12 The most common approach used to calculate the costs of GBV has been an “accounting methodology”, in which costs are calculated for specific categories of costs, and total cost to society is simply the sum of all distinct categories of costs. Typical of this approach is CDC (2003), which specifies two types of costs:

- _Direct costs_ are actual expenditures related to GBV, including health care services, judicial services and social services.

- _Indirect costs_ represent the value of lost productivity from both paid work and unpaid work, as well as the foregone value of lifetime earnings for women who have died as a result of GBV.

A recent estimate of the direct health care costs of intimate partner violence against adult women in the U.S. found costs of over 4 billion dollars in 1995, including both mental health and medical care costs (CDC, 2003). Similar methodologies have been employed by to generate estimates for the U.S. (Spalter-Roth, 1995), Canada (Greaves et al., 1995; Health Canada, 2002), Holland (Korf et al., 1997), the U.K. (Stanko et al., 1998), Switzerland (Godenzi and Yodanis, 1998), and Australia (Australian Institute of Criminology, 2002), as well as for the states and provinces of Queensland (Blumel et al., 1993), British Columbia (Kerr and McLean, 1996), Northern Territory (Office of Women ́s Policy, 1996), and Washington (New and Berliner, 2000).<sup>13</sup> To the best of our knowledge, there are only two such direct cost studies for GBV in developing countries. Mansingh and Ramphal (1993) estimate that the direct costs of treating victims of intimate partner violence in Kingston Public Hospital (Jamaica) totaled U.S. $454,000 in 1991 (in 2001 dollars). Sánchez et al. (2004) find that the Colombian national government spent approximately 184 billion pesos (U.S. $73.7 million) in 2003 to prevent, detect and offer services to survivors of family violence—an amount equal to approximately 0.6% of the total national budget.<sup>14</sup> One of the weaknesses of the accounting approach to estimate direct costs is that any list of categories is essentially arbitrary and alternative categorizations can always be devised (Buvinic and Morrison, 1999). An even more serious weakness is that key categories of costs can be inadvertently left out of the calculations. For example, most estimates of direct costs do not include the costs generated by children witnessing or being a victim of family violence.<sup>15</sup>

> 13 These studies are reviewed in Yodanis et al. (2000) and WHO (2004).

> 14 These represent expenditures of the following institutions:  Colombian Social Welfare Insitute (Instituto Colombiano de Bienestar Social), Sub-secretariat for security and peaceful coexisetence (Subsecretaria para asuntos de seguridad y convivencia ciudadana), Attorney General ́s Office (Fiscalía General de la Nación) and the National Medical-Legal Institute (Instituto Nacional de Medicina Legal). The $73.7 million refers only to services related to family violence.

> 15 These impacts may include: poorer performance in school (Larraín et al., 1997); increased probability of delinquency, both as a juvenile and as an adult (Windom, 1989;  Dahlberg, 1998; Thornberry et al., 2001); children leaving abusive homes to live on the street (Hernández Rosete, 1998); substance abuse (Molnar et al., 2001) ; attempted suicide (Dube et al., 2001) ; higher probability of committing family violence as an adult (Strauss, et al 1980).