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Economic Costs of Domestic Violence: A Community Study in South Africa

Economic Costs of Domestic Violence: A Community Study in South Africa



The present study estimated economic costs...

The present study estimated economic costs
of domestic violence against women who sou-­
ght help from a community care centre in South
Africa. It aimed to relate the victims’ income and
victims’ family income to violence related inju-­
ries and related costs. This was a cross sectional
study with face-­to-­face interviews in a community
care center in which victims of domestic violence
sought various kinds of assistance. In total, 261
women were interviewed.



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    Economic Costs of Domestic Violence: A Community Study in South Africa Economic Costs of Domestic Violence: A Community Study in South Africa Document Transcript

    • HealthMED  -­  Volume  5  /  Number  6  -­  Suppl.  1  /  2011Koustuv  Dalal1,  Suraya  Dawad212 particularly   in   low-­income   countries,   should   be   a  prioritized  task  in  the  policy-­making  process3,6.     The   present   study   estimated   economic   costs   In   addition,   health   economists   have   strongly   ad-­of   domestic   violence   against   women   who   sou-­ vocated  for  methodological  improvements  in  the  ght  help  from  a  community  care  centre  in  South   cost   calculation   of   violence,   particular   in   low-­Africa.  It  aimed  to  relate  the  victims’  income  and   income  countries3,  7.  Furthermore,  WHO’s  multi-­victims’   family   income   to   violence   related   inju-­ country   study   advocates   for   more   studies   due   to  ries  and  related  costs.  This  was  a  cross  sectional   the  gaps  in  research  on  violence  against  women,  study  with  face-­to-­face  interviews  in  a  community   particularly  in  relation  to  intimate  partner  violence  care  center  in  which  victims  of  domestic  violence   in  developing  countries8.    sought   various   kinds   of   assistance.   In   total,   261   Stopping   violence   against   women   is   a   social  women  were  interviewed.  The  average  economic   responsibility  and  not  doing  this  is  a  violation  of  cost  of  each  domestic  violence  incidence  was  691   women’s  human  rights9.    Societies  are  obligated  to  USD  while  average  cost  for  medical  expenditure   provide  protection  of  their  women  and  to  provide  was   29   USD   and   average   loss   of   income   due   to   counseling  for  them10.    Furthermore,  societies  are   -­ expected  to  provide  police  servcies,  as  well  as  ju-­es  and  higher  individual  and  family  incomes  were   stice  systems  for  these  women11.    protective  factors  for  severity  of  violence  related   Domestic   violence   results   in   different   physi-­injuries.  Pain  and  discomfort  due  to  domestic  vio-­ cal   and   psychological   health   problems.   A   high  lence  emerged  as  expensive  for  both  medical  costs   number  of  physically  abused  women  have  injuries  and  productivity  losses.  Considering  the  average   -­monthly  income  of  482  USD,  domestic  violence   ing  bruises,  wounds,  pelvic  pain,  back  pain,  head-­averaged  a  cost  per  incident  of  691  USD  during   aches  and  fractured  bones12  -­14.  Physically  abused   -­ reproductively   active   women   also   encounter   gy-­hold   budget.     We   found   that   domestic   violence   naecological  problems  including  terminated  preg-­against   women   resulted   with   expensive   injuries,   nancies,  low-­weight  babies,  peri-­natal  deaths  and  pain  and  discomforts. sexually  transmitted  diseases  such  as  HIV/AIDS    economic  costs,  violence  against   8,  13,  15  -­17 .    Psychological  consequences  of  women  women,  IDDO  model,  South  Africa. victims  of  domestic  violence  are  depression,  anxi-­ ety,   low   self-­esteem,   fear   of   intimacy   and   post-­ traumatic  stress  disorder   12,  13,  18,  19.  Besides  physi-­ Introduction cal  and  psychological  problems,  female  victims  of   violence   exhibit   risk-­taking   behaviours   like   un-­ Violence   is   one   of   the   most   expensive   public   healthy  feeding  habits,  substance  abuse,  alcohol-­health  problems  globally  1  –  5 -­ ism   and   even   suicidal   behaviours12,   19,   20.  Abused  come  countries  account  for  more  than  90%  of  vio-­ women  also  use  higher  proportion  of  community  lence   related   health   and   socioeconomic   burden6.     and  healthcare  services4,  12,  19.  However  few  stud-­The   WHO   and   others   have   indicated   that   cost   ies  have  examined  the  economic  consequences  of  calculation   and   economic   analysis   of   violence,   domestic  violence3,  6,  8,  21.  Journal  of  Society  for  development  in  new  net  environment  in  B&H 1931
