Economic Costs of Violence Against Women in Mozambique

Abstract

Huge efforts have been made to make society aware of the concerns of violence against women (VAW). Hiding this phenomenon creates obstacles to quantify and clearly understand related aspects as well as leads to barriers to undertake actions for the reduction or elimination of VAW. The aim of this study is to estimate costs associated with VAW and produce data that will help in the design of strategies for the reduction or elimination of VAW. The economic cost of VAW was calculated for the cities of Maputo, Matola, Beira, and Nampula, for a time horizon of 4 years (2005–2008). Calculation of economic costs of VAW considered costs for health care, judicial costs, the assistance provided by the justice services, and support from civil society organizations offering services to women subjected to violence. The economic cost of VAW in Maputo, Matola, Beira, and Nampula, for a time horizon of 4 years (2005–2008), was US$1,473,828.7, with the health sector absorbing about 81% of the amount, justice 17%, and organizations working in the area of prevention with 2%. Although calculated costs represent an estimate, it is clear that VAW consumes a significant amount of the state budget. Estimated value is much higher than the budget allocated to the National Action Plan for Prevention and Combat of Violence Against Women. The improvement of collection of statistical data may lead to producing more robust estimates and have more absolute and comparable data.

Keywords

violence against women economic cost of violence domestic violence

Introduction

Violence against women (VAW) is a widespread and multifaceted social problem that constitutes not only a crime but a public health and social issue with severe implications for women’s lives. It is also not only the women who suffer but their children too, who generally witness the occurrence of such cases (Envall & Eriksson, 2006). VAW is not a problem that is only experienced in poor or less upper-middle-income countries. A report by UNICEF (2000) shows that in some upper-middle-income countries, VAW may reach levels comparable with or even higher than some less upper-middle-income countries.

As recognition of its implications and as a result of several years of advocacy carried out by citizens and civil society organizations, Mozambique, following the example of many other countries, approved in 2009 a law that treats VAW as a public crime (Assembleia da República, 2009). As of 2008, the Government of Mozambique has been allocating a specific budget in the National Action Plan for the Prevention and Combat of VAW, coordinated by the Ministério da Mulher e Acção Social [Ministry of Women and Social Affairs].

Domestic VAW is linked to an imbalance in power relations between women and men and is exacerbated by the supreme rights attributed to men over women, based on the male dominance and social constructions of patriarchal values in some African cultures (Arthur & Mejia, 2006). According to The State of African Women Report: Key Findings (2018), this type of violence is “influenced by structural and historical power imbalances between men and women” (p. 133). Contributors to VAW are “male dominance and control in the family and community, and lack of sanctions against perpetrators of violence” (p. 133). Low socioeconomic status or educational levels and the social acceptance of attitudes condoning violence are also mentioned as aggravators of VAW.

VAW involves significant costs to society, in the form of medical care, legal and judicial assistance, social services, and production and productivity losses (Envall & Eriksson, 2006; Helweg-Larsen et al., 2010). It affects the physical and psychological aspects of the victim (e.g., visits to health care facilities, stays in hospital, surgical costs, costs of getting to and from hospital or physical and emotional therapy, time away from paid work, and interruptions to domestic responsibilities at home; The State of African Women Report: Key Findings, 2018). It has significant weight on the tight budget of developing countries, who could use funds allocated to combat and prevent violence in other priority areas. Globally, the impact of VAW constitutes 11% of the world’s gross domestic product (GDP): 5.26% to VAW and 4.25% to child abuse and sexual crimes.

Materials and Methods

The aim of this study was to estimate costs associated with VAW and produce data that will help in the design of strategies for the reduction of VAW in Mozambique. This study was carried out with populations from Maputo, Matola, Beira, and Nampula, with considerations made for a time horizon of 4 years (2005–2008), four main cities in the three regions of the country (South, Center, and North), cities with a high convergence of people from different cultural backgrounds, and the expected higher frequency of cases of VAW.

