types of GBV and
classification process to determine the most specific incident type.
67
A set of operational definitions related to the selected type of violence and the methodology/methods
chosen also needs to be determined. These definitions include but are not limited to the following:
68
Prevalence: Number of currently married/engaged women ages 18 years and up who have been
victimized by an intimate partner at some point in their lifetimes (lifetime prevalence) or during the 12 months
preceding the study.
69
Incidence: The number of separate episodes of IPV that occurred among currently married/engaged
women ages 18 and up during the 12 months preceding the survey. For IPV, incidence frequently exceeds
prevalence as it is often repeated. In other words, one survivor (who is counted once under the prevalence
definition) may experience several victimizations over the course of 12 months each of which contributes to
the incidence count.
Victimization Rate: The number of IPV victimizations involving currently married/partnered women
ages 18 and up
Utilization Rate: The proportion of women who use a specific service after an incident of violence.
Non-market work: Unpaid work performed by household members who produce goods and services
for the household's own consumption. The time spent on household work - measured through a Time Use
Survey - is assigned a monetary value, which forms the basis for the measurement of the monetary value of
the work performed by household members. International studies have revealed that using different wage
standards leads to significant differences (up to 100 per cent) in total values. It should be noted, however, that
the imputation of monetary values for working time on the basis of the time use survey is the only possibility
for measuring both the monetary and temporal volumes of unpaid work.
70
Productivity Loss: The reduction in total labour supply of household members due to the impact of
incidence of violence reduces the overall productivity of the household. Productivity reflects changes in the
work habits of the individual member of the household including loss of concentration, working slower than
usual, feeling tired, having accidents, etc. The lower productivity due to violence is also reflected in lower
earnings as a result of the changes in work pattern.
66
See http://www.gbvims.com/gbvims-tools/classification-tool/.
67
See http://gbvims.com/wp/wp-content/uploads/ClassificationTool_Feb20112.pdf.
68
Nata Duvvury, Caren Grown and Jennifer Redner, “Costs of intimate partner violence at the household and community
levels: An operational framework for developing countries” (Washington, International Center for Research on Women, 2004).
69
National Center for Injury Prevention and Control, “Costs of Intimate Partner Violence Against Women in the United
States. (Atlanta, Center for Disease Control and Prevention, 2003).
70
ECE/CES/GE.30/2006/SP/24.
63
Valuing unpaid work – common methodologies
Replacement cost method – the “generalist” approach. This method assesses unpaid work based
upon wages of housekeepers. One problem with this method is that housekeepers do not perform all unpaid
work and this method may not be appropriate for assessing volunteer work.
Replacement cost method – the “specialist” approach: This method assesses unpaid work based upon
wages paid to occupations performing similar activities as are done in households. It has been pointed out that
this method is affected by a disparity in productivity between people engaged in unpaid work and an occupation
due to differences in economies of scale and in the capital equipment ratio.
Opportunity cost approach: Based on consumer theory, this approach assumes that a rational
consumer divides his or her time between leisure, housework and market work in such a way as to gain
maximum utility. It is true when the value of housework time equals the market wage rate of that person; it
is his or her opportunity cost of time. As such, the average wages by sex can be used for valuing the
opportunity cost.
The opportunity cost approach would be the preferred method and can be modified to use specified
minimum wages, if wages for individual women are difficult to gather.
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Annex 3
Key informant interview questions
Questions for key informants may include the following:
1. Can you tell me about the nature of the existing legislation on DV?
2. Can you tell me about the DV policy framework? Do you think it is robust? Do you think it is
effective?
3. What services are available to DV survivors seeking help? Are they available in all
governorates/areas?
4. What type of DV prevention services exist?
5. What data, and other information, is available on DV from your ministry? What is the type of
data?
6. What (if any) budget data on DV is available from your ministry?
65
Annex 4
Illustrative example of mapping help seeking behaviour - the case of Nicaragua
During a participatory study carried out by the Nicaraguan Network of Women against Violence, rural
Nicaraguan women taking part produced a diagram to assess the public’s view of the proposed DV law. The
diagram identifies the individuals or institutions that might be able to help “Maria,” a woman whose husband
beats her. The circles indicate, by size and proximity to Maria, how helpful and accessible each individual or
institution is perceived to be. The text accompanying the circles illustrates the views expressed by women in
the group.
This diagram method can be adapted to different cultures by changing the religious institutions and other
services as appropriate. For example, the family can be further specified to natal family, marital family,
extended family, kin and clan, depending on the relationships that are important in a specific context.
