Economic costs of violence against young children in turkey

ECONOMIC COSTS OF VIOLENCE AGAINST YOUNG CHILDREN IN TURKEY

2013, JULY, ISTANBUL, TURKEY

ECONOMIC COSTS OF VIOLENCE AGAINST YOUNG CHILDREN IN TURKEY Report of the Project Registered by Bernard van Leer Foundation under

TUR-2012-081

Project Team

Melek BASAK Duygun Fatih DEMIREL Eylul Damla GONUL SEZER

* Nuriye Zeynep Okten has participated in estimating the economic cost of violence against young children in Turkey as a consultant in the parts related to economics theory.

Executive Summary “Child abuse casts a shadow the length of a life time.�

Herbert Ward The extent of violence against children and its consequences are only now becoming visible as a worldwide problem. It takes place in every society in various forms and often deeply rooted in cultural, economic and social practices. Children are open to experience violence either by the members of their households and acquaintance or by strangers.

A large proportion of young children (ages between 0 and 8) in every society suffer significant violence within their homes or close family cycles. Domestic violence against young children is a very common issue in Turkey too and it takes place both as direct violence or indirect (witnessing) violence.

The consequences of violence on children include physical damage and injuries, disorders in mental health, loss of self-confidence, loss of adaptation skills to the social environment, possibility of reflecting violence to others in future and many others.

However, the

complexity of violence lends itself to quantify these consequences via simple and direct approaches very seldom.

In order to be able to quantify and provide a clearer picture and span of violence on young children, utilizing economic data related to the above mentioned consequences is expected to have a highly significant value; that is, the crucial impacts of violence against young children is expected to become more tangible by associating them with their financial values.

In this project, the target is to construct an applicable framework in order to be able to estimate economic costs of violence against young children in Turkey. This framework is founded on definitions, classifications and rankings related to violence and cost concepts. In this study, healthcare costs, police and justice system costs, social services cost, and long term productivity losses are included.

The results show that economic burden of violence against young children in Turkey turns out to be ranging between 4.8 and 47.1 billion Euros of 2012. With minimum cost values, 2 bridges across Bosphorus, 5 bridges over Ä°zmit Bay, medical equipment for more than 1100 fully fledged hospitals, approximately 650 wind turbines of 1MW can be constructed or i

bought. These examples highlight the importance of child maltreatment in terms of monetary values.

Once the economic consequences of violence experienced by young children in Turkey are estimated, the cost assessment approach that is utilized in this study is adapted to the UK to compare the results and to validate the outcomes of the study. That is, if the number of violence cases in Turkey occurred in the UK, the cost of violence against young children would be estimated within a range of 46 and 98 billion Euros of 2012. The differences between Turkey and the UK cases reveal the deviations in economic well-fare and variances in perceptions of societies on child maltreatment in two countries.

All of the outcomes of this study reflect that violence against young children in Turkey is an important issue which cannot be ignored by government and public. In fact, this report reveals that child maltreatment has devastating economic consequences besides physical and psychological damage that the victim suffers. Thus, the impacts of violence against young children pass down through the generations which may result in the cultural and social corruption.

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Table of Contents Table of Contents ........................................................................................................................................... iii List of Figures .................................................................................................................................................... v List of Tables ...................................................................................................................................................... v List of Abbreviations ...................................................................................................................................... vi Chapter 1 Introduction .................................................................................................................................. 1 1.1 The Scope of the Study.........................................................................................................................................4 1.2 Terms and Definitions .......................................................................................................................................5 1.2.1 Violence against Children: .........................................................................................................................5 1.2.2 Types of Violence...........................................................................................................................................6 1.2.2.1 Physical Abuse.........................................................................................................................................6 1.2.2.2 Sexual Abuse ...........................................................................................................................................6 1.2.2.3 Emotional (Psychological) Abuse ..................................................................................................8 1.2.2.4. Neglect ......................................................................................................................................................9 1.3 Literature Survey ...................................................................................................................................................9 Chapter 2 Violence against Young Children in Turkey .................................................................... 18 2.1 Children in Turkey ............................................................................................................................................. 19 2.2 Existing Studies in Turkey .............................................................................................................................. 22 2.2 Procedures Applied in Turkey....................................................................................................................... 26 2.2.1 Actors Involved in Violence Incidences ............................................................................................ 26 2.2.2 Determination of Severity Degrees of Incidences ......................................................................... 28 2.2.3 Identifying the Actions Taken against the Incidences................................................................. 29 Chapter 3 : Methodology............................................................................................................................. 34 3.1 Two approaches for violence cost estimation ........................................................................................ 34 3.1.1 Prevalence-Based Method (Walby’s Approach) ............................................................................ 35 3.1.2 Incidence – Based Approach (Fang’s Method) ............................................................................... 36 3.2 Costs to be Included for Turkey Case ......................................................................................................... 37 3.2.1 Healthcare Costs ......................................................................................................................................... 38 3.2.2 Police and Justice Systems Costs .......................................................................................................... 38 3.2.3 Social Services Costs ................................................................................................................................. 38 3.2.4 Productivity Losses ................................................................................................................................... 38 3.3 A Linear Additive Model for Turkey Case ................................................................................................. 39 3.3.1 Cost Calculations......................................................................................................................................... 39 3.3.1.1 Rate of maltreatment for ages between 0-8 ........................................................................... 39 iii

3.3.1.2 Calculating Healthcare Services Costs....................................................................................... 40 3.3.1.3 Calculating Police Services Costs................................................................................................. 41 3.3.1.4 Calculating Justice System Services Costs ............................................................................... 42 3.3.1.5 Calculating Social Services Costs ................................................................................................. 43 3.3.1.6 Calculating Productivity Losses ................................................................................................... 45 3.3.2 Aggregation of Costs ................................................................................................................................. 49 Chapter 4 Results .......................................................................................................................................... 52 4.1

Service Expenditure Costs ....................................................................................................................... 54

4.1.1 Health Care Service Costs........................................................................................................................ 54 4.1.2 Police Costs ................................................................................................................................................... 55 4.1.3 Justice System Costs .................................................................................................................................. 57 4.1.4 Social Service Costs.................................................................................................................................... 58 4.2

Productivity Loss ......................................................................................................................................... 60

4.2.1 Fatal Cases ..................................................................................................................................................... 60 4.2.2 Non-Fatal Cases ........................................................................................................................................... 61 4.3

Aggregation of Costs ................................................................................................................................... 64

4.4

Other Long-Term Consequences ........................................................................................................... 65

Chapter 5 Cost Comparison ....................................................................................................................... 70 5.1

Obtaining the Unit Costs for Comparison .......................................................................................... 70

5. 2

Obtaining the Total Costs for Comparison .......................................................................................... 71