    • HealthMED  -­  Volume  5  /  Number  6  -­  Suppl.  1  /  2011 In   South   Africa,   a   ‘culture   of   violence’   is   a   th  Africa.  It  also  aimed  to  relate  the  victims’  inco-­strong   pervasive   feature   of   post-­apartheid   lega-­ me  and  victims’  family  income  to  violence  related  cy,  which  often  induce  violence  against  women22.     injuries  and  related  costs.      Studies   suggest   that   there   are   relatively   high   le-­vels  of  acceptance  of  domestic  violence  in  South  Africa23.   One   in   every   four   women   has   experi-­enced  physical  violence  at  some  stage  in  her  life24.    Those  subjected  to  violence,  particularly  violence   This  was  a  cross-­sectional  study  that  was  un-­against   women,   are   often   afraid   to   report   this   to  legal  authorities  or  friends  and  family  because  of   Africa.    For  this  study,  only  related  costs  and  inju-­fear  of  social  stigma  and  the  wide  level  of  social   ries  due  to  violence  against  women  were  conside-­acceptance  of  violence4,  25.  Domestic  violence  and   red  in  the  current  study.  The  study  was  conducted  gender-­based   violence   aimed   at   women   is   high   during  August  –  October  2008.across  all  economic  and  racial  groupings26.   Several   studies   have   reported   on   risk   factors   Study  Areaand   social   consequences   of   domestic   violence1-­5,   Chatsworth  is  a  large  township  within  the  Dur-­27-­  29 .  However,  less  information  is  available  on  the   ban  Metropolitan  area,  which  was  created  during  economic  costs  of  domestic  violence  against  wo-­ the   apartheid   regime,   as   an   area   for   housing   pe-­men,  though  policy  makers  may  be  better  convin-­ ople  of  ‘Indian’  population.    It  remains  predomi-­ced  by  monetary  values  for  adopting  preventative   nantly  inhabited  by  the  Indian  population,  and  in-­strategies3,   4.   In   particular,   knowledge   is   lacking   formal  settlements  in  and  around  Chatsworth  pro-­about  the  cost  of  domestic  violence  in  relation  to   vide   housing   for   refugees   and   other   black   urban  injuries.    Yodanis  and  his  colleagues  argue  that  the   populations.    The  total  population  of  Chatsworth  cost  for  acts  of  physical,  sexual,  and  psychologi-­ is  approximately  750  000.cal  abuse  against  women  and  children  falls  on  the  victims,  their  friends,  relatives,  and  employers   9.     Chatsworth  Community  Care  CentreFurthermore,  governments  also  “incur”  expenses   In   2002   the   Institute   for   Security   Studies   pu-­in  terms  of  their  justice  and  legal  systems,  medical   blished   Violence   Against   Women,   exploring  and  social  systems,  refuge  and  support,  re-­housing   women’s  experiences  of  gender-­based  violence  in  and  public  assistance9,  1.     South  Africa   26.  This  highlighted  the  limited  sup-­ Several  studies  have  indicated  that  identifying   port  women  received  from  police,  government  de-­the  victims  of  domestic  violence,  especially  in  the   partments  and  the  healthcare  sector  and  the  crucial  developing  countries  is  a  methodological  problem   in  providing  counseling  and  support  for  survivors  violence2  -­4.  Furthermore,  the  victims  of  domestic   of   domestic   violence   26.   Chatsworth   Community  violence  in  the  developing  countries  are  reluctant   -­to  disclose  the  information  regarding  their  victimi-­ vides  counseling  and  a  wide  range  of  support  for  zation  in  absence  of  regular  screening  at  the  health   victims  of  domestic  violence  in  Chatsworth  30.  care  facilities3.  The  Chatsworth  Community  Care   -­ Study  populationded  the  unique  opportunity  to  study  the  victims  of   In  absence  of  registry  data  a  complete  list  of  wo-­domestic   violence.   CCCC   is   the   only   communi-­ men  who  have  been  victims  domestic  violence  is  ty  care  centre  at  the  big  community,  Chatsworth,   unavailable  in  South  Africa.  All  female  victims  of  providing  services  to  the  victim  women  for  more   domestic  violence  who  visited  CCCC  for  rendering  than  a  decade  and  is  well  acquainted  with  the  trust   any  sort  of  service  constituted  the  study  population.  of  the  women  regarding  their  private  issues30.     Average  number  of  women  who  sought  assistance   This  current  study  aimed  to  estimate  economic   from   CCCC   per   month   is   between   500   and   550.    costs   of   domestic   violence   against   women   who   We  used  the  WHO  guidelines  and  terminologies  to  sought  help  from  a  community  care  centre  in  Sou-­ 2 .  1932 Journal  of  Society  for  development  in  new  net  environment  in  B&H
