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close this bookViolence against Women (WB)
close this folderAppendix
View the documentAppendix A. recommendations for government action to combat violence against women
View the documentAppendix B: definition of violence against women
View the documentAppendix C: methodology for estimating the healthy years of life lost due to domestic violence and rape
View the documentAppendix D: sample danger
View the documentAppendix E Treatment protocols for battered women

Appendix C: methodology for estimating the healthy years of life lost due to domestic violence and rape

The calculation of the disability-adjusted life years (DALYs) lost due to domestic violence and rape is based on estimates of the share of life years lost to premature mortality and that can be attributed directly to gender-based victimization. The burden of disease is the net present value of the future stream of disability caused by incident cases in 1990 plus the future stream of healthy life lost from premature mortality from 1990 deaths by disease condition. A 3 percent per year discount rate is assumed in the exercise to translate future years of life lost into their present value. Non-uniform age weights are also assumed, but because the loss of life is valued according to the future stream of age specific weights and not just the weight of one year, the results of the analysis are not very sensitive to the introduction of non-uniform age weights. To equate morbidity and mortality, the global burden of disease (GBD) exercise assigns "disability weighting factors (between 0.02 and 0.9) to conditions based on their interference with normal enjoyment of life and functioning. A rating of 0.02 represents minimal interference with well-being and productivity, and weightings of 0.6 and higher represent major life dislocations, with 0.9 appropriate only for conditions just short of death, such as coma.

A full discussion of the methodology, including the estimation of incidence by region and by age group and assumptions about disability weights, age-weighting, and the discount rate, is contained in Murray forthcoming and Murray and Lopez forthcoming.

Since domestic violence and rape are not diseases per se, the GDB frames gender-based victimization as a risk factor that increases the incidence of certain other morbidities and conditions, such as physical traumas and depression. Thus, the calculation of DALYs lost to genderbased victimization begins with the GDB estimates of DALYs lost due to each condition and then estimates the percentage of the total for that condition attributable to domestic violence or rape. (An analogy would be estimating the proportion of disability resulting from emphysema, lung cancer, and heart disease that can be attributed to smoking.)

Appendix table C.1 summarizes the estimates of attributable risk used to calculate the DALYs lost due to rape and domestic violence. The evidence supporting each percentage estimate is on file with the World Bank GBD team. The DALYs lost to each condition is multiplied by the percentage attributable to gender victimization and then summed across conditions. The total DALYs lost to domestic violence and rape can then be compared to totals calculated for different disease categories, such as tuberculosis and malaria.

The table gives estimates only for DALYs lost due to rape and domestic violence among women age 15 to 44. Thus it excludes DALYs lost due to other gender-based forms of victimization, such as genital mutilation.

Appendix table C.1 Disability-adjusted life years lost to women age 15 to 44 due to conditions attributable to domestic violence and rape

Relevant conditions

Total DALYs lost to women age 15 to 44 (millions)

Share attributable to domestic violence and rape

STDs (excluding HIV)

15.8

2 percent

HIV

10.6

2 percent

Abortion

2.5

10 percent

Depression

10.7
(men age 15 to 44) 5.4

50 percent of difference between women and men

Alcohol dependence

0.9

10 percent

Drug dependence

1.1

10 percent

Post-traumatic stress disorder

2.1

60 percent

Unintentional injures

6.7

20 percent of total burden minus burden attributable to motor vehicle accidents and occupational injuries;

Suicide

5.5

30 percent

Homicide

0.9

60 percent

Intentional injury

1.2

90 percent

Total

58.0

6 percent

Source: World Bank data.