Chapter 6 Conclusion ................................................................................................................................... 74

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List of Figures Figure 1.1 Risk groups for VAC.....................................................................................................................................2 Figure 2.1Percentage of young children in some OECD countries for 2010 .......................................... 20 Figure 2.2 Infant mortality: deaths per 1000 births (OECD, 2012b)......................................................... 21 Figure 2.3 Child Poverty (OECD, 2012c) ............................................................................................................... 21 Figure 2.4 Child well-being ranks (OECD, 2009) ............................................................................................... 22 Figure 2.5 Levels of severity of violence against young children................................................................ 29 Figure 2.6 Flowchart of the procedures in case of a violence incidence .................................................. 31 Figure 4.1 Impacts of child abuse on committing crime ................................................................................. 66 Figure 4.2 Impacts of child maltreatment on income levels ......................................................................... 67 Figure 4.3 Impacts of child maltreatment on economic well-being........................................................... 67

List of Tables Table 1.1 Cost classifications in existing literature........................................................................................... 14 Table 2.1 Population data and demographic indicators for Turkey .......................................................... 19 Table 3.1 The extent of domestic violence and comparing classifications (Walby, 2004) ............... 36 Table 3.2 The estimated cost of domestic violence (Walby, 2004) ............................................................ 36 Table 3.3 The average lifetime cost per victim of fatal and non-fatal child maltreatment (Fang et.al., 2012) ........................................................................................................................................................................ 37 Table 3.4 Total lifetime costs of child maltreatment, 2008, United States (Fang et.al., 2012) ....... 37 Table 3.5 Statistics on different abuse types based on ages ......................................................................... 44 Table 3.6 Probability of being abused at a specific age ................................................................................... 44 Table 4.1 US child maltreatment data .................................................................................................................... 53 Table 4.2 Turkish child maltreatment data.......................................................................................................... 53 Table 4.3 Calculation of unit cost of healthcare service .................................................................................. 54 Table 4.4 Total cost of healthcare service............................................................................................................. 55 Table 4.5Calculation of number of children police in Turkey ...................................................................... 56 Table 4.6 Budget of Children Bureau ...................................................................................................................... 56 Table 4.7 Total police system cost ........................................................................................................................... 56 Table 4.8 Average unit cost of a lawsuit ................................................................................................................ 57 Table 4.9 Total justice system cost .......................................................................................................................... 58 Table 4.10 Unit cost of CPS.......................................................................................................................................... 58 Table 4.11 Annual cost of social services .............................................................................................................. 59 Table 4.12 Total and average costs of social services ...................................................................................... 59 Table 4.13 Unit cumulative and annual productivity loss cost per fatal case ........................................ 61 Table 4.14 Unit cumulative and annual productivity loss cost per non-fatal case .............................. 63 Table 4.15 Best and worst case total productivity loss costs ....................................................................... 64 Table 4.16 Summary of all costs of child maltreatment in Turkey............................................................. 65 Table 5.1 Unit Costs for UK and Turkey................................................................................................................. 71 Table 5.2 Total Service Cost for UK and Turkey based on Incidence numbers in Turkey ................ 72

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List of Abbreviations VAC

Violence against Children

WHO

World Health Organization

TSPCAN

Turkish Society for Prevention of Child Abuse and Neglect

TURKSTAT

Turkish Statistical Institute

OECD

Organization for Economic Co-operation and Development

USA

United States of America

EU

European Union

US

United States

CAPTA

Child Abuse Prevention and Treatment Act

UNICEF

The United Nations Childrenâ€&#x;s Fund

UN

United Nations

ICRW

International Center for Research on Women

CPS

Child Protective Services

MFSP

Ministry of Family and Social Policies

UK

United Kingdom

GDP

Gross Domestic Product

IQ

Intelligence Quotient

DGS

Directorate of General Security

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Chapter 1 Introduction Violence against children (VAC) has only become a recognized fact after “Battered Child Syndrome� was described by C. Henry Kempe in 1962 (Zambone et. al., 2012), although children all around the world had been victims of violence throughout the history. During the past three decades, an increasing number of studies have been carried out in diverse disciplines to uncover the extent and dimensions of the ongoing problem. Some improvements have been achieved but VAC still continues to be a vital problem affecting a huge number of children every year and everywhere.

Childhood violence victimization has significant consequences such as; death, physical / mental disability and health problems, low self-esteem, education failure, alcohol and drug abuse, further victimization and becoming an offender.

Risk factors for VAC can be aggregated under four nested groups (Figure 1.1) as risk factors related to child, to parent, to family and to community and society. The list of risk factors related to the child includes; premature births and unwanted or disabled child. The most important risk factors related to the parents are; being an adolescent or single parent, being exposed to violence, substance use, having poor parenting skills and physical/mental health problems. Family originated risk factors focuses around the following four factors which are; the size of the family, poverty, domestic violence and cultural issues. Community and society rooted factors hold a basic share and include; lack of legal, cultural and social support, racial or other discrimination (WHO, 2007).

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Community & Society Family Parent

Child

2 Figure 1.1 Risk groups for VAC

According to Population Reference Bureau (2012), world population in 2012 is estimated to be over 7 billion. 26 percent of this is the children who are under 15 years old. The population of less developed countries is five times more than developed countries. Since the number of children living under poverty conditions is very high in the world, VAC should be considered as a significant issue as poverty is a major risk factor.

Based on WHO (2007), the most risky group in VAC is 0-4 age group. WHO reports that 57000 incidences of VAC resulted with mortality. The ratio of deaths due to VAC is 1.8/100000 for girls and 2.2/100000 for boys in rich and developed countries while these rates are multiplied by 2 or 3 in developing countries (0.036 - 0.054 for girls, 0.044 - 0.066 for boys). The most frequent type of abuse is emotional maltreatment (70 percent – 80 percent), followed by physical abuse (13 percent – 75 percent), and sexual abuse (1 percent – 9 percent).

The documented VAC cases show significant differences, reflecting social norms and values (International Society for Prevention of Child Abuse and Neglect, 2006) in different regions of the world. However, it should be noted that no reliable evidence exists to indicate that some ethnic groups are more likely to maltreat their children than the others; the difference in numbers might be explained by regional factors such as poverty or ratio of adolescent mothers in the population. It should also be noted that, documented cases represent only the cases that are known to the authorities and they are too far from representing the true prevalence rates (WHO, 2007).

Consistent findings show that infants and young children face more fatal risks resulting from abuse and neglect compared to older children, so it is essential that VAC in early years of childhood should be treated with more care. Although young children are less likely to be

sexually abused they are more open to physical, psychological abuse and neglect including medical neglect.