66
Annex 5
Help-seeking by women after experiencing DV
Women who experience violence access help from various institutions and thus incur costs in accessing
the services which need to be included in the costing study. To understand the various pathways of help-
seeking, the diagrams below lay out potential services that might be accessed by women in the health-care
system, criminal justice system, civil legal system, housing and refuge and social services. These are only
indicative and need to be tailored to the specific legal and institutional structures in the countries of the study.
Health-care system
Criminal justice system
67
Housing and refuge
Civil legal services
68
Social services
69
Annex 6
Estimating lost productivity
Output method
This approach takes into account all outputs based on the value of all goods and services produced by
the household (quantity x price) at market equivalent prices.
71
This approach would be applicable in
economies where household and domestic production are paid based on the units of output. The valuation
of unpaid work in this approach requires data on the output of the unpaid work such as the number of meals
prepared, items of clothing washed and ironed, area of house cleaned, children taught, number of elderly
given care, etc.
This approach also needs data on the wage rate per unit of output, such as the labour charge for each
meal prepared, charge per item of clothing washed and ironed, number of children tutored, payment for each
elderly person given care.
72
The output method is theoretically superior but unfortunately it is difficult to apply
if the goods and services produced are not sold on the market.
73
Input methods
This approach is applicable for household and personal services for which individuals are paid by the
time spent, depending upon the country practice of payment for those activities, such as taking care of children
and the elderly, transporting household members, teaching children, cleaning and other similar activities. This
approach is also applicable to volunteer work in non-profit institutions.
The input approach values household production as the sum of all values of its inputs which include
labour inputs (time use) and the use of physical capital (the land, dwellings and equipment owned by
households). However, time use surveys only provide information on time use so the valuation methods in
practice do not take into account the value of the physical capital used by households in non-market
production.
74
There are two broad approaches in applying the input methods to evaluate the wages: the opportunity
cost and the market replacement cost.
75
Opportunity cost approach
The opportunity cost approach is based on the potential wage that the person would earn in the market.
Underpinned by consumer theory, this approach assumes that a rational consumer divides their time between
leisure, housework and market work in such a way as to gain maximum utility. It is true when the value of
housework time equals the market wage rate of that person; it is her or his opportunity cost of time.
The most common wage used in this method is the potential wage of the person based on sex, educational
level and age, that is to say the valuation will change depending upon who is engaged in the unpaid work.
76
71
Nancy Folbre, “Valuing non-market work”.
72
Ibid.
73
Joke Swiebel, “Unpaid work and policy-making towards a broader prospective of work and employment”.
74
Debbie Budlender, “Measuring the economic and social value of domestic work: Conceptual and methodological
framework” (Geneva, International Labour Office, 2011).
75
Douaa Mahmoud and May Gadallah, “Imputing monetary value to Egyptian females: unpaid domestic and care work”.
76
Nancy Folbre, “Valuing non-market work”.
70
This approach assumes that the worker has a job opportunity in the paid labour market and that compensation
is based on the worker’s qualification or possible paid employment instead of the type of work done. This
means that it uses different wages for the same activity when the work is performed by different people. For
example, the time spent cooking a meal by a university graduate has more value than the same time spent by
someone without formal schooling doing the same activity, even if that person is a better cook.
77
Replacement cost method – the “generalist” approach
This method assesses unpaid work based upon wages of housekeepers. One problem with this method
is that housekeepers do not perform all unpaid work and it may not be appropriate for assessing volunteer
work.
78
Time use surveys are considered very useful tools in this context since they provide detailed information
on how individuals spend their time on a daily or weekly basis with a combination of specificity and
comprehensiveness not achieved in any other type of surveys.
79
Well designed, standardized time use surveys
can provide a basis for international comparisons of time use.
Replacement cost method – the “specialist” approach
This method assesses unpaid work based upon wages paid to individuals performing similar activities
as are done in households. The value of unpaid work for a specific activity is equal to the compensation or
wage rate of a specialist engaged in this activity multiplied by the time spent on the activity. It has been
highlighted that this method is affected by a disparity in productivity between people engaged in unpaid work
and an occupation due to differences in economies of scale and in the capital equipment ratio.
80
The differences between the values from the different approaches become particularly big where there
are large inequalities in salaries in the economy. This is the situation in many countries.