To calculate the economic costs of VAW, documents containing violence case records from institutions dealing with these matters were collected. Based on the information gathered hereby, interviews were carried out with officials from the Ministry of Health, Ministry of Home Affairs, Ministry of Justice, Ministry of Women and Social Affairs, women and child care offices, police stations, hospitals, and humanitarian organizations and/or associations. The purpose of the interviews was to query or explore the magnitude of the problem of violence in its different forms and causes, as well as to gather sensitivities about available statistical data, particularly those data which had not been prepared specifically for a study of VAW, such as the operating costs of health, justice, and civil society institutions. Interviewed officers helped identify available data on different institutions and facilitated contact with key persons.

Based on methodologies used by other authors (Duvvury et al., 2013; Godenzi & Yodanis, 1999; Morrison & Orlando, 2004; National Center for Injury Prevention and Control [NCIPC], 2003; Pereznieto et al., 2014; Roldós & Corso, 2013) and on available data, equations have been derived which were used in calculations carried out in this study. The calculation of economic costs of VAW considered costs for health care, judicial costs, the assistance provided by the justice services, and support from civil society organizations offering services to women subjected to violence. Production and productivity losses were not considered due to missing data about the occupation of the victims and the fact that a significant number of victims usually work in subsistence and community work or informal economic activities which are difficult or even impossible to measure (Pereznieto et al., 2014). The calculation was based on data collected from public institutions and civil society organizations mentioned above, dealing with victims of VAW, as well as the victims themselves.

For the calculation of health costs, three levels of injury were considered, which were characterized as follows:

High (N₁): Qualified voluntary corporal offenses, sexual infringement, rape, arson, frustrated murderer, and a false imprisonment.

Medium (N₂): Simple voluntary corporal offenses, abduction, injury, and ill-treatment.

Low (N₃): Moral offenses, death threats, home and abandonment of minors, theft, indecent assault, and defamation.

Health costs for the three levels were calculated based on the following mathematical equations, based on average costs per patient as presented in Table 1:

Health costs (N_{1}) = % N_{1} \times Victims \times (OC + LF + MC + HC),

(1)

Health costs (N_{2}) = % N_{2} \times Victims \times (OC + LF + MC),

(2)

Health costs (N_{3}) = % N_{3} \times Victims \times (OC + LF),

(3)

where %N₁, %N₂, and %N₃ represent the percentage of victims of each level; Victims represent the total number of victims; OC, the operational costs; LF, costs of the labor force; MC, medication costs; and HC, the hospitalization costs. OC, LF, MC, and HC are average costs per patient (victim), obtained by the division of the global costs for the period by the number of victims attended. This approach has been used in other studies, with some minor modifications (KLYNVELD PEAT MARWICK GOERDELER [KPMG], 2016; Morrison & Orlando, 2004).

Table 1.

Average Health Costs (in U.S. Dollars) per Patient.

Parameter	Costs in U.S. Dollars
Parameter	Maputo	Beira	Nampula	Total
Number of patients attended	332,508	305,869	212,504	850,881
Number of hospitalized patients	67,758	48,236	32,028	148,022
Average operational costs per patient	22.8	21.6	1.73	15.37
Average costs of the labor force per patient	18.5	16.87	8.67	14.67
Average medication costs per patient	1.83	1.77	1.83	1.80
Average hospitalization costs per patient	1.0	1.4	2.1	1.37

Global health costs were then calculated from Equations 1, 2, and 3 using Equation 4:

\begin{array}{l} Global health costs = Health costs (N_{1}) + Health costs (N_{2}) \\ + Health costs (N_{3}) . \end{array}

(4)

Given the subsidized nature of the public health system in Mozambique, the calculation of medication and hospitalization costs presents some difficulties and may be well below real values. The calculated mean values are based on the global funds spent on a service in a given period (Duvvury et al., 2013; Godenzi & Yodanis, 1999; Morrison & Orlando, 2004; NCIPC, 2003; Pereznieto et al., 2014; Roldós & Corso, 2013). In developing countries, global funds do not necessarily reflect the real needs of the sector but the available budget for the period. Under these conditions, funds allocated for a certain period may be a poor indicator of the real price of a service, and there is a strong suspicion that services for victims of violence are under-provided in developing countries (Morrison & Orlando, 2004). Despite this, these values are useful because they allow estimation of the amount spent by these institutions for the care or treatment of cases of violence.