Public, professional, and governmental awareness of VAC is still low in Turkey although Turkish Society for Prevention of Child Abuse and Neglect (TSPCAN) was founded in the early 1980‟s (Kesim, 1993). A study carried out in late 1999 estimates the expected number of reported suspect cases as 250 000 – 300 000 based on the figures calculated for the western developed countries (Oral et. al., 2001).

3 Turkey is a young country in terms of its age distribution. Figures of TURKSTAT related to year 2012 are as follows; the median age is 30.1 and children under age 15 constitutes 24.9 percent of the total population which is 75 627 384. This ratio corresponds to 18 857 179 children under 15 years (TURKSTAT, 2013). These figures show that in Turkey the need for urgent improvement in preventing actions on VAC is a vital issue.

According to the comparative figures given in the first OECD publication on six child wellbeing indicators (OECD, 2009), Turkey‟s performance is very low. The six dimensions considered in the child well-being study are material well-being, health and safety, educational well-being, family and peer relationships, behaviors and risks, and subjective well-being. Among 30 OECD countries some of the results related to Turkey are as follows; Turkey‟s performance is the worst in bullying estimates which are also considered as dimensions in child maltreatment. In child poverty, which is a very important VAC risk factor, Turkey again ranked as the worst performing country; and third worst country after USA and Mexico in teen births, which is known as a very critical risk factor as well.

Considering the fact that infants and young child between ages 0 and 8 face more risks of neglect, psychological abuse and physical abuse compared to older children, one expects to have higher number of neglect and abuse incidences for this age range. Although the risk of sexual abuse is still high for young children, it is less likely to take place when compared to older groups. Thus a large proportion of young children aged between 0 and 8 in Turkey are open to experience violence. The perpetrators of these violated children are mostly the members of their households and acquaintances whom they know and trust in most cases.

Studies show that strangers are less likely to take place in VAC especially for young children.

Although recent efforts to increase the awareness about the subject has significantly improved, the achievements and reported cases are still far from representing the true picture.

Hence, the utilization of economic data related to the impacts of violence against children can be used to highlight the significance of the situation. In this project the objective is to construct a framework for estimating economic costs of violence against young children in Turkey and to utilize it to calculate the estimated figures for the economic burden generated.

This chapter deals with the significance of estimating the cost of violence against children of ages 0-8 in Turkey and the scope of the report. The existing studies on prevalence of violence against children, and related topics such as, domestic violence, intimate partner violence, and similar types are summarized. The literature survey that takes place in the following pages covers not only the prevalence but also economic impacts of violence. The chapter also includes the terms used in the report and definition of violence against young children.

1.1 The Scope of the Study The consequences of violence on children include physical damage and injuries, disorders in mental health, loss of self-confidence, loss of adaptation skills to the social environment, possibility of reflecting violence to others in future and many others.

However the

complexity of violence lends itself to quantify these consequences via simple and direct approaches very seldom.

In order to be able to quantify and provide a clearer picture and span of violence on young children, utilizing economic data related to the above mentioned consequences is expected to have a highly significant value; That is, the crucial impacts of violence against young children is expected to become more tangible by associating them with their financial values.

In this project, the target is to construct a framework in order to be able to estimate economic costs of violence against young children in Turkey. This framework will be founded on definitions, classifications and rankings related to violence and cost concepts.

Here, to

encompass both direct and major indirect costs is a main objective since covering the major indirect costs is a difficult but important task which is fully neglected or only partially involved in existing studies.

The phase of data evaluation and estimation the financial values will be conducted by using a modified cost assessment approach based on traditional analysis methods. Once the economic consequences of violence experienced by young children in Turkey are estimated, the cost

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assessment approach that is utilized in this study will be adapted to an appropriate EU country to compare the results and to validate the outcomes of the study.

1.2 Terms and Definitions This sub-section defines the violence against children and the types of violence included in this report by referring to privileged group that have strong command on the child rights and child welfare in the literature.

1.2.1 Violence against Children: In literature, there exist several definitions for violence against children. Child Welfare Information Gateway (2008) claims that “any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act which presents an imminent risk of serious harm. In its report called “World Report on Violence and Health”, World Health Organization (2002) defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal development or deprivation”.

For the study, violence against child is defined as any act inducing physical, sexual, psychological damage or risk of damage to a child executed by the member of households, acquaintances and/or strangers. In this project violence against children of ages between 0 and 8 are considered. Here, we try to make a clear and short statement about violence definition due to the fact that we need to estimate the costs related to violence against young children in Turkey.

Violence against children can be examined in three main categories according to abuse/maltreatment type of the incidences. These are physical abuse, sexual abuse and/or exploitation and emotional (psychological) abuse, and they are explicitly examined in the following sections. The categorization process mentioned above is based on the classifications in existing studies.

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1.2.2 Types of Violence According to the Centers for Disease Control and Prevention in the US, “any act or series of acts of commission or omission by a parent or other caregiver that result in harm, potential for harm, or threat of harm to a child” is defined as child maltreatment. In the literature, violence against children is classified four main categories namely; physical abuse, sexual abuse, emotional maltreatment and neglect. In the following sub-sections, these types are described based on the existing literature, respectively.

6 1.2.2.1 Physical Abuse Physical abuse is defined as application of physical force against a child consciously which causes or carries a risk of physical damage or injury. According to CAPTA (Child Abuse Prevention and Treatment Act) such injury is considered abuse regardless of whether the caretaker intended to hurt child. Based on the definitions given by Child Welfare Information Gateway and US National Center for Injury Prevention and Control (these physical acts include punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand or any other object), burning, dropping, pushing, smothering and poisoning and etc.

Basically, physical abuse can be viewed as any harm or threat to health of a child by means of non-accidental physical injury as defined in laws of Alabama, the USA, while several states including Alaska, Arizona, California considers maltreatment to a child as an act or omission that has consequences in which there occurs a need for the child to be protected and provided.

1.2.2.2 Sexual Abuse The second category within the definition of violence against children is the sexual abuse/exploitation that children of ages between 0 and 8 experience. In its digest named “Domestic Violence against Women and Girls”, UNICEF (2000) defines sexual abuse as “coerced sex through threats, intimidation or physical force, forcing unwanted sexual acts or forcing sex with others”. This definition seems to be very broad as it covers the sexual abuse to women and girls of ages above 18. In fact, in the same digest, it is stated that incest or sexual abuse against children is the most invisible form of violence as it is considered taboo and not reported to the officials in many cases.

Child Welfare Gateway (2011) reports that The Federal Child Abuse Prevention and Treatment Act (CAPTA) defines sexual abuse as “the employment, use, persuasion,

inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, and in cases of caretaker or interfamilial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children or incest with children”. de Boer-Buquicchio, who is Deputy Secretary General of the Council of Europe defines sexual abuse and exploitation against children as “an attempt to the child‟s human dignity and a serious violation of children‟s rights, which causes irreparable damage to the victim‟s physical and mental health and often has life-lasting effect.