81
Indirect cost estimate methods
Accounting
The total number of days of paid work or household chores lost due to DV (which is identified by
responses to a survey question) is multiplied by the mean daily earnings to find a monetary estimate of
lost earnings, whether this incapacitation is temporary (due to injury) or permanent (due to death or long-
term incapacitating injury). This approach was used in the 2003 Center for Disease Control (CDC) study
in which the mean daily earnings were calculated for the mean age of women affected by the various types
of DV (rape, physical assault or stalking). In the case of non-paid household chores, an imputed wage is
used. Women in the United States lost 10.1, 8.1 and 7.2 days of paid work, respectively, from stalking,
rape and physical assault. The number of days of household chores lost from these three types of DV was
even greater, at 12.7, 13.5 and 8.4 days respectively. Multiplying these days lost by market or imputed
wages yielded a wage loss of $1.7 billion in 1995; wages and productivity lost due to premature death
alone was $892 million.
82
77
Nancy Folbre, “Valuing non-market work”.
78
ECE/CES/GE.30/2006/SP/24.
79
Indira Hirway, “Time-use surveys in developing countries: an assessment”, Unpaid Work and the Economy (2010) pp. 252-324.
80
ECE/CES/GE.30/2006/SP/24.E.
81
Douaa Mahmoud and May Gadallah, “Imputing monetary value to Egyptian females: unpaid domestic and care work”.
82
CDC, “Costs of Intimate Partner Violence Against Women in the United States (2003).
71
Econometric
A second approach to calculating indirect costs of DV is to econometrically estimate the impact of DV
on women’s labour force participation and earnings. This approach, employed by Lloyd (1997)
83
and Farmer
and Tiefenthaler (2004)
84
for the United States and Morrison and Orlando (1999)
85
for Chile and Nicaragua,
requires microdata sets that contain standard labour force information on women’s participation, hours worked
and earnings, as well as detailed information on women’s experience of DV. A reduced form earnings equation
for women is estimated, including a selectivity correction for labour force participation. After estimating labour
force participation equations, Morrison and Orlando estimated earnings equations with standard explanatory
variables and various variables that measured the presence of DV and found that the presence of any kind of
DV—whether sexual, physical or psychological—is associated with a reduction in earnings between 34 per
cent and 46 per cent. One drawback of this approach is simultaneity between earnings and violence, which
makes it difficult to establish the causal relationship between the two. A method that previous studies have
used to overcome this issue is the instrumental variable approach, in which a variable that is related to violence
but not to earnings, such as number of times spouse arrives home intoxicated, is used to control for violence.
86
Propensity score matching
Propensity score matching (PSM) has been suggested as an alternative approach to overcome the
limitations of econometric regression analysis in general, and several of the complications associated with
instrumental variables, in particular by Morrison and Orlando. PSM is a non-parametric technique used to
estimate causal treatment effects and is useful for managing selection bias in observational studies. Selection
bias typically arises when a comparison group is not available. In experimental settings, individuals can be
randomised into two groups: those receiving the intervention (often called the treatment group) and those who
do not (often called the control group) which ensures a counterfactual exists.
Normally, the outcomes between the two groups would be observed to obtain a purely unbiased effect-
estimate. An early study by Sanchez and others (2004)
87
used propensity score matching to measure the impact
of DV in Colombia on a range of health and labour market outcomes. Based on a sample survey of over 2,000
women aged 15 to 49 in the cities of Bogota, Barranquilla and Barrancabermeja the study found that women
who experienced moderate violence would have earned approximately $60 more per month had they not been
so victimized, and that women who suffered severe violence would have earned more than $100 per month
more—this compared to mean monthly earnings for the entire sample of US $142.
83
Susan Lloyd, “The effects of domestic violence on women’s employment”, Law and Policy vol. 19; No. 2, 1997. Pp. 139-167.
84
Amy Farmer and Jill Tiefenthaler, “The employment effects of domestic violence”, Accounting for Worker Well-Being.
(Emerald, 2004). pp. 301–334.
85
Andrew Morrison and Maria Beatriz Orlando, “Social and economic costs of domestic violence: Chile and Nicaragua”, In
Too Close to Home, Andrew Morrison and Maria Loreto Biehl, eds. (Washington, D.C., Inter-American Development Bank, 1999).
pp. 51- 80.
86
Andrew Morrison and Maria Beatriz Orlando, “The costs and impacts of gender-based violence in developing countries:
methodological considerations and new evidence.” (Washington, D.C., The World Bank, 2004).
87
Rocio Ribero and Fabio Sánchez, “Determinantes, efectos y costos de la violencia intrafamiliar en Colombia” (Bogotá,
Universidad de los Andes, Centro de Estudios sobre Desarrollo Económico, 2004).
72
Annex 7
Sample household questionnaire
88
Case study of women in national shelter (Peace House in Hanoi)
The sample was 20 women who were in the National Shelter at the time. The age group was 18–49. The
sample included new entrants residing for last four months in the shelter (10), those who have returned for
second or third time (5) and those being supported in returning to home (5). When doing such a study, women
in the process of divorce, should be included in the sample.