    • HealthMED  -­  Volume  5  /  Number  6  -­  Suppl.  1  /  2011 Sampling  technique -­ To  identify  their  economic  losses  and  severity  of  injuries  as  a  result  of  domestic  violence,  victims   Injured  and  visited  medical  doctor  and  admitted  to  who   sought   the   services   of   CCCC   were   intervi-­ewed.     Every   second   female   victim   who   visited   did  not  visit  medical  doctor.CCCC  was  selected  for  the  study  and  interviewed   In   South  Africa   the   education   system   has   the   following  grades:  No  education,  Primary  educati-­ Research  Instruments -­ Structured   pre-­tested   questionnaires   with   clo-­se-­ended   questions   were   administered   by   CCCC  volunteers.   Questions   were   asked   regarding   vic-­ Cost  calculationstims’  age,  education,  number  of  family  members,   As  the  study  consisted  of  a  sample  of  women  income,  severity  of  injuries,  expenditure  for  trea-­ who   had   experienced   domestic   violence,   the   co-­tment,  victims/relative’s  loss  of  income  due  to  the   sts  accounted  for  here  were  based  on  their  injury   severity,   pain   and   discomfort.   For   each   category  costs.  Questions  were  asked  about  family  income,   the   victims   were   asked   about   the   amount   spent  mode  of  income  and  family  economic  issues.  Se-­ for  treatment  and  related  loss  of  income.  As  South   -­ Africa  has  no  registry  system  like  the  Scandinavi-­ -­ an  countries,  the  authors  had  to  rely  on  self  repor-­ ted   information.   The   counselors   of   CCCC   were  and  visited  medical  doctor  or  hospital  emergency   regarded   as   trustworthy   in   the   eyes   of   victims   -­ who  sought  assistance  for  handling  such  personal  mitted  to  hospital2.  However  in  absence  of  health   information  for  more  than  a  decade30.  Therefore,  care  set  up  including  trained  nurses  and  physici-­ maximum  disclosure  of  fact  by  the  victim    was  hi-­ans,  we  had  relied  on  victim’s  report  on  injuries,   ghly  expected.  pain  and  discomfort  and  could  not  use  established   According  to  researchers,  there  different  met-­ hodologies  are  use    to  measure  direct  and  indirect  to   measure   injuries.  The   questionnaire   regarding   costs:   proportionality,   econometric   and   accoun-­economic  elements  was  validated  and  used  in  pu-­ ting3,  32.    The  current  study  employed  accounting  blished  literatures3,  31.   methods   for   estimating   the   costs3.   The   average   -­ Data  collection  procedures mestic  violence  incidence. Data  were  collected  by  the  volunteers  at  CCCC   Cost  elements  in  the  study  were  for  previous  30  over   a   period   of   3   months   (August   –   October   days  from  the  date  of  interview.  All  the  monetary  and  counseling  to  the  victims  of  domestic  violen-­ce  at  CCCC  for  the  previous  10  years.  They  were  further  trained  to  administer  the  questionnaire  and   Statistical  analysisconducting  the  face-­to-­face  interviews.     Health  economic  analysis  of  violence  and  inju-­ ries  had  not  developed  many  instruments  to  mea-­ Variables  of  interest sure  the  costs.  Most  commonly  used  instrument  is   The  following  variables  were  used:    age  group,  education,  number  of  family  members,  victims  in-­ suggest   that   no   amount   of   statistical   analysis   is  come,  family  income,  mode  of  income,  per  capita   probably   able   to   compensate   for   poor   quality   of  family   income,   total   medical   costs,   income   loss   cost  data  presented  in  simple  statistics33,  34.  There-­due  to  victimization  of  domestic  violence. fore  for  cost  estimation  we  mainly  used  arithmetic   Severity   of   injury   due   to   domestic   violence   mean,   mode   and   standard   deviation.   After   esti-­ mating  the  cost  elements,  the  study  grouped  them  Journal  of  Society  for  development  in  new  net  environment  in  B&H 1933
