In Utah, one in three women will experience some form of sexual violence (SV) during their lifetime, and one in eight women and one in 50 men will experience rape (Utah Department of Health, 2008). Utah ranks 10th in the nation for reported rape (U.S. Department of Justice, 2013). What makes this statistic particularly alarming is that “rape is the only violent crime in Utah that is higher than the national average” (U.S. Department of Justice, 2013). Other violent crimes, such as homicide, robbery or aggravated assault, are “historically half to three times lower than the national average”. The effects of SV can be physical, emotional, and/ or psychological. SV affects the immediate quality of life and can have lasting consequences for survivors. When compared to individuals who are not raped, rape survivors have been found to have a significantly higher prevalence of reporting dissatisfaction with life (14.7% vs. 4.8%); not receiving the social and emotional support they need (33.8% vs. 13.2%); reporting fair or poor health (25.9% vs. 10.7%); and experiencing activity limitations because of physical, mental, or emotional problems (39.2% vs. 19.7%; Utah Department of Health, 2010).
Public health approaches SV through primary prevention, defined as preventing SV before it occurs. Public health personnel are concerned with approaches that can affect people and the communities where they live, learn, work, and play; and these approaches may include involving entire communities to prevent SV, as SV affects everyone directly or indirectly. In order to conduct primary prevention through all levels of our society, various sectors must be engaged, including policy makers.
Prevention strategies focus on policy, social norms, and increasing protective factors, as well as decreasing risk factors for SV. With this goal in mind, the Utah Department of Health Violence and Injury Prevention Program, in partnership with the Utah Coalition Against Sexual Assault, put together a whitepaper called the Costs of Sexual Violence in Utah (Cowan, 2015). This report was designed to guide SV prevention resources throughout the state.
n 2015, the Utah Department of Health, together with the Utah Coalition Against Sexual Assault, compiled data highlighting the economic burden of SV. The figures and data in this snapshot are from that report. The report looks at child (0-17 years) sexual assault and adult (18+ years) incidents of rape and sexual assault. To estimate the cost of SV in Utah, existing data were used and methodology was adopted (Cowan, 2015). Cost categories factored in economic health, emotional health, physical health, and occupational/ financial health of the individuals. Furthermore, the report looked at Utah government spending for prevention, as well as government spending on survivors and on perpetrators (oversight and confinement).
In 2011, in Utah an estimated 3,609 children ages 0-17 were victims of sexual assault. That same year, there were 20,666 adult rape victims and 54,742 adult other sexual assault victims (Table 1). The majority of sexual assault and rape victims were female, including 63% of child sexual assault victims, 84% of adult rape victims, and 75% of adult other victims of other forms of sexual assault.
When all cost categories for the entire Utah population were aggregated, the 2011 direct and indirect costs of SV was $4.9 billion. That breaks down to over $800 million for child sexual assault and over $4 billion for adult rapes. The cost per SV incident in 2011 was an average of $184,504 for children per incident. For adults, rape costs were $154,598 per incident and other sexual assault costs were $282 per incident. For adult rapes, the largest cost category, suffering and lost quality of life, came out to $126,713 per adult rape incident. Additionally, mental health care cost $3,610 per adult rape incident, suicidal acts cost $7,535 per incident, and substance abuse costs per adult rape are $5,039 per incident. These costs are significant to both the individual and society.
In 2011, government spending in Utah related to SV totaled more than $109 million (Table 2). Estimated spending on sexually violent offenders was higher than spending on victims who were raped or sexually assaulted for the one year. Utah spent over $92 million (84.4%) on offenders, including costs of investigation, confinement, and the sex offender registry. It is important to note that the Rape, Abuse, & Incest National Network (www. rainn.org) estimates that the majority of rapes are not reported to the police and only about 0.6% of rapists will be incarcerated, suggesting that the vast majority of perpetrators are not included in the offender cost category. That same year, Utah spent just under $16.5 million (15.1%) on victims of SV, primarily on medical bills for victims on Medicaid, sexual assault examination payments, and child protective services. Finally, $569,000, or just 0.5% of government funding, was spent on prevention programs (Cowan, 2015).
As documented, there are substantial health and economic consequences of SV. Furthermore, connections can be made to SV across all domains of health. This impact can and should have policy implications, and may be addressed through policy change.
Physical & Reproductive Health – The very act of SV violates a person’s agency over her or his own body and denies her or him the right to decide when and how to engage sexually, as well as potential for unwanted pregnancy, potential for sexually transmitted infections (STIs), injury to repro- ductive organs, and overall physical injury. The Adverse Childhood Experiences study associates SV victimization in childhood to higher rates of chronic disease and adverse health behaviors later in life (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002; Sommers, 2007).
Social Health – SV is shown to have impacts on victims’ social health, including: strained relationships with family, friends, and intimate partners; diminished emotional support from and contact with friends and family; decreased likelihood of marriage; and isolation or ostracism from family or community (Jacqueline M. Golding, 2002; Krug et al., 2002).