The case study of those who had accessed Peace House was in narrative form, focusing on women’s
experiences of violence in the marriage. A useful framework to use is the four stages of help seeking –
(1) experienced violence but did not disclose or seek help, (2) disclosed to family and friends only, (3) disclosed
and sought help from formal services, and (4) moving to the recovery process. This can be combined with a
timeline of women’s lives, starting with their marriage.
The interview should begin with a general conversation with the woman covering basic demographic
information. It should then turn to her experience of violence in the marriage. A timeline marking when the
violence first occurred, tracing its escalation, and marking the point when she left, can be a useful tool (as below).
☐☐
Start first incident, second, ……………, until seeking shelter
Once the timeline is marked, the interview can focus on:
(1) The early incidents of violence: what happened, how did she feel, how did it affect her, why she
did not disclose or seek help?
(2) When did she first tell others: what happened, how did she feel, how did it affect her, why did she
tell others?
(3) When did she first seek formal help: what happened, how did she feel, how did it affect her?
(4) Then the interview can focus on getting information on incidents of violence leading to seeking
protection in the national shelter. The timeframe could be the incidents in the 12 months preceding
her stay in the shelter.
(5) Interview concludes with her recovery including current strategies and future plans.
It would be good to develop a mapping of help-seeking for each woman.
Domains of information to cover in the interview
Demographic
• Age, home residence, household – number, relationship, how long married, education (woman and
spouse);
• Employment profile (woman and spouse) – where, occupation, how many years, salary/wage;
• Children – how many, ages, what grade levels.
88
This is an international format that can be adapted to the Arab context.
73
Experience of Violence
• When it first occurred? How often? Type of violence – physical, sexual, emotional, financial control;
• Did you miss work? How often? On average, how many days?
• Would your husband miss work? How often? On average, how many days?
• If you worked at home, were you able to work? How often? How many days?
• Were you unable to do housework? How often? How many days?
Help-seeking
Health care
• Were you injured? How often? What type of injuries?
• Did you get health care? How many times did you visit a health facility? Was it a commune, district
or provincial facility?
• Do you have health insurance? What did you have to pay? How much did you spend? Doctor’s fees?
Laboratory tests? Medicines?
• Did you miss work for health care? Were you accompanied by anyone else? Did they miss work?
How many days?
• Did you have to travel to the health facility? What did you spend on transport?
• Were you admitted to the hospital? How many days? What were the charges for the hospital stay?
• Did relatives or friends take care of you? Did they have to stay in a hotel? What costs did they incur?
Police
• Did you seek help from police? How many times? Did you go to the local/District/Provincial police
station?
• Did you have to pay any fees?
• Did you miss work? How many days?
• Did a relative or friend accompany you? Did they miss work? How many days?
• Did they have to spend money on transport? How much? Did you have to spend money on meals?
How much?
• Did you have to go back to the police station for follow-up? How many times?
• Was your husband/partner arrested? Was there a criminal trial? How many days did it take? Did you
have to pay lawyer’s fees? What other charges did you have to pay? Did you have to pay for bail?
Did you have to pay for other fees? How much?
Legal Aid
• Did you go to a local legal aid committee? District level? Provincial? How many times?
• What costs did you incur – fees, transport, meals, lodging? Did you miss work? Did a relative or
friend accompany you? Did they miss work?
74
Shelter
• Did you, at any time, leave the house after an incident of violence? How many times?
• Where did you go? Did you stay with friends, shelter, lodging?
• What expenses did you incur – fees, transport, meals? If with a relative or friends, what costs did
they incur?
• Did you miss work? How many days? Did they miss work? How many days?
• Did you take your children? Did they miss school? How many days?
Judicial System
• Did you file for divorce? Was violence the grounds for the divorce?
• How long did the process take?
• What costs did you incur – fees, transport, lodging, meals?
• Were you able to work? How many days?
• What happened to your children? Who looked after them? What costs did you incur?
Recovery Process
• What are you doing now?
• Did you have to relocate? What expenses did you incur?
• Did you have to re-establish the household? Did you have to replace property, other equipment?
• What job do you have? Is it similar to your previous job? Is the salary lower/same/higher?
• Did you enroll in any training programmes? How much did it cost?
Children
• What has bs the impact on children? Do they have health problems? How often have you taken them
to a health facility? What is the cost? Do they have anxiety/stress? Are they in school? Did they miss
or fail exams?