    • HealthMED  -­  Volume  5  /  Number  6  -­  Suppl.  1  /  2011according  the  quartile  distribution  for  better  stati-­ Every  measure  was  put  in-­place  to  make  certain  stical  analysis.     that  respondents  granted  us  informed  consent  be-­ fore  being  interviewed.  Verbal  consent  was  obta-­performed   to   examine   the   relationship   between   ined   from   the   respondents.     Due   to   literacy   pro-­severity  of  injuries  due  to  violence  and  demograp-­ blem  we  could  not  seek  written  consent  from  the  hic  and  economic  variables. respondents.  In  all  cases,  autonomy,  privacy  and   A  pie-­diagram  was  used  to  represent  the  sour-­ rights  of  withdrawal  were  maintained.    CCCC  was  ces  of  money  for  treatment  of  victims  of  violence. involved  in  all  aspects  of  arranging  and  managing   SPSS  version  18  was  used  for  statistical  anal-­ interviews   and   was   available   to   provide   counse-­ysis. ling  to  any  of  those  interviewees  who  required  it.   Ethical  permission The  study  received  ethical  permission  from  the  Human  and  Social  Sciences  Ethics  Committee  of   Among  the  261  respondents,  44%  of  the  wo-­the  research  adhered  to  the  strict  guidelines  set  out   men  had  minor  injuries  (injured  but  did  not  visit  for  research  into  domestic  violence  by  the  World   -­Health  Organization35. red   and   visited   medical   doctor   and/or   hospital  Table.  1.    Demographics  of  violence  related  injuries,  pain  and  discomforts -­ -­ tor  and  admitted  to   medical  doctor Age  group                             57 29 7 12 8 6 47 21 13 55 28 6 34 29 21 45 30 18 70 20 40 20 10 25 25 13 37 37 13 Total      =  261 Education                                 52 13 13 30 44 13 43 29 13 25 50 Total  =  261 No.  of  family  members   13 11 13 34 34 38 31 34 33 16 16 12    6    5    4 Total  =    2221934 Journal  of  Society  for  development  in  new  net  environment  in  B&H
    • HealthMED  -­  Volume  5  /  Number  6  -­  Suppl.  1  /  2011 -­and  17%  had  pain  and  discomfort  due  to  violence.   The   average   cost   per   incidence   for   visiting   Women   with   no   education   suffered   the   most   -­ primary   education   suffered   most   from   moderate   -­tal  medical  expenditure  per  incidence  was  28.89   most  from  violence  related  pain  and  discomforts.  income   due   to   victimization   of   domestic   violen-­ four  members’  in  their  families.   More   than   70%   of   women   responded   about  the  total  cost  of  domestic  violence  incidence  was   their  family  income  and  almost  58%  provided  res-­ ponses  about  their  personal  income.  Respondents’   Women   in   their   thirties   were   most   affected   monthly  average  income  was  481.64  USD  (3400  by   domestic   violence   (Mean  Age   =   35.58,   SD   =  are  concerned,  women  in  their  late  forties  (45  -­49   mode  average  monthly  income  was  133.16  USD   -­ -­ pita  family  income  (=  total  family  income/  number  Table  2.    Victims  individual  and  family  income  per  month  and  injury  victimization   medical  doctor -­ doctor  and  admi-­ medical  doctor Victims  income  pm                  p=0.04 41 37 45 49 27 26 34 27 10 26 7 11 22 11 14 13 Family  income  pm              p=  0.02 46 40 49 44 26 29 28 30 3 14 10 10 25 17 13 16 Mode  of  income                        p=  0.04 48 40 27 40 22 30 28 15 16 13 8 30 14 17 17 15 Per  capita  family  income      p=0.08 50 36 50 44 26 29 24 28 7 13 9 11 17 22 17 17Journal  of  Society  for  development  in  new  net  environment  in  B&H 1935
    • HealthMED  -­  Volume  5  /  Number  6  -­  Suppl.  1  /  2011 for  physicans,  30%  on  purchasing  medicines,  7%   on   medical   investigations   such   as   x-­rays,   blood   -­ tests,  24%  on  transport  to  visit  medical  facilities.  gher  family  size  had  proportionally  less  exposure   The  majority  of  the  victims  had  spent  up  to  16.85  to  violence  related  injuries,  pain  and  discomforts.   The   lower   was   the   income,   higher   was   the   -­ high   enough   with   an   average   loss   of   income   of  portional  inverse  relation  between  family  income  and  injury  and  utilization  of  medical  facilities  was  observed.  Women  who  were  sole  providers  in  the   Among   the   respondents,   150   women   had   some  family  were  affected  the  most  in  terms  of  violence.     