Emotional Health – Emotional health consequences of SV result from other impacts on the domains of health, as seen in the Social Health section. For example, victims of SV can experience both immediate and chronic emotional/psychological health consequences, including but not limited to: anxiety; withdrawal; distrust of others; post-traumatic stress injury; depression; attempted or completed suicide; and low self-esteem/self-blame (Campbell & Dworkin, 2009; Goodman, Koss, & Russo, 1993; Yuan, Koss, & Stone, 2006).
Occupational and Financial Health – As a result of SV, victims often suffer occupational and financial
burdens, including time off from work without pay or loss of work, as well as overall lost productivity. The financial burden of SV victimization includes medical and mental health care costs, in addition to other related costs such as property damage, pregnancy (not to mention child rearing), and potentially housing or relocation issues.
Intellectual Health – Given that the majority of victims of SV experience first-time victimization before the age of 25, we know that the educational achievement, and therefore the intellectual health, of victims is at risk. This is due, in part, to the diminished opportunity to learn in a safe and equitable environment, and individuals who have experienced SV may miss school as a result of their victimization. The intellectual health and academic achievement of victims is gaining increased attention as educational institutions work to comply with the Title IX law.
Several implications that affect policy have been identified from the Costs of Sexual Violence Report (Cowan 2015).
- SV results in a large expense to society.
- There is a lack of priority placed on prevention in Utah. Funding prevention efforts has the potential to result in reduced costs for perpetrator and victim services incurred by the government, in addition to reducing the financial burden on society that inevitably picks up some of the remaining non-governmental spending costs and additional intangible costs.
- It should be noted during the 2016 and 2017 legislative sessions in Utah the Department of Health received appropriations from the federal Temporary Assistance for Needy Families Fund (https://www.benefits.gov/benefit/613) to allocate to local programs in order to implement SV primary prevention activities. Since these are one-year, one-time funds, a more sustainable approach to
funding to address SV prevention in Utah is necessary.
By bringing to light the economic impact of SV on Utah communities, we hope to educate about strat- egies that would help reduce costs effectively, as well as help with the evaluation of SV prevention approaches to address these problems in the best way possible. For more information on SV, including SV prevention in Utah, please visit http://health.utah. gov/vipp/topics/rape-sexual-assault/.
- Campbell, R., Cabral, G. & Dworkin, E. (2009). An Ecological Model of the Impact of Sexual Assault on Women’s Men tal Health, Trauma Violence Abuse 10(3), 225–246. https://doi.org/10.1177/1524838009334456
- Cowan, L. (2015). Costs of Sexual Violence in Utah 2015. Salt Lake City, Ut. Retrieved from https://justice.utah.gov/ Violence/Documents/costs-sexual-violence-report.pdf
- Goodman, L. A., Koss, M. P., & Russo, N. F. (1993). Violence Against Women: Physical and Mental Health Effects.
- Applied and Preventive Psychology, 2(2), 79–89. Retrieved from https://arizona.pure.elsevier.com/en/ publications/violence-against-women-physical-and-mental-health-effects-part-i-
- Jacqueline M. Golding, S. C. W. and M. L. C. (2002). Sexual Assault History and Social Support: Six General Population Studies. Journal of Traumatic Stress, 15(3), 171–266. https://doi.org/10.1023/A:1015247110020
- Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., & Lozano, R. (2002). World report on violence and health. Retrieved from http://apps.who.int/iris/bitstream/10665/42495/1/9241545615_eng.pdf
- Sommers, M. S. (2007). Defining Patterns of Genital Injury from Sexual Assault, 8(3), 270–280. https://doi. org/10.1177/1524838007303194
- U.S. Department of Justice. (2013). Crime in the United States by State, 2013. Retrieved from https://ucr.fbi.gov/crime- in-the-u.s/2013/crime-in-the-u.s.-2013/tables/5tabledatadecpdf/table_5_crime_in_the_united_states_by_ state_2013.xls
- Utah Department of Health. (2008). Sexual Violence. Utah Health Status Update. Retrieved from https://ibis.health. utah.gov/pdf/opha/publication/hsu/2008/08Apr_SexualViolence.pdf
- Utah Department of Health. (2010). Behavioral Risk Factor Surveillance System. Retrieved from http://ibis.health.utah. gov/query/selection/brfss/BRFSSSelection.html
- Yuan, N. P., Koss, M. P., & Stone, M. (2006). The Psychological Consequences of Sexual Trauma. VAWnet.org National Online Resources Center on Violence Against Women, (March). Retrieved from http://vawnet.org/sites/de fault/files/materials/files/2016-09/AR_PsychConsequences.pdf
Waters M & Ferrell D. (2019). Cost of Sexual Violence in Utah. Utah Women’s Health Review. doi: 10.26054/0KBN5JFNFS.