The information for incidents in the last 12 months can be collected in the following tabular format (the
interviewer does not have to read out list but should circle as appropriate). This helps organize the information
collected in the qualitative interview.
75
904
(a) You say
there have been
incidences
where your
husband/partner
has hurt you or
threatened to
hurt you. How
many
incidences of
this nature do
you remember
in the last 12
months?
(b) What happened in the
last of these incidents?
DO NOT READ FROM
THE LIST, MATCH
RESPONDENT’S
ANSWER TO ALL
OPTIONS THAT APPLY
BELOW
(c) Did you have
any injuries after
this incident?
Mark whatever
applicable
DO NOT READ
FROM THE
LIST, MATCH
RESPONDENT’S
ANSWER TO
ALL OPTIONS
THAT APPLY
BELOW
YES
NO
1
2
(d) Did you receive
health care after this
incident?
YES
NO 1 2
(e) Did you
have to take
time off from
work after this
incident?
YES
NO
1
2
INCIDENCE 1
Insulted her or made her
feel bad about
herself..……………A
Belittled or humiliated her
in front of other
people….……….B
Did things to scare or
Intimidate her on
purpose……………C
Threatened to hurt her
or someone she cares
about……….D
Slapped
her………………………E
Thrown something that
could hurt
her………………………F
Pushed or shoved
her…………….G
Hit with his fist or with
something else that could
hurt……H
Kicked, dragged or beaten
up……..I
Choked or burned on
purpose…….J
Threatened to use or
actually used a gun, knife
or other
weapon…………………..K
Had sex when did not
want………..L
Force her to do something
sexual that she found
If YES, Did you
sustain any of
the following
injuries after the
incident?
Y N
A. CUTS ,
PUNCTURES
BITES
1 2
B. SCRATCH,
ABRASION,
BRUISES
1 2
C. SPRAINS,
DISLOCATIONS
1 2
D. BURNS
1 2
E.
PENETRATING
INJURY,
DEEP CUTS,
GASHES
1 2
F. BROKEN
EARDRUM,
EYE INJURY
1 2
G. FRACTURED,
BROKEN
BONES
1 2
H. BROKEN
TEETH
1 2
If YES,
A) Did you go to a
Y N
HOSPITAL
1 2
HEALTH
CLINIC
1 2
DENTIST
1 2
TRADITIONAL
HEALER
1 2
OTHER
_____________96
(SPECIFY)
B) How much money
did you have to
spend?
A. SERVICE
________
B. TRANSPORT
________
C. MEDICINE
_________
(A) If YES,
how many
days did you
have to take
off because of
this incident?
(B) Did you
get paid for the
days you had
to take off
from work?
YES….. ……1
NO………….2
(C) How many
days were you
paid for out of
all the days
you missed
work?
76
degrading or
humiliating………….M
Had sexual intercourse
because she was afraid of
what
he might
do……………………….N
Physically forced her to
have sexual intercourse
when she did not want
to…………O
I. OTHER
_______________
96
(SPECIFY)
INCIDENT 2
INCIDENT 3
904 (Cont)
(f) Did you have to stop
housework after this incident?
IF c IS INDICATED ASK G
OTHERWISE SKIP TO h
YES NO
1 2
How many days?
(g) You said you could not take
care of the children, were they fed
by someone else, fed themselves?
– IF HAVE CHILDREN
YOUNGER THAN 5
YES NO
1 2
(h) Did any of
your children
have to miss
school after
this incident?
IF CHILDREN
IN SCHOOL
YES
NO
1
2
(i) Did you
husband/partner
have to take time
off from work
after
this incident?
YES NO
1 2
INCIDENCE 1
IF YES, what are the types of
work you had to forego?
A. FETCHING WATER
B. FETCHING FIREWOOD
C. CARING FOR CHILDREN
D. IRONING
E. WASHING CLOTHES
F. SWEEPING
G. WASHING DISHES
H. WASHING VEHICLES
I. DISPOSE GARBAGE
J. COOKING
K. CARING FOR SICK
L. SHOPPING/HOUSEHOLD
NEEDS
FED BY SOMEONE
ELSE……………………….1
FED THEMSELVES………2
WENT HUNGRY………….3
IF YES,
A. How many
school days did
they miss?
If YES,
A. How many
days did he have
to take off because
of this incident?
B. Did he get paid
for the days you
had to take off
from work
YES….. ……1
NO………….2
C. How many
days was he paid
for out of all the
days you missed
work?
77
M. RUNNING ERRANDS
N. OTHER HOUSEWORK
INCIDENCE 2
INCIDENCE 3
904 (Cont)
(j) Did your husband/partner have
to stop or reduce the work he
usually does around the house?