Council of Europe Convention on the Protection of Children against Sexual Exploitation and Sexual Abuse (2007) defines sexual abuse against a child as “engaging in sexual activities with a child who, according to the relevant provisions of national law, has not reached the legal age for sexual activities; engaging in sexual activities with a child where: use is made of coercion, force or threats; or abuse is made of a recognized position of trust, authority or influence over the child, including within the family; or abuse is made of a particularly vulnerable situation of the child, notably because of a mental or physical disability or a situation of dependence.”

The laws of the majority of the states in the USA also states sexual exploitation as a part of sexual abuse (Child Welfare Information Gateway, 2011). Sexual exploitation includes “allowing, permitting, or encouraging a child to engage in prostitution and allowing, permitting, encouraging or depicting a child for commercial purposes” as it is stated in Code 26-14-1 (1)-(3) of Alaska.

One of the clearest definitions for sexual abuse is given by laws of Arkansas in Code 12-18103. In this code, it is indicated that “sexual intercourse, deviate sexual activity, or sexual contact by forcible compulsion” is considered as sexual abuse. Here, sexual contact stands for “an act of sexual gratification involving touching, directly or through clothing, the sex organs, buttocks, or anus of a person or the breast of a female; encouraging of a child to touch the offender in a sexual manner; and the offender requesting to touch a child in a sexual manner”.

Due to the fact that we are interested in estimating the cost of violence against young children in Turkey, it is necessary for us to make a clear definition that makes it easy for us to identify the incidences in which children face sexual abuse or exploitation. Therefore, we can define

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sexual abuse against a child as any act of sexual contact with a child by any member of households, acquaintances and/or strangers including touching directly or indirectly to any part of the body of a child or make him/her touch the offender with a sexual manner, sexual intercourse or encouraging or forcing a child to join in any sexual activity.

1.2.2.3 Emotional (Psychological) Abuse Emotional or psychological abuse against children appears to be one of the most significant violence types, since it has crucial impacts on a child throughout his/her entire life. Child Welfare Information Gateway (2008) defines emotional abuse as “a pattern of behavior that impairs a child‟s emotional development or sense of self-worth”. The definition includes “constant criticism, threats, or rejection, as well as withholding love, support or guidance” as the acts constituting the emotional abuse. The acts such that blaming, belittling, degrading, intimidating, terrorizing, isolating, restraining, confining, corrupting, exploiting, spurning, or behaving in a manner that is harmful, potentially harmful or insensitive to the child‟s developmental needs, or can potentially damage the child psychologically or emotionally are drawing the range of psychological abuse. To illustrate the terrorizing, setting unrealistic expectations of the child with threat of loss, harm, or danger if the expectations are not met; and threatens or perpetrates violence against a child or a child‟s loved ones or objects (including toys, pets, or other possessions) (Kairy et al., 2002) According to UN Secretary General‟s World Report on Violence against Children (2006), psychological violence against a child is defined as insults, name-calling, ignoring, isolation, rejection, threats, manipulation, emotional indifference, and belittlement, witnessing domestic violence, and other behavior that can be detrimental to a child‟s psychological development and well-being.

In most of the laws of the states in the USA, the language used in emotional abuse definitions is based on “injury to the psychological capacity or emotional stability of the child evidenced by an observable or substantial change in behavior, emotional response, or cognition”.

As it can be concluded from the definitions above, this type of violence against children is the most difficult one to determine in terms of proof and identification. Child Welfare Information Gateway (2008) claims that child protective services cannot be involved in emotional or psychological abuse incidences without obvious evidence or harm, or mental injury to the children which can be detected in first appearance.

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1.2.2.4. Neglect Neglect could be defined as any act of parents or/and caregivers which creates inconvenient situations in the life and well-being of a child. Child Welfare Information Gateway (2011), states that neglect is the failure of caretaker to provide the child with food, shelter, education, health service, safety and etc. Department for Education and Skills (2006) defines neglect as “The persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to provide adequate food, clothing and shelter (including exclusion from home or abandonment); protect a child from physical and emotional harm or danger; ensure adequate supervision (including the use of inadequate care-givers); or ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a child's basic emotional needs.”

Office on Child Abuse and Neglect, Children's Bureau states that neglect may be harder to define or to detect than other forms of child maltreatment. This is because some forms of neglect are underestimated due to the cultural values and perceptions of communities (Child Welfare Information Gateway, 2008). The consequences of this failure could appear in various types. Thus, the neglect is classified as some categories by child welfare experts, namely physical neglect; medical neglect; inadequate supervision; environmental, emotional, and educational neglect. According to UNICEF (2006), neglect increases the rates of mortality and morbidity. Also the frequency of neglect of disabled children is higher than the others.

1.3 Literature Survey There are several studies concerning the prevalence, underlying reasons and consequences of violence against children and women, domestic violence, intimate partner violence and similar violence types. Finkelhor (1994), collects several researches that aim to examine sexual abuse on children and states the percentage of exposing to sexual abuse in girls as 7 to 36 percent, this number changes in boys to 3 to 29 percent. According to Lampe (2002), the ratio of physical violence incidences in which the victim is a child changes between 5 percent and 50 percent. According to UNICEF and the Body Shop (2006) approximately 133 to 275 million children all over the world experience a type of violence within their homes. In Child Helpline International‟s report on Violence against Children (2012), it is stated that five major

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forms of violence against children can be categorized as physical abuse, bullying, sexual abuse, neglect and emotional abuse whose prevalence rates in cases are 29 percent, 26 percent, 20 percent, 14 percent and 11 percent respectively. Child Welfare Information Gateway (2012) reports that the number of children that die due to abuse and neglect reaches to 1537 in 2010 in the USA, which means that a rate of 2.07 out of 100000 children die as a consequence of violence.

In literature, the costs associated with domestic violence, violence against women and children, intimate partner violence, and crime are categorized into several groups such as direct-indirect, tangible-intangible, and service based costs. The groupings in existing literature is shown in Table 1.1, in which the first column refers to the name and the author(s) of the studies and the second column is dedicated to the cost classification and brief definitions.

 Direct Costs to Individuals: affected by the The New Zealand family violence Economic Cost of Family  Cost to Government: Health Care, Welfare, Violence, Snively et al., Justice Law Enforcement 1994.  Cost to Others: Voluntary sector such as families, churches.

1,234,706 K$ (per survive & government)

 Social Services/Education Selected Estimates of the Costs of Violence Against  Criminal Justice  Labor/Employment Women, Center for  Health/Medical Research on Violence against Women and Children, 1995.

