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The Center for Health and Gender Equity (CHANGE) is a research and advocacy organization that seeks to integrate concern for gender equity and social justice into international health policy and practice. CHANGE staff can be reached by e-mail at change@genderhealth.org or at http://www.genderhealth.org.

Women's participation. Violence against women hinders their participation in development projects and lessens their contribution to social and economic development. In Mexico a study that sought to learn why women often stopped participating in development projects found that men's threats were a major reason. Men perceived the growing empowerment of their wives as a threat to their control and beat them to try to stop it (73). In Papua New Guinea some husbands have prevented their wives from attending meetings by locking them in the house, by pulling them off vehicles taking them to the meetings, or by pursuing and dragging them home (38).

Even if men do not prevent women's participation, they may use force to deprive them of its benefits. Women participating in micro-credit schemes in Bangladesh and Peru and garment workers in the Mexican maquiladoras report that husbands often beat their wives and take what the women have earned (73, 406, 407).

To avoid violence, many women censor their behavior to suit what they think will be acceptable to their partners, in effect “making women their own jailers” (38). In Papua New Guinea, for example, a study by the Department of Education found that a main reason that female teachers gave for not taking promotions was fear that it would provoke their husbands to more violence (174).

Such fears can lead to adverse effects on the health of women and their families, as well as reducing earnings. Fear of rape, for example, has contributed to undernutrition among Ethiopian refugee families living in Sudanese border camps (266). Ethiopian women refugees surveyed said they cooked fewer meals for their children because they feared being raped while out collecting firewood. In fact, many had been raped during the 2- to 3-hour forays to collect fuel. In Gujarat, India, female rural health promoters discussing obstacles to their work emphasized their reluctance to travel alone between villages for fear of being raped. They asked for self-defense training to continue their work (249).

Women's productivity. Researchers have only begun to explore the possible impact of domestic violence on women's labor force participation and earnings, and studies yield inconsistent conclusions. In studies in Santiago, Chile, Managua, Nicaragua, and Chicago, for example, the impact of domestic violence on women's likelihood of being employed varied greatly (278, 312). Some women worked less in order to protect their children or because their partners would not allow them to work, while other women sought employment to lessen financial dependence on their abuser.

Domestic violence does appear to have a consistent impact on women's earnings and their ability to remain in a job, however (47, 278, 312). The study in Chicago found that women with histories of domestic violence were more likely to have experienced spells of unemployment, to have more job turnover, and to suffer more physical and mental health problems that could affect their job performance. They also had lower incomes and were much more likely to receive public assistance (278). Similarly, in Managua abused women earned 46% less than women who did not suffer abuse, even after controlling for other factors affecting earnings (312).

Evidence from the US suggests that victimization in childhood may also reduce a woman's educational attainment and income. Researcher Batya Hyman found that women who were sexually abused in childhood earned 3% to 20% less annually than women who had not been abused, depending on the type of abuse experienced and the number of perpetrators (222). Incestuous abuse affected income indirectly through its impact on educational attainment and mental and physical health status. Women sexually abused by strangers suffered an additional direct effect on income.

Costs to the economy. For countries the costs of gender-based violence are substantial. For example, in Canada a 1995 study estimated that violence against women cost the country 1.5 billion Canadian dollars (US$1.1 billion) in lost labor productivity and increased use of medical and community support services (106). Another study in Canada put the cost of violence against women much higher, after including costs for social services, criminal justice, labor and employment, and the health care system. The study estimated that physical and sexual abuse of girls and women cost the economy 4.2 billion Canadian dollars each year, nearly 90% of that borne by the government (192).

Not surprisingly, women who have experienced physical or sexual assault in either childhood or adulthood use health services more often than other women, as studies in Nicaragua, the US, and Zimbabwe show (147, 257, 273, 312, 394, 455, 464, 473). Over their lifetimes, victims of abuse average more surgeries, physician and pharmacy visits, hospital stays, and mental health consultations than other women, even after accounting for other factors affecting health care use.

Such increased need for health care adds considerably to health care costs. For example, in the Washington state HMO study (see p. 19), the added cost associated with childhood abuse for this plan alone was estimated at over US$8 million per year (459). Another US HMO study found that female victims of partner violence cost the health plan 92% more than a random sample of other women who received services from the health plan that year. The extra costs were not due to excess emergency room charges (473).