YES NO
1 2
(k) Did you go
to the police
after this
incidence?
YES
NO
1
2
(l) Did you
have to pay
them any
money?
YES
NO
1
2
(m) Did you
leave the house
after this
incidence?
YES
NO
1 2
(n) Did you file a
formal complaint
after this incident?
YES NO
1 2
INCIDENCE
1
IF YES, what are the types of work
he had to forego?
A. FETCHING WATER
B. FETCHING FIREWOOD
C. CARING FOR CHILDREN
D. IRONING
E. WASHING CLOTHES
F. SWEEPING
G. WASHING DISHES
H. WASHING VEHICLES
I. DISPOSE GARBAGE
J. COOKING
K. CARING FOR SICK
L. SHOPPING/HOUSEHOLD
NEEDS
M. RUNNING ERRANDS
N. OTHER HOUSEWORK
IF YES,
A. Did you
pay for
transport? If
YES how
much did you
pay?
TRANSPORT
____________
If YES,
A. How much
did you pay?
If YES,
A. Where did
you go?
Y N
SHELTER
1 2
FAMILY
1 2
FRIEND
1 2
Other
_______ 96
(SPECIFY)
B. How many
days did you
spend there?
DAYS
C. Did you have
to pay any
money to stay
there? If YES,
how much did
you have to pay
per day?
DAILY RATE
________
If YES,
A. Did you have
to pay any fees?
YES….. ……1
NO………….2
B. How much did
you pay?
A. FILING COST
_______________
B. TRANSPORT
_______________
78
INCIDENCE 2
INCIDENCE 3
904 (Cont)
(o) Did the
complaint go to
court
Y
N
1
2
(p) Did you go to
any other
authorities in the
community after
this incident?
Y
N
1
2
(q) We have talked about various
fees and other costs you had to
bear. Did you for all these fees out
of your own pocket? Did your
husband/partner pay for some of
them? Did your family pay for
some of them? ASK IF ANY
COSTS ARE MENTIONED
(r) I know that these are difficult
experiences to deal with? Did
you feel any of the following
because of this incident?
INCIDENCE
1
If YES, did you
pay any court,
lawyer fees
A. COURT
_______
B. LAWYER
_______
C.
TRANSPORT
_____
Were there any
costs to this
action?
A. FEES
___________
B. TRANSPORT
_________
SELF …………………………1
HUSBAND……………………2
NATAL FAMILY……………..3
SELF AND HUSBAND………..4
SELF AND NATAL
FAMILY ………….5
SELF/NATAL
FAMILY/HUSBAND…………...6
Y N
A. YOUR DAILY WORK
SUFFERED
………………………….. 1
2
B. FELT UNABLE TO PLAY
A USEFUL PART IN
LIFE………… 1 2
C. FOUND IT DIFFICULT
TO ENJOY DAILY
ACTIVITIES…. 1 2
D. HAD THE THOUGHT
OF ENDING YOUR
LIFE…………. 1 2
INCIDENCE
2
INCIDENCE
3
79
Annex 8
List of participants in the expert group meeting
• Aslihan Kes, International Centre for Research on Women (ICRW), USA.
• Elizabeth Villagomez, Researcher and Consultant, Spain.
• Nicole Farnsworth, Kosovo Women’s Network, Kosovo.
• Philippa Olive, University of Central Lancashire, United Kingdom.
• Karin Helweg-Larsen, University of Copenhagen, Denmark.
• Mathilde Sengoelge, More Safety Consulting, France.
• Olga Kalashnyk, La Strada, Ukraine.
• May Gadallah, Cairo University, Egypt.
• Caroline Forde, National University of Ireland, Galway.
• David Walker, ITAD, United Kingdom.
• Bassam Dar Abou Rabih, Ministry of Women Affairs, Palestine.
• Naglaa El-Adly, National Council for Women, Egypt.
• Lana Saeed, Family Affairs Council, Kingdom of Saudi Arabia.
• Enshrah Ahmed, UNFPA Regional Office, Egypt.
• Germaine Haddad, UNFPA Regional Office, Egypt.
• Manal Benkirane, UN Women Regional Office, Egypt.
• Mehrinaz El Awady, ESCWA.
• Nada Darwazeh, ESCWA.
• Sukaina Al-Nasrawi, ESCWA.
• Hala Attieh, ESCWA.
80
Annex 9
Questions on costing DV
You mentioned that you had previously been subjected to violence by your husband. Did that violence result
in you suffering from psychological problems over the past 12 months? For those who responded 1-4 to
question WA in section B.