4.225.954.322 $

 Tangible Losses  Property damage and loss  Medical care  Mental health care  Police and fire services  Victim services  Productivity  Intangible Losses: Pain, suffering, and reduced quality of life.

more than $70 billion

Counting the Costs: Estimating the Impact of Domestic Violence in the London Borough of Hackney, Stanko et al., 1998.

     

5-7.5 million £

Measuring the Costs and Benefits of Crime and

 Direct Property Loses  Medical and Mental Health Care

Victim Costs and Consequences: A New Look, National Institute of Justice Research Report, Miller, et. al., 1996.

Police Cost Civil Justice Costs Housing Costs Refuge Cost Social Services Directorate Costs Health Costs

$450 billion of 1993

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Justice, Cohen, 2000.

The Economic and Social Costs of Crime, Brand and Price, 2000.

Australian Studies of the Economic Costs of Domestic Violence, Australian Domestic and Family Violence Clearinghouse, 2001.

Costs of Intimate Partner Violence against Women in the United States, US Department of Health and Human Services., 2003

Estimating the Costs &Impacts of Intimate Partner Violence in Developing Countries, A Methodological Resource Guide ICRW, 2004.

       

Victim Services Lost Workdays Lost Schooldays Lost Housework Pain & Suffering / Quality of Life Loss of Affection / Enjoyment Legal Costs Associated with Tort Claims Long-term Consequences of Victimization

 Economic / Social Costs: the full impact of crime on society, to individuals, households, institutions and businesses.  Opportunity Costs: to value the human, physical and financial resources that will be „freed up‟ for potential alternative uses when a crime is prevented.  Transfer Payments

59.9 billion £

 Tangible Costs: crisis services, accommodation services, legal services, income support and health/medical services costs.  Intangible Costs: replacing damaged or lost household items, replacing school uniforms and equipment when children change schools and settlement of a partner‟s outstanding debts, loss of workforce  Opportunity Costs: loss of employment promotion opportunities, quality of life.

Sample Based Study

 Direct costs: emergency department (ED) visits; hospitalizations; outpatient clinic visits; services of physicians, dentists, physical therapists, and mental health professionals; ambulance transport; and paramedic assistance.  Indirect Costs: lost productivity from both paid work, household chores and the present value of lifetime earnings for victims of fatal IPV (Intimate Partner Violence)

$5.8 billion

In Developed Countries;  Aggregate Costs including service-related costs, the value of economic output lost, and human and emotional costs  Employment/Labor Costs: market work and often explore the impacts of violence on absenteeism, productivity and earnings of women.  Service Costs  Non-monetary Costs : Human Costs such as loss of happiness, loss of quality of life, loss of self-esteem and satisfaction, life expectancy and experienced pain In Developing Countries;

Literature Review

 Health Service Costs

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 Employment/Labor Costs  Non-Monetary Costs

The Cost of Domestic Violence, Sylvia Walby, 2004.

The cost of domestic violence is partly borne by the state and the wider society, partly by the individual who suffers the violence, and partly by employers.

22,869 billion £ of 2001

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 All Services; Criminal Justice System, Health care, Physical &Mental health, Social services, Housing and refuges, Civil legal costs.  Employment costs  Human costs Costs of Intimate Partner Violence at the Household and Community Levels, International Center for Research on Women, 2004.

The costs & impacts of gender-based violence in developing countries: Methodological considerations and new evidence, Morrison and Orlando, 2004.

The costs of domestic violence against women in fyr Macedonia*, Gancheva et al., 2006.

 Direct Costs: the value of goods and services used in treating or preventing violence (included service related costs)  Non-Monetary Costs: human costs, including increased suffering, morbidity and mortality; abuse of alcohol and drugs; and depression.  Economic multiplier effects include such aspects as increased absenteeism; decreased labor market participation; reduced productivity; lower earnings, investment and savings; and lower intergenerational productivity.  Social multiplier effects; the impact of violence on interpersonal relations and quality of life.

$ 1.5 billion

 Direct costs: health care services, judicial services and social services.  Indirect Costs: loss of productivity from both paid work and unpaid work, the value of lifetime earnings for mortality.

4 billion dollars of 1995

 Direct costs are the actual money expenditures for goods and services used in dealing (treating or preventing) with domestic violence.

4, 986,779 Macedonia dinars of 2006

 Indirect costs are the value of goods and services lost because of domestic violence.

Valuing the Impacts of Domestic Violence: A review by sector∗, Alys Willman, 2009.

The cost of violence: Economic and Personal Dimensions of Violence against Women in Denmark, Helweg-Larsen et al., 2010.

The Economic And Social Costs Of Domestic Violence Against Women In Andalusia, Villagómez, 2010.

Domestic Violence: the intruder in the workplace and vocational integration, Leroy, 2011.

The Economic Dimensions of Interpersonal Violence, World Health Organization, 2011.

 Physical & Reproductive Health, Mental Health, Legal/Judicial, Housing/Shelter, Education, Employment and Productivity are examined in three sections that cost to individuals, community, and macro (society/state).

Literature Review

 Health care contacts costs due to injury by violence  Attributable health care costs  Labor market: Income impact, Production loss  Judicial system costs: Police reported physical violence, Police reported threats, Domestic disputes, Restrictions imposed by police, Police reported rape  Shelters  National Action Plans Cost

21 million Denmark Krone

    

2,356.8 million Euro

Social Cost Physical & Mental Health Cost Judicial Cost Cost to Employment Cost to Children

13

 Direct medical costs: A&E treatment, hospitalization, general medicine and psychiatric care, medication use;  Non-medical direct costs: civil justice, criminal justice, prison, local and national police activities;  The costs of direct social consequences: emergency shelter, housing, various benefits, sick pay, preventive measures;  The costs of indirect consequences: lost production due to death, sickness and imprisonment.

2,472 million Euro

 Direct costs and benefits; costs of legal services, direct medical costs, direct perpetrator control costs, costs of policing, costs of incarceration, costs of foster care, private security contracts, economic benefits to perpetrators  Indirect costs and benefits; lost earnings and lost time, lost investments in human capital, indirect protection costs, life insurance costs, benefits to law enforcement, productivity domestic investment, external investment and tourism, psychological costs, other nonmonetary costs.

Literature Review

The Socio-Economic Cost of Violence against Women: A Case Study of Karachi, Social Policy and Development Center, 2012.

 Individual Cost  Direct Cost: Medical cost, police cost, judicial cost, cost on emergency, accommodation.  Indirect Cost: Opportunity cost or lost earnings.  Institutional Cost  Hospital/Clinic  Civil/Criminal Courts  Law Enforcement Agencies  Welfare Organizations  Employers/Business

Table 1.1 Cost classifications in existing literature

Total Cost is not given

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References Australian Domestic and Family Violence Clearinghouse, 2001, Australian Studies of the Economic Costs of Domestic Violence, Australian Domestic and Family Violence Clearinghouse.