With  regards  to  medical  costs  that  victims  had   Table  3  indicates  that  54  –  92%  of  female  victims  to  pay  themselves,  the  average,    was    28.89USD  (   -­ Women  from  higher  income  groups  had  spent   proportionally  more  for  higher  amount  of  medical  the  victims  of  domestic  violence  paid  (out  of  poc-­ women   from   higher   average   family   income   had  Table  3.    Relationship  between  economic  losses  and  injury  severities   medical  doctor doctor  and admitted  to medical  doctor Total  medical  costs                  p=  0.00 27 82 63 24 46 6 14 47 16 3 0 13 11 9 23 16 Income  loss                                          p=0.02 27 46 31 41 27 18 61 18    9 18 8 41 37 18 0 0Table  4.    Relationship  between  economic  losses  and  per  capita  family  income  of  the  victims Per  capita Per  capita Per  capita Per  capita 2666  &  Above              n Total  medical  costs                p=  0.01 28 40 19 11 32 28 15 11 18 24 33 22 22    8 33 56 Income  loss                                      p=  0.03 25 0 11 20 37 17 11  0 25 33 11  0 13 50 67 801936 Journal  of  Society  for  development  in  new  net  environment  in  B&H
    • HealthMED  -­  Volume  5  /  Number  6  -­  Suppl.  1  /  2011highest  proportions  of  income  loss  due  to  dome-­ violence4,  8,  27,  36.    We  concur  with  the  reasons  offe-­stic  violence. -­ cation  might  have  more  choice  in  partners  and  mi-­own  medical  costs.    Only  20%  victims  had  received   ght  be  able  to  choose  to  either  get  married  or  not,   and   are   probably   able   to   negotiate   more   control   and  autonomy  within  the  marriage.    Women  with   higher  education  might  be  able  to  view  things  in   a  different  light  compared  to  those  who  were  not   those  with  higher  education  are  more  literate  and   those  with  lower  education  do  not  perceive  certain   acts  to  be  violence  against  them  and  hence  do  not   report  them  as  such.    Hence,  it  appears  that  educa-­ tion  has  a  protective  effect  not  only  on  violence  in-­ cidence  also  on  economic  losses  due  to  violence.     The  study  also  considered  the  number  of  fami-­ ly   members   in   the   household.   It   appears   that   as   the  number  of  family  members  in  the  household   increases,   the   number   of   incidences   of   violence  Figure  1.    Financing  sources  of  medical  trea-­ decreases.    This  could  be  that  too  many  people  or  tments  for  injuries  due  to  domestic  violence senior  members  in  the  household  serves  as  a  de-­ terrent  to  perpetrators  of  violence.     Those  who  reported  lower  personal  and  family   income  were  more  likely  to  report  being  victims   of  violence.    The  main  reason  here  was  that  lack   This  study  tried  to  estimate  the  cost  burden  of  domestic  violence  from  a  community  care  centre   violence2,   4,   8,   19,   36,   37.     Usually,   lack   of   money   le-­where  victims  of  violence  seek  assistance.  Avera-­ ads  to  frustration,  which  may  translates  into  vio-­ge  economic  cost  of  each  domestic  violence  inci-­ lent  attacks.    In  the  home,  victims  of  these  violent  dent  was  691  USD,  while  average  cost  for  medi-­cal  expenditure  was  29  USD    and  average  loss  of   -­income  due  to  domestic  violence  was  2092  USD.     men  in  poorer  families  more  than  it  affects  their   Women  in  their  30s  were  most  affected  by  do-­ richer   counterparts2,   4,   8,   24.   Women   who   are   sole  mestic  violence.    This  could  possibly  be  attributed   earners  in  the  family  were  at  highest  risk  of  being  to  the  fact  that  these  women  are  ages  when  they   victims  of  domestic  violence.  When  the  husband  are   reproductively   active,   and   need   to   negotiate   can  not  earn  or  receive  economic  support  from  his  issues  around  contraceptive  use,  protected  versus   wife,  the  situation  might  hurt  his  ego  which  indu-­unprotected  sexual  intercourse  etc.    This,  at  times  could  become  quite  contentious  resulting  in  vio-­ study  from  India  38.  Since  Chatsworth  is  predomi-­ nantly  occupied  by  people  of  Indian  origin,  simi-­from  Africa  and  Asia4,  13,  26,  27,  36,  37.   lar  socio-­cultural  beliefs  might  be  adopted  among   Proportionally,  women  with  no  education  suf-­ those  families  where  economic  empowerment  of   women  is  not  willingly  warranted.  those  with  primary  education  suffered  most  from   Pain   and   discomfort   were   major   problem   for   victims  of  domestic  violence.  Proportionally  they  suffered  most  from  violence  related  pain  and  dis-­ constitute   highest   numbers   for   both   medical   ex-­comfort.    This  is  in  line  with  previous  studies  in   penditures  and  for  income  loss.  However,  psycho-­which  higher  education  was  associated  with  less   logical  aspects  of  domestic  violence  have  multipl-­Journal  of  Society  for  development  in  new  net  environment  in  B&H 1937