Did the violence perpetrated by your husband against you result in psychological problems?
WY0
1. Yes 2. No
WY: You mentioned that you had previously been subjected to violence by your husband. Did that violence
result in physical injury over the past 12 months? For those who responded 1-4 to question WA in section B.
Did the violence perpetrated by your husband against you result in physical injury?
WY
1. Yes 2. No (go to LB01)
LA: Please specify what type of injury you sustained as a result of violence perpetrated by your husband
over the past 12 months.
B
Type of injury
No. VI
Over the past 12
months
2. No
1. Yes
Scratch, abrasion or bruising
LA01
Sprain, dislocation
LA02
Burns or bite marks
LA03
Cut or deep wound
LA04
Burst ear drum
LA05
Eye injury
LA06
Fractures or broken bones
LA07
Broken teeth
LA08
Internal injuries (fractures or haemorrhage)
LA09
Other (please specify)
LA10
81
LB01: Need for medical attentions or health care as a result of violence perpetrated against you by your
husband over the past 12 months.
Over the past 12 months
Indicator
No. VII
3. No, go
to section
LD1
2. Yes, I did not
receive medical
care LD1
1. Yes, I
received
medical care
Over the past 12 months, have you required
medical attention or health services?
LB01. VIII
LC: The type of health care received as a result of the violence perpetrated against you by your husband.
Over the past 12 months
Services
Number
D: How much did
you pay? (total
acts of violence)
in Israeli shekel
C: How much did
you pay? (last act
of violence) in
Israeli shekel
A: Did you pay for the
service?
1. Yes
2. No (go to the next
item)
3. No medical services
were needed (go to the
next item)
Doctor, nurse, pharmacist or
technician
LC01
Hospital, clinic, health centre fees
(excluding overnight)
LC02
Hospital overnight fees
LC03
No. of days
No. of days
Number of days spent in hospital
LC04
Transport costs, including
chaperone
LC05
Tests (X-rays, laboratory, etc.).
LC06
Medicines and treatment
LC07
Alternative medical treatment
(Arabic medicine, herbal medicine,
etc.).
LC08
Other expenses related to health
care (food, drink, etc.), including
chaperones
LC09
Medical Consultation
(psychiatrists, counsellor, other
consultations).
LC10
Other medical or health reports
LC11
82
LD1: Need for legal services and consultations as a result of the violence perpetrated against you by
your husband
Over the past 12 months
Indicator
No. XX
3. No, I did
not receive
legal
assistance
2. Yes, I
did not
receive
legal
assistance
(go to
section
LD3)
1. Yes, I
received legal
assistance
Over the past 12 months, did you require legal
services/consultations?
LD1. XXI
LD2: Legal services and consultations as a result of the violence perpetrated against you by your
husband.
D. How much did
you pay? (total
acts of violence)
In Israeli shekel
C. How much
did you pay?
(last act of
violence?)
In Israeli
shekel
A. Did you
pay for the
service?
Legal services
LD2. XXII
1. Yes
2. No (go to
next item)
3. I did not
require legal
services (go
to next item)
Lawyer fees
LD2-1
Court and case fees
LD2-2
Consultations (visiting a legal
consultation centre)
LD2-3
Reports or other fees (police,
lawyer, etc.)
LD2-4
Other costs (transport,
communications, food, etc.)
LD2-5
Online legal consultations
LD2-6
• Determined in Israeli shekels according to the exchange rate provided to researchers, and is converted from any currency
mentioned
83
LD3: Other financial costs over the past 12 months?
D: How much did
you pay? (all acts of
violence) In Israeli
shekel
C: How much
did you pay?
(last act of
violence)
In Israeli
shekel
A: Did you pay any
other costs?
Costs
LD3
1
. Yes
2. No (go to the next
item)
3. Not applicable (go
to the next item)
Transport to parents’
house or other
destinations because
you left your house or
the place where the
violence occurred
LD3-1
Telephone and mobile
bills
LD3-2
Other costs (food,
drinks, rent, hotel bills,
etc)
LD3-3
LN: You have noted the costs paid by you for medical and legal services, among others. Did you pay those costs alone or did
someone help you over the past 12 months? If you answered ‘yes’ to any of the above sections (LC, LD1, LD2, LD3), please complete
the present section.
1. Yes
2. No
4. Did you pay those costs alone or did someone help you over the past 12
months?