Brand, S., Price, R., 2000, The economic and social costs of crime, Economics and Resource Analysis, Research, Development and Statistics Directorate Home Office Research Study 217, UK. Center for Research on Violence against Women and Children, 1995, Selected Estimates of the Costs of Violence against Women, Canada.

Centers for Disease Control and Prevention in US, available http://www.cdc.gov/violenceprevention/childmaltreatment/definitions.html

online

at

Child Helpline International, 2012, Violence Against Children: Child helpline data on abuse and violence. The Netherlands.

Child Welfare Information Gateway, 2008, Child Abuse and Neglect. Washington, DC, the USA. Child Welfare Information Gateway, 2011, Definitions of Child Abuse and Neglect.

Washington, DC, the USA. Child Welfare Information Gateway, 2011, About CAPTA: A legislative history. Washington, DC: U.S. Department of Health and Human Services, Children's Bureau.

Child Welfare Information Gateway, 2012, Child Abuse and Neglect Fatalities 2010: Statistics and Interventions. Washington, DC, the USA. Cohen, M. A., 2000, Measuring the costs and benefits of crime and justice Council of Europe Convention on the Protection of Children against Sexual Exploitation and Sexual Abuse (2007), Lanzarote, Spain.

Definitions of Child Abuse and Neglect, the Child Welfare Information Gateway State Statutes Series, at www. childwelfare.gov/systemwide/laws_policies/statutes/defi ne.cfm Department for Education and Skills, 2006, Working Together to Safeguard Children: a guide to inter-agency working to safeguard and promote the welfare of children, London, UK. Duvvury, N., Grown, C., Redner, J., 2004, International Center for Reseacrh on Women, Estimating the costs and impacts of intimate partner violence in developing countries, International Center for Reseacrh on Women, Washington D.C. Finkelhor, D.,1994, The international epidemiology of child sexual abuse. Child Abuse and Neglect, 18(5): 409-417.

Gancheva, Y., Petrova, P., Sekuloska, H., Stojanovik-Aleksoska, K., 2006, The costs of domestic violence against women in fyr. Macedonia, Macedonia.

Helweg-Larsen, K., Kruse, M., Sorensen, J., Bronnum-Hansen, H., 2010, The cost of violence: Economic and personal dimensions of violence against women in Denmark, National Institute of Public Health, University of Southern Denmark, Rockwool Fund Reseacrh Unit, Denmark.

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International Center for Research on Women, 2004, Costs of Intimate Partner Violence at the Household and Community Levels, International Center for Research on Women, Washington DC. International Society for Prevention of Child Abuse and Neglect, 2006, World perspectives on child abuse, 7th ed. Chicago, the USA. Kairys, S. W., Johnson, C. F., and Committee on Child Abuse and Neglect, 2002, The Psychological Maltreatment of Children –Technical Report, 109/4 PEDIATRICS e68.

Kesim, N. Z.,1993, Physical Abuse in Children: A forensic Medicine Evaluation. N.Z. Kesim&o.Polat (Eds.) Physical Abuse in Children. Postgraduate thesis (pp.34-45, 67-74) Marmara University, Istanbul, Turkey Lampe, A., 2002, Prevalence of sexual and physical abuse and emotional neglect of children in Europe. Z Psychosom Med Psychother, 48(4):370-380.

Leroy, 2011, Domestic violence: the intruder in workplace and vocational integration, Confederation of Family Organizations in European Union.

Miller, R., Cohen, M. A., Wiersema, B., 1996, Victim costs and consequences: a new look, U.S. Department of Justice, Office of Justice Programs, National Institute of Justice Research Report.

Morrison, A., Orlando, M. B., 2004, The Costs and Impacts of Gender-based Violence in Developing Countries: Methodological Considerations and New Evidence, World Bank, Washington, DC. OECD, 2009, Comparative Child Well-being across the OECD, Doing Better for Children, Chapter 2, 21-63.

Oral, R., Can, D., Kaplan, S., Polat, S., Ates, N., Cetin, G., Miral, S., Hanci, H., Ersahin, Y., Tepeli, N., Bulguc, A. G., Tiras, B., 2001, Child abuse in Turkey: an experience in overcoming denial and a description of 50 cases, Child Abuse & Neglect 25, 279-290.

Palus, V. J., 2011, Risk factors and services for child maltreatment among infants and young children, Children and Youth Services Review, Maltreatment of Infants and Toddlers Volume 33, Issue 8, 1374-1382.

Population Reference Bureau, 2012, 2012 World Population Data Sheet, Washington, the USA.

Snively, S., 1994, The New Zealand economic cost of family violence, Coopers and Lybrand, New Zealand.

Social Policy and Development Center, 2012, The socio-economic cost of violence against women: A case study of Karachi, Gender Reserach Programme Reserach report No. 5, Karachi, Pakistan.

Stanko, E. A., Crisp, D., Hale, C., Lucraft, H., 1998, Counting the costs: estimating the impact of domestic violence in the London Borough of Hackney, Crime Concern, Surrey, UK. TURKSTAT, 2013, Turkish Statistical Institute news release, no. 13428.

UN Secretary Generalâ€&#x;s World Report, 2006, Violence against Children.

UNICEF and The Body Shop. (2006). Behind Closed Doors. New York, NY: UNICEF UNICEF, 2000, Domestic Violence against Women and Girls. Florence, Italy.

UNICEF, 2006, World Report on Violence against Children. Geneva, Switzerland.

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US Department of Health and Human Services, 2003, Costs of intimate partner violence against women in the United States, US Department of Health and Human Services, Atlanta, Georgia.

US National Center for Injury Prevention and Control, http://www.cdc.gov/ViolencePrevention/childmaltreatment/definitions.html

available

at

Villagomez, E., 2010, The economic and social costs of domestic violence against women in Andalusia, United Nations Economic Commission for Europe, Conference on European Statististicians, Geneva.

Walby, S., 2004, The Costs of Domestic Violence, Women and Equality Unit, Department of Trade and Industry, London.

WHO, 2007, Preventing child maltreatment in Europe: a public heath approach: Violence and Injury Prevention, Rome, Italy.

Willman, A., 2009, Valuing the Impacts of Domestic Violence: A review by sector, Social Development Department, The World Bank, Washington D.C. World Health Organization, 2002, World Report on Violence and Health. Geneva, Switzerland.

World Health Organization, 2011, The Economic Dimensions of Interpersonal Violence, Department of Injuries and Violence Prevention, World Health Organization, Geneva.

Zambone, M.P., Jacintho, A.C., Medeiros, M.M., Guglielminetti, R., Marmo, D.B.,2012, Domestic violence against children and adolescents: a challenge, Rev Assoc Med Bras JulAug; 58(4):465-71.