    • HealthMED  -­  Volume  5  /  Number  6  -­  Suppl.  1  /  2011a  long-­term  policy  implication  because  economic  loss   for   pain   and   discomfort   generated   from   do-­ Considering   average   monthly   income   of   482  victims  themselves  or  by  relatives.  This  study  also   women  seems  to  be  very  expensive  as  the  average   -­nanced  by  perpetrators.     This  study  had  some  limitations.  The  answers   the   home   being   the   place   where   most   violence  to   questions   might   have   been   affected   by   recall  bias.   The   study   has   also   potential   social   desira-­ haven  for  women.    Steps  need  to  be  taken  to  revert  bility  bias,  and  response  bias  particularly  for  the   to  the  home  being  a  safe  haven.  It  has  been  evi-­SES   measures.   Economic   elements   of   domestic   denced  that  economic  empowerment  with  higher  violence  are  not  normally  distributed  as  the  high   education  of  the  women  are  protective  factor  2,  8,  40.  values  of  standard  deviations  indicated  large  vari-­ Therefore  policy  makers  can  emphasize  on  those  ation.  Also  health  economic  analysis  of  cost  ele-­ protective  issues.  The  cumulative  effect  of  abuse  ments   support   the   concept   that   as   health   impact   and  violence  was  noted  in  the  WHO  study  in  whi-­varies  among  human  beings,  cost  elements  do  not   ch  the  recent  experience  of  ill-­health  was  associ-­exhibit  normal  distribution   39.    The  study  did  not   ated  with  a  lifetime  of  violent  experiences  8.    This  consider  the  societal  costs  such  as  hospital  costs,   adds  to  the  notion  that  violence  does  not  have  a  judicial  costs  and  police  costs.  The  study  was  con-­ once  time  price  to  be  paid,  but  rather  the  effects  ducted  in  a  suburb  of  Durban.  A  nationwide  study   can  be  felt  years  down  the  line.    Hence,  one  act  of  is   required   in   South  Africa   to   estimate   the   eco-­ violence  today  could  lead  to  various  episodes  of  nomic  costs  of  domestic  violence  better.  The  study   ill-­health  in  the  future.used  a  convenience,  help-­seeking  sample,  and  was   Studies  looking  at  economic  costs  of  violence,  thus  not  representative  of  female  violence  victims.   like  this  study,  can  aid  in  the  promotion  of  social  Furthermore,  we  do  not  know  what  percentage  of   policy  and  reduction  of  violence  against  women.    those  women  approached  for  participation  in  the   Findings  of  studies  like  these  illustrate  how  vio-­ lence   against   women   has   the   potential   to   adver-­were  apparent  between  participants  and  non-­par-­ sely  affect  governments,  businesses  and  families  registry  data.  Actual  prevalence  of  violence  aga-­ potential  to  encourage  policy  makers  and  decisi-­inst  women  is  unknown  in  the  study  area  or  even   on  makers  to  address  the  issue  of  violence  against  in  South  Africa  in  general.  In  the  absence  of  regi-­ women,  thereby  reducing  their  own  costs  as  well.  stry  or  household  survey  the  best  way  to  estima-­te  domestic  violence  and  related  cost  identifying  victims  from  hospital  records,  police  records,  and  women  service  centers  3,  4.  However,  such  samples  may  well  not  be  representative  of  the  female  po-­pulation  in  South  Africa,  or  even  of  all  abused  vic-­tims.    Given  the  focus  of  the  research,  it  is  especi-­ally  important  that  this  was  a  highly  economically  marginalized  sample  who  sought  help  as  victim.  Surveillance  of  violence  and  injuries  at  health  care  facilities  and  community  service  centers  is  recom-­mended  which  is  effective  for  better  estimation  of  incidence  and  cost41.1938 Journal  of  Society  for  development  in  new  net  environment  in  B&H
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