The calculation of the judiciary costs was made using Equation 5 and data in Tables 2 and 3:

\begin{array}{l} Justice costs = LF \times Victims \times % Justice + AD \times Victims \\ \times % Justice, \end{array}

(5)

Table 2.

Procedural Costs per Victim (Process) in U.S. Dollars (José et al., 2011).

Court Procedural Costs	Wage per Process
Magistrates in criminal areas	23.57
Justice Officers in criminal areas	40.37

Source. Ministério da Justiça, Procuradoria da República, Tribunal Judicial da Cidade de Maputo, and Ministério do Interior.

Table 3.

Estimated Administrative Costs in U.S. Dollars (José et al., 2011).

Item	Average per Year
Water	1,559
Electricity	37,934
Office supplies	104,475
Paper	58,244
Tonner	46,231
Total	248,443

Source. Ministério da Justiça, Procuradoria da República, Tribunal Judicial da Cidade de Maputo, and Ministério do Interior.

where LF represents average costs of the labor force, per victim, in the justice system; AD represents the average administrative costs per victim; Victims represent the number of victims, and %Justice represents the percentage of cases taken to court for judgment and court decision. According to official statistics, only 6.1% of reported cases of violence are taken to court. For that reason, estimated justice costs will, therefore, be low. This results from the fact that most reported cases of violence are practiced by partners and, normally, the first instance that deals with the problem makes efforts to reconcile on both sides. When no reconciliation is possible, cases are sent to higher instances.

The calculation of economic costs of VAW considered further costs of organizations’ working cases of violence (Table 4). These organizations work toward counseling victims and, sometimes, granting legal advice for the victims alongside the promotion of workshops and other educational activities. Due to limited budgets, most of their collaborators work on a volunteer basis and the amounts spent in a certain period do not reflect the needs of the organization but rather the available budget. Therefore, values used represent underestimated values.

Table 4.

Average Annual Costs of Associations and Organizations (in U.S. Dollars).

Organization	Average Costs
CAPAZ	416.7
MULEIDE	175.6
NHAMAI	29,854
OMM	4,065.7
Total	34,512

Results

Table 1 presents average health costs per patient, calculated from data collected in the central hospitals of Maputo, Beira, and Nampula, the three main cities of the country and cities where this study was carried out. Calculation of data in Table 1 was carried out using data from 2008, the final year of the time horizon of the study (see José et al., 2011, for more details).

Table 2 presents the costs of the labor force of magistrates, justice officers, and other employees of the justice system involved in the attendance of cases of VAW. These data, together with data about the administrative costs in Table 3, were then used to calculate the justice costs using Equation 5.

Average annual costs of associations and organizations in Table 4 represent a fraction of the budget of these organizations which is allocated to the attendance of victims of violence. The low budgets presented in Table 4 may be representative of the low level of services provided to the victims.

Most of the cases of VAW are reported in Maputo, with victims numbering 38.4%, followed by Beira with 29.3%, Nampula with 18.2%, and Matola with 14.0%. According to data from Gabinete de Atendimento da Mulher e Criança Vítimas de Violência Doméstica [Office of Assistance for Women and Children Victims of Domestic Violence], Level 1 injuries (high level) account for 8.6% of all VAW reports, Level 2 for 16.4%, while Level 3 injuries (low level of injury) account for 75% (José et al., 2011). A calculation of health costs for the three levels of injury resulted in data presented in Table 5.