Number
5. I bore them alone
LN01
6. I bore them with my husband
LN02
7. I bore them with my husband’s parents
LN03
8. I bore them with my husband and his parents
LN04
9. I bore them with my husband and parents
LN05
10. I bore them with my parents
LN06
11. My husband bore them
LN07
12. My husband’s parents bore them
LN08
13. My husband and his parents bore them
LN09
14. My husband and my parents bore them
LN10
15. My parents bore them
LN11
16. Insurance
LN12
17. Other (please specify)
LN13
84
LK: Over the past 12 months, your house might have sustained some damage as a result of the violence.
Did this happen?
B
Items
No.
Over the past 12 months
C. What was the
cost of replacing
or fixing the items,
or the estimated
cost of damage? In
Israeli shekel
B. Did you replace or fix
the damages items?
A. Was your property
damaged?
1. Yes
2. No
1. Yes.
2. No (go to the next item)
Not applicable (go to the
next item)
Dishes, utensils and
tableware
10 LK
Electronic devices (mobile,
remote, table, laptop)
02LK
Electrical tools
03LK
Car
04LK
Bicycle/children’s toys
05LK
Ornaments/clocks
06LK
Carpets
07LK
Clothes
08LK
Furniture
09LK
Other (please specify)
10LK
LH: Your children’s absence from school because of violence.
B
As a result of the violence perpetrated against you
by your husband, did your children have to miss
school or university over the past 12 months?
Number
Over the past 12 months
BC
BB
BA
No. of days
of absence
No. of
boys/girls
1. Yes
2. No
3. Not applicable (if
the answer is 2 or 3,
go to the next item)
Children missed school
1LH0
Children missed university
02LH
LFF: Going to work over the past 12 months.
2. No, go to
LF09
1. Yes
No.
Have you worked at all over the past 12 months?
LFF
85
LF: As a result of violence perpetrated by your husband or in your place of work or study, over the
past 12 months.
B
When did violence affect your work or studies?
Number
Over the past 12 months
BB
BA
No. of days
1. Yes
2. No
3. Not
applicable (if
answered 2 or
3. go to the next
item)
Was your work affected, leading to a drop in
productivity of quality?
10 LF
Your husband interrupted your work (constant
calls, threats, coming to your place of work, etc.)
02 LF
Inability to focus
03 LF
Loss of self-confidence
04 LF
Obliged to change your route or mode of transport
for fear of going to work
05 LF
Paid absence from paid work
06 LF
Unpaid absence from paid work
07 LF
Absence from unpaid work (family cares, etc.)
08 LF
Absence from school or university
09 LF
LFW: Affects on the husband’s work because of violence he has perpetrated against his wife
B
In which of the situations below was your husband’s work affected by
his violence against you?
Number
Over the past 12 months
BB
BA
No. of days
1. Yes
2. No
3. Not
applicable
(if answered
2 or 3, go to
next item)
Was your husband’s work negatively affected over the past 12 months?
LFW1
Paid absence from work
LFW2
Unpaid absence from paid work
LFW3
Absence from unpaid work (family work)
LFW4
86
LQ: The impact of violence against you by your husband on you and your husband in completing
household chores over the past 12 months
B
Did the violence perpetrated against you by your husband
affect your or your husband’s ability to complete household
chores?
Number
Over the past 12 months
2. No (if you
answered ‘no’ to
LQ1+LQ2, go to
WD)
1. Yes
Wife
LQ01
Husband
2 LQ0
LR: Did the violence perpetrated against you by your husband affect your or your husband’s ability to
complete household chores over the past 12 months?
Over the past 12 months
Did the violence perpetrated against you by
your husband affect your or your husband’s
ability to complete household chores over the
past 12 months?
Number
Husband
Wife
BA
CA
BB
CB
No. of
days
1
. Yes
2. No
3. Not
applicable (if
you answered 2
or 3, go to the
next item)
No. of
days
1
. Yes
2. No
3. Not
applicable (if
you answered
2 or 3, go to
CA)
Childcare (carrying, feeding/breastfeeding,
bathing, changing, preparing them for
school, health/medical care, taking them to
school or university)
LR01
Caring for older persons (personal care,
medical care, accompanying them to
medical/health services, preparing food)
LR02
Teaching children (reading, help with
schoolwork)
LR03
Household chores (preparing meals,
cleaning, sweeping, laundry, tidying, dusting,
window cleaning, washing floors, taking out
the trash)
LR04
Shopping for the household (buying food,
medical supplies, school supplies, petrol,
clothes, household devices and furniture)
LR05
Other household tasks (cleaning the garage
or courtyard, clearing leaves)
LR06
Social activities (welcoming guests, visiting
friends and family, going to weddings and
funerals)
LR07
19-00070