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Chapter 2 Violence against Young Children in Turkey Signing the United Nations Convention on the Rights of the Child, Turkey admits to correspond to the issues declared in article 19 of the convention, which is: 1. States Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child.

2. Such protective measures should, as appropriate, include effective procedures for the establishment of social programmes to provide necessary support for the child and for those who have the care of the child, as well as for other forms of prevention and for identification, reporting, referral, investigation, treatment and follow-up of instances of child maltreatment described heretofore, and, as appropriate, for judicial involvement.

As well as this, Turkey also accepts to protect children against violence according to the Principle 9 of Universal Declaration of Child Rights, that is: The child shall be protected against all forms of neglect, cruelty and exploitation. He shall not be the subject of traffic, in any form.

The child shall not be admitted to employment before an appropriate minimum age; he shall in no case becaused or permitted to engage in any occupation or employment which would prejudice his health or education, or interfere with his physical, mental or moral development.

Turkey also admits to be a party for European Convention on the Exercise of Children Rights.

Therefore, Turkey is responsible with providing the precautions and services necessary for preventing any kind of violence applied to children.

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The first part of this chapter is dedicated to some demographical facts and existing studies on violence against young children in Turkey. Most of the violence works in Turkey are either descriptive incidence based studies including; triggering factors, violence type frequency distributions, perpetrator characteristics or prevalence based surveys directed to older children and adults carried out to estimate the figures related to VAC. Rest of Chapter 2 is about the official procedures performed and actors involved in a case of violence incidence in Turkey.

2.1 Children in Turkey

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According to TURKSTAT 2013 data, the total population of Turkey is 74 885 million in 2012, and this number is projected to be 85 407 million in 2025. The total number and percentage of young people under age 20 are 25 308 000 and 33.8 percent respectively. The number of children under 10 years old is 12 567 000 and they represent 16. 8 percent of the whole population. Expectation of life at birth is 72.0 for men and 77.2 for women and population increase rate is 12.5 ‰ per year. Table 2.1 illustrates the population data for years 2010, 2012 and projected data for 2025 for Turkey.

Population (1000) Total 0-9 0-19 Expectation of life at birth (years) Total Men Women Population increase rate (‰) Population (1000) Total 0-9 0-19 Expectation of life at birth (years) Total Men Women Population increase rate (‰)

2010

2012

2025

73 003 12 564 25 229

74 885 12 567 25 308

85 407 12 417 25 002

74.3 71.8 76.8 13.0 2010

74.6 72.0 77.2 12.5 2012

75.9 73.1 78.9 7.7 2025

73 003 12 564 25 229

74 885 12 567 25 308

85 407 12 417 25 002

74.3 71.8 76.8 13.0

74.6 72.0 77.2 12.5

75.9 73.1 78.9 7.7

Table 2.1 Population data and demographic indicators for Turkey

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As demonstrated in Figure 2.1, the percentage of young children in Turkey is quite high when compared with other OECD countries (OECD, 2012a). Although it is expected to fall down to 14.5 percent in 2025, it will still exceed the current population mean of these countries.

Studies all over the world indicate that young children are at greatest risk of physical violence, emotional violence and neglect although sexual abuse is more likely to occur at older ages. The short and long term consequences are usually vital for the abuse victims of all ages however

victimization would generate more dangerous results for young children 20

since they are more vulnerable and need to be protected by elders.

Consequently, Turkey has to be very sensitive and has to proceed very quickly for the wellbeing of her young population.

25 20 15 10 5

Denmark Finland Norway Spain Sweden Hungary Austria Germany Czech Republic France Switzerland Netherlands Belgium Irland Greece United Kingdom Luxembourg Poland Italy Portugal USA Turkey Mexico

0

Figure 2.1Percentage of young children in some OECD countries for 2010

Comparison of Turkey and some OECD countries for important indicators or risk factors related to child abuse are given in Figure 2.2, Figure 2.3 and Figure 2.5 representing infant mortality, child poverty rates and child well-being scores respectively.

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25 20 15 10 5 Denmark Finland Norway Sweden Hungary Austria Germany Czech Republic France Switzerland Netherlands Belgium Irland Greece United Kingdom Luxembourg Poland Italy Portugal USA Turkey Mexico

0

21

Figure 2.2 Infant mortality: deaths per 1000 births (OECD, 2012b)

Figure 2.3 Child Poverty (OECD, 2012c)

According to OECDâ€&#x;s child well-being report (2009), Turkey ranked as 30th in material wellbeing, 30th in educational well-being, 30th in health and safety, 29th in risk behaviors and 12nd in quality of school life amongst the 30 OECD countries.

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80 70 60

Quality of school life

50

Educational well-being

40

Material well-being

30

22

20 10 0

Figure 2.4 Child well-being ranks (OECD, 2009)

In Figure 2.4, Turkey is evaluated only via three dimensions on child well-being namely, Material Well-being, Educational Well-being and Quality of School Life. For two former dimensions Turkey scores the lowest among all these countries as she does in the evaluations of previous years. However the latter, Quality of School Life score is surprisingly too high (second highest following Norway) and might be considered an indicator of a significant positive change as long as we do not examine the case in details. There are two factors contributing to this dimension and one of them is “bulling”, which is also considered to be an abuse behavior. Unfortunately when “bulling” is individually examined Turkey‟s score turns out to be the worst among all again. The fact that Turkey has a high score in Quality of School Life is an interesting issue to be analyzed in details whereas she has the lowest scores in Material and Educational Well-beings.

2.2 Existing Studies in Turkey Even there have been several efforts for molding public opinion about the significance of child maltreatment, to our knowledge; estimation of the cost of violence against children has not been yet examined in Turkey. Most studies about the topic are related with the prevalence of violence against children and women, its reasons, its impacts on human beings and society and the ways to prevent it. The studies could be categorized in three groups. The first group is consisting of studies whose research populations are medically reported cases. The second group covers the studies related with characteristics of the perpetrators and the final group includes all other studies, typically based on local and regional surveys.

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This and the following two paragraphs are dedicated to the first group of existing studies in Turkey. Being the first clinical multidisciplinary child abuse and neglect team in Turkey, Oral et. al., (2001) record child maltreatment cases at five hospitals in Izmir province. Among 50 cases, in which the age distribution is 9.2 ± 6.7 years, 60 percent of victims experience physical abuse, while this number turns to be 18percent for emotional abuse, 26 percent for sexual abuse, and 20 percent for neglect. Referring to Johnson, (1990), Oral et. al. claim that there should be approximately 250 000 – 300 000 child maltreatment cases.