Table 5.

Health Costs for the Three Levels of Injury for Period 2005–2008 (Values in U.S. Dollars).

Province	Level of Injury			Total
Province	High	Medium	Low	Total
Maputo	59,101.2	120,428.8	361,892.1	541,422.1
Matola	21,055.3	28,258	147,428.1	196,741.4
Nampula	6,589.5	16,068.4	45,335	67,993
Beira	25,261.1	29,626.5	326,948.8	381,836.4
Total	112,007.1	194,381.7	881,604.0	1,187,992.9

Judicial costs in the period 2005–2008 for the four regions covered by the study amount to a total of 251,916 U.S. dollars, namely, US$96,834.2 for Maputo, US$35,314.8 for Matola, US$45,955.7 for Nampula, and US$73,811.3 for Beira.

The overall economic cost of VAW, calculated in this study using Equation 4, was US$1,473,828.7, with the health sector absorbing about 81% of this value, justice about 17%, and associations working in the area of prevention and control of violence at around 2%.

Summary Results From the Interviews With the Officials of the Government on the Budget Allocated to VAW

At a government level, government officials reported the following budget:

Budget allocated for the operation of the care and counseling offices for victims of VAW,

Salaries of the staff in the offices of care and counseling for VAW,

Salaries for medical doctors and justice staff when they attend to the victims of violence.

Discussion

Estimated health costs are much lower than expected, not just because the number of cases reported is far below the total cases of VAW but also because of the subsidized costs of the public health system and the assumptions made in the methodology used. In addition, this study does not consider cases of treatment in private hospitals, due to inaccessibility of data, nor the effects of violence on long-term health, which is responsible for significant cases of depression and anxiety, alcohol, tobacco, and drug abuse. The global economic cost of VAW obtained in this study for the covered period (US$1,473,828.7) represents half of the budget allocated to the National Plan of Action for the Prevention and Combat of Violence Against Women, 2008–2012 (US$2,933,333.3 for a period of 5 years), approved by the Government of Mozambique with the objective of contributing to the reduction of VAW in Mozambique (MMAS, 2005).

This analysis should be interpreted carefully as this study covered only the four main cities of the country, for 4 years and not for the 5-year period covered by the National Plan of Action for the Prevention and Combat of Violence Against Women, 2008–2012. The inclusion of an additional year in the calculation would raise the global amount from US$1,473,828.7 to US$1,842,285.9. Extrapolation to the whole country would again raise the estimated value to an amount higher than US$8,333,333.3, as the four cities considered in this study (Maputo, Matola, Beira, and Nampula) represent less than 20% of the Mozambican population (Instituto Nacional de Estatística, 2017). As remaining areas of the country do not necessarily have the same characteristics as the four main cities of the country, extrapolation should not be carried out by merely assuming a linear and straightforward relation of costs and variables involved.

With the results of the interviews with the government actors, the researchers consider that there is no direct budget allocated to address VAW, but rather an indirect budget for this purpose. Some of these limitations were in accordance with what the literature also reports (Envall & Eriksson, 2006; Godenzi & Yodanis, 1999; NCIPC, 2003; Pereznieto et al., 2014), namely, (a) unavailability of a national system that collects and manages criminal and medical statistics about VAW; (b) the willingness of victims to report cases of violence; (c) the fact that the public health system is a subsidized one, where costs practiced in public hospitals are not real costs; and (d) the inability to estimate costs associated with loss of productivity and increased absenteeism, due to missing data about the occupation of the victims and the fact that a significant number of victims usually work in subsistence and community work or informal economic activities, which are difficult or even impossible to measure. The lack of comprehensive data on program use, or help-seeking by women experiencing abuse, means that it is not possible to interpret and coherently calculate the true cost of VAW. As a consequence, the form of cost varies depending on the degree to which the response to VAW has been established.

