The first thing most people think of when asked about the economic cost of abuse is health care. This is not surprising considering the enduring stereotypes – the image of a domestic violence victim with a black eye and broken arm or the rape victim going to the ER after being attacked by a stranger. This immediate focus on health care costs is also not without good reason: intimate partner violence (IPV) results in two million injuries for US women every year and medical costs ranging from $2.3 billion to $7 billion within one year of violence. Consequently, women experiencing physical abuse faced health care costs 42% higher than non-abused women.
It is essential that women receive affordable, quality treatment for these health costs so that they may remain safe and economically secure, which means looking beyond the stereotypes to address every aspect of health-related impacts, including the following.
- Mental health care: Whether survivors experience depression, anxiety or PTSD, mental health needs can be just as costly and impactful as more visible physical needs. They may also affect survivors’ ability to maintain their jobs and care for themselves or their families.
- Long-term health care: Health care costs continue to be 19% higher for survivors than for non-abused women even five or more years after physical violence. Mental health needs, especially for sexual assault survivors, may also take years to appear, long after survivors are eligible for crime victim compensation (CVC) or other financial assistance. In addition, trauma from domestic and sexual violence often leads survivors to engage in other risky behaviors, such as abusing drugs or alcohol and unsafe sex, with far-reaching consequences on their health.
- Access to health insurance: In order for survivors to weather the added costs of physical and mental health care without falling into dangerous economic insecurity, they must have adequate health insurance. However, survivors may receive insurance through their abusive partner, which complicates their decisions to leave or seek treatments that their abuser could find out about. Survivors with employment-based insurance may be at risk of losing it if their jobs are in jeopardy from an abuser targeting them at work. Survivors may also be suffering abuse or harassment at the workplace in order to keep their jobs and health insurance.
This week is National Women’s Health Week and WOW is thrilled that “Talk to my doctor about any domestic or interpersonal violence” is a recommendation for every age and that mental health is a priority. Considering the immense impact of violence on health, it is critical that doctors have the training to respond to domestic violence, sexual assault and stalking. Rather than checking off whether they asked about domestic violence, they should be able to recognize the signs of each form of violence and take appropriate action, such as by directing survivors to mental health professionals and community resources. Adequate and supportive policies are also needed at every level. Health care professionals, direct service providers and policymakers should account for the importance of health insurance for survivors’ economic security and the added complications that survivors may face in acquiring or accessing it. In addition, policies should address the long-term and diverse health impacts of violence. For example, survivors would benefit from having access to CVC funds long after the crime itself and insurance coverage for contraception or STI treatment that may be needed following reproductive coercion or sexual assault.
National Women’s Health Week is a good start towards a great mission, but until the proper training, infrastructure and policies are in place, a simple annual check-up is not going to significantly address the health-related consequences of violence.