A study carried out by the World Health Organization (WHO, 2005) showed a higher incidence of violence practiced by the partner in rural areas when compared with the urban area of the same country, due probably to traditional and cultural aspects but also to reduced access to social and justice services (Helweg-Larsen et al., 2010; KPMG, 2016; Pereznieto et al., 2014). This situation introduces unattended cases considered as hidden cases of violence. Within the hidden cases of violence, one can also consider the individuals as lesbians, bisexual, or transgender, who are not readily accepted by society and whose complaints may not be taken seriously, thus inhibiting them from reporting cases of violence (KPMG, 2016).

While research data show more incidence of marital violence in rural areas (WHO, 2005), the situation in urban areas shows a reduction of marital violence but an increase of violence by other actors (Duvvury et al., 2013; WHO, 2005). As VAW is a complex phenomenon, analyses of data about violence in urban and rural areas require particular attention. In urban areas, women have more employment opportunities and, according to Duvvury et al. (2013), they are more likely to experience marital violence by partners who are unable to deal with the autonomy of their wives. This phenomenon causes higher levels of distraction and affects their job performance and their ability to maintain employment, resulting in job losses and consequently higher social costs for society.

Mozambique has a weak social service, different from developed countries who invest seriously in social services. Social costs may reach a significant amount of global costs. An overview of the social costs of violence in various countries shows variations between 2% and 50% of the global costs (Council of Europe, 2014). This large discrepancy may be influenced not only by the different investments made in each country but also by the categorization of social costs used in each country that may consider this item of the agenda as seriously as other countries.

Global costs of VAW in different countries, mainly when comparing upper-middle-income and lower-income countries, should be made carefully. The higher costs of violence in upper-middle-income countries are not necessarily evidence of more occurrence of violence in upper-middle-income countries. They are associated with the availability of a more comprehensive and more exact systems of reporting and collection of data about violence, a higher level of legal and social service provision, and better access of the victims to those services. This leads to more exact data and, consequently, more robust estimates can be carried out with the availability of budgets that reflect more closely the needs of an individual sector (Helweg-Larsen et al., 2010; KPMG, 2016; Morrison & Orlando, 2004; Pereznieto et al., 2014).

Due to the narrow focus on measurable costs, the costs reported in this study are not detailed. Therefore, the figures only provide a partial estimate of the costs incurred by individuals, families, the health sector, government, and the economy as a whole. Furthermore, to extrapolate national costs, the researchers presumed that the unit costs provided are indicative of the costs in regions not covered by this study. Another limitation would be the inadequate information systems, meaning that only fragmented data are available. Despite these limitations, the central proposition of the study, that a country incurs a loss of productivity because of VAW, is verified. This highlights the need for the government to address VAW as a priority issue for building economic prosperity and peace.

Conclusion

Even with the limitations described, results presented show that estimated values consume a significant amount of the state budget. These results should support the need for raising awareness about the importance of introducing measures for the prevention or reduction of VAW. Furthermore, the study shows the importance of introducing a national system for the collection of statistical data about violence, to improve the quality of the estimated results. Due to limitations in their budgets, developing countries tend to underestimate the importance of the collection of data to feed national databases, with data that will provide evidence and will be crucial to support government policy and allocation decisions in relevant areas. This system should consider effective collaboration of the different sectors responsible for the attendance of violence and integration of all data necessary to monitor and improve the quality of estimates of costs, particularly the social aspects of violence.

Although the literature reported similar studies carried out in different countries, comparison of results seems difficult because some underlying data used in the estimations are different between different countries. The higher costs reported for other countries are an example hereof and do not necessarily mean the occurrence of more cases of violence. Basic salaries and basic costs for medical treatment and hospitalization in those countries are much higher than those practiced in Mozambique (Dolezal et al., 2009; Envall & Eriksson, 2006; Morrison & Orlando, 2004). Estimated values will, therefore, be much higher even for the same population size. Continued advocacy for systematic collection of statistical data about VAW is crucial in Mozambique and worldwide.

Footnotes

Acknowledgments

The authors acknowledge the financial support, collaboration, and encouragement from United Nations Entity for Gender Equality and the Empowerment of Women (UNWomen) in Mozambique, whose support was crucial for the research carried out and the production of this publication. We also would like to thank Lídia Mutemba, Quitéria Cossa, and all the staff of the Center of Coordination of Gender Matters (CeCAGe) from the Eduardo Mondlane University for the support on data collection, and Anna Galle from the International Center for Reproductive Health (ICRH-Ghent Belgium) for the support on the manuscript review.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study has been funded by the United Nations Entity for Gender Equality and the Empowerment of Women (UNWomen).

ORCID iD

Beatriz Manuel

Author Biographies

Sílvia Tchamo is graduated in business administration at the Eduardo Mondlane University (UEM), Faculty of Economics, and later, in 2009, she completed her master’s degree in accounting and finance at the Technical University of Lisbon and concluded in 2011. She currently works for Sasol Petroleum Temane Limited, and works as financial manager, where she is responsible for preparing the company’s financial information. Previously, from 2012 to 2014, she worked for Rio Tinto Coal Mozambique as a business analyst and from 2006 to 2011 worked for the company Airports of Mozambique where she was the financial analyst responsible for preparing the company’s budget in line with the economic and financial plan, and monitoring and analysis of its execution.

Mauro Mucambe studied in Legal Sciences from 2004 to 2008, at the then Higher Polytechnic University Institute—ISPU, now Polytechnic University. Participated in various trainings promoted by the Center for Legal Assistance and Practice, to highlight the training on “Precautionary Provisions” and “Domestic Violence.” In 2009, he joined the training of magistrates at the Center for Judicial Studies (CEJ), in Portugal, having graduated at the Public Prosecution Magistracy. He served as trainee for the Public Prosecution Magistrate of the Lisbon District Attorney General’s Office after the graduation,From 2010 until now, he serves as Public Prosecutor Magistrate, initially assigned to the Kampfumo Municipal District, in the sorting together of the District, From January of 2014 he was working at the Municipal District Kamavota. In September 2018, he was appointed on a commission to serve as District Prosecutor of the KaMavota Municipal District.

Generosa José is a PhD student in gender studies at Uppsala University Center for Gender Research since 2018. She examines the challenges and opportunities of implementing gender mainstreaming at UEM. Lecturer at UEM, she coordinates the UEM-Sida subprogram 2017–2022 on gender mainstreaming. She holds MSc in mathematics and MEd in computer-assisted education. As director of Center of Coordination of Gender Matters from the Eduardo Mondlane University (CeCAGe) during 2009–2015, she led teams that developed gender educational modules and research on socioeconomic costs of violence against women (VAW) in Mozambique, from which it was extracted the article on economic costs of VAW in Mozambique.

Beatriz Manuel is a fourth-year PhD student at Ghent University in Belgium, and a lecturer and researcher at Faculty of Medicine of the UEM in Maputo, Mozambique. The aim of her doctoral research is to identify ways to improve curricula on intimate partner violence (IPV) curriculum content to enhance prevention and medical care in Mozambique. She takes a multidisciplinary approach that encompasses the fields of medical education, family and community health, public health, sexual and reproductive health and rights, HIV/AIDS, gender matters, research methods, and evidence summaries and evidence informed health care. She holds a master’s degree in Health Professions Education from the Maastricht University in the Netherlands that investigated the strategies of human resources training approach to people living with HIV.

Gracinda Mataveia is a PhD candidate in in Animal Science from the University of Pretoria, Republic of South Africa. She is a lecturer and researcher in two areas, one on veterinary sciences and another on gender study. She is also a social activist with a particular focus on human rights and facilitator of gender trainings. She has participated in conferences and congress with communications in abroad countries. She has publications in veterinary sciences and on gender studies. Since 2015, she is a director of CeCAGe.

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