Tıraş et. al, (2009) try to point out the prevalence and severity of child abuse in Turkey via analyzing 215 recorded cases. They claim that in 39.5 percent of cases, the victim faced neglect; while this amount becomes 29.8 percent for physical abuse, 21.4 percent for psychological abuse, and 9.3 percent for sexual abuse. They report that 55.3 percent of cases are followed-up by Child Protective Services. They also state that 17.8 percent of perpetrators are acquitted while 11.9 percent of perpetrators are convicted. Ozbaran et. al., (2009) examined psychiatric disorders in 20 sexually abused children between ages 5 to 16. They point out that those who are sexually abused are more likely to show symptoms of psychiatric disorders than those who do not face sexual violence.

Koç et. al., (2012) claims that the rate of sexual abuse takes place 49 percent, physical abuse is 25 percent, and emotional abuse rate is 11 percent, within the 89 child abuse and neglect cases for 12 months. The fathers are offenders in 67 percent of the cases of physical abuse and in 9 percent of the cases of sexual abuse.

This and the next paragraph are related with the second groups of studies. In a report by General Directorate of Family and Social Researches (TURKSTAT, 2006), it is stated that 17 percent of fathers and 35 percent of mothers who have children ages between 3 and 17 declare that they sometimes applied physical force for punishment. In the report, it is also mentioned that 9.3 percent of parents perform physical punishment, 7.3 percent of them scared their children, and 31.8 percent shout at their children.

Ayan and Kocacık (2009) examine the domestic violence that primary school students experience. The study is performed in Sivas province in seventy primary schools with students of ages 12-14. They find that the perpetrator of violence is the mother in 54 percent of the cases whereas father is responsible for the violence with a percentage of 46. The violence between the parents seems to be the common reason for both mother and father to

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apply violence against their children. The most significant factor for a mother to perform violence is related with her education level while this variable becomes the sex of the child for the father. The rest of this section is about the studies related with third group.

Zoroglu et. al. (2003), examined 862 high school students in Istanbul province to analyze suicide attempt and link it with child maltreatment. 83 of 862 students attempt suicide and 42 percent of them face physical abuse, 50 percent of them experience emotional abuse, 43.2 percent are neglected and 20.3 percent are sexually abused. The percentage of those who have attempted suicide and have faced at least one type of violence is found to be 79.7. The control group consists of 735 students who have not attempted suicide. Zoroglu et. al. (2003), claim that 10.3 percent of them experience physical abuse, 11.8 percent of them are emotionally abused, 13.2 percent are neglected, and 6.1 percent are sexually abused. The percentage of being exposed to at least one type of violence in this group is 29.3.

Alikasifoglu et. al. (2006), applied a questionnaire on 1871 female high school students in İstanbul province. They state that 13.4 percent of the respondents are sexually abused and 93 percent of the perpetrators are male. According to their findings, the incest ratio reaches to 1.8 percent.

Page and İnce (2008) examine the domestic violence in Turkey and claim that those who were exposed to violence in their childhoods tend to be a victim perpetrator in their adult lives.

They also argue that 25 to 75 percent of women who are victims of domestic violence experienced physical or sexual abuse in their childhoods.

In her master thesis on impacts of domestic violence on male children to commit a crime of performing violence, Ovacık (2008) states that even though there exist no significant relation between being exposed to domestic violence and committing a crime of violence, it is observed that the number of male children who committed a crime and were a violence victim is so high that it will not be proper to neglect.

According to a report of Turkish General Directorate of Women Status (T.C. Başbakanlık Kadın Statüsü Genel Müdürlüğü, 2009), the percentage of women who experienced physical violence at any part of their lives are found to be 39, and this percentage is claimed to be 15 for sexual violence. 7 percent of women who were victims of sexual violence assert that the incidences occurred while they were at the ages under 15.

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According to a report on child abuse and domestic violence in Turkey which was carried out

by Premiership Social Services and Society for the Protection of Children (Başbakanlık Sosyal Hizmetler ve Çocuk Esirgeme Kurumu and UNICEF Türkiye, 2010), 56 percent of the children of age 7-18 are witnessing physical violence while this amount is 49 percent for emotional violence and 10 percent for sexual abuse. As well as these values, 25 percent of the children of the same age group are victims of neglect, 51 percent are exposed to emotional violence, 43 percent are exposed to physical violence and 3 percent are victims of sexual abuse.

25

A report on child health in Turkey (Halk Sağlığı Uzmanlığı Derneği Çocuk Sağlığı Çalışma Grubu, 2011) treats experiencing violence as an important health issue for children. In this report, it is suggested that 15 to 75 percent of children in Turkey are exposed to physical violence while this amount reaches to 20 percent for sexual abuse cases. It is also claimed that in a study performed among 26009 children of ages 13-18, the prevalence of physical violence is found to be 22 percent, oral violence to be 53 percent, emotional violence to be 36 percent, and sexual violence to be 16 percent. By referring to Yılmaz (2008), the same report also states that the results of a study accomplished in İzmir province with 1607 students of ages 12-17, the prevalence of physical abuse is 48 percent, sexual abuse is 8 percent, emotional abuse is 60 percent, and neglect is 17 percent.

In the report of UNICEF (2011) on status of children in Turkey claims that at least 10 percent of children whose ages between 7 and 18 exposed to one type of sexual abuse and in 1 percent of these cases, children were forced to watch pornographic materials and in 0.05 percent of the cases, they were forced to touch or forced to make touch. Güner et.al, (2010) reflect that between 13.9 and 87 percent of children are exposed to physical abuse while Güler et al, (2002) suggest that 46 percent of children experience neglect and abuse based on Prime Minister Family Research Foundation.

Koçak (2012) asserts that the ratio of children that are exposed to physical abuse reaches to 40 percent while this ratio is 10 percent for the prevalence of sexual abuse. However, only 0.2 percent of the physical violence and 0.1 percent of sexual violence are reflected to official departments, in fact, this may be seen as a proof for the gap between the number of actual and reported incidences.

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2.2 Procedures Applied in Turkey The problem to be examined in this project is the estimation of cost of violence against young, which we define as any act inducing physical, sexual, psychological damage or risk of damage to a child executed by the member of households, acquaintances and/or strangers, children in Turkey. In order to identify the borders of the study, in this section the actors that are involved in violence incidences, the actions taken against the incidences and the types of incidences with their associated severity degrees are defined. From now on, we will call 26

violence instead of violence against a child for the purpose of easiness.

2.2.1 Actors Involved in Violence Incidences The actors that are involved in a violence incidence are child/victim, perpetrator, parent/caretaker, household members, and staff at medical, police and justice, social and transportation services as well as the nongovernmental organizations. These actors are not necessarily being involved in the incidences as there exist several types of cases of different severities which require diverse actions. The actorsâ€&#x; participations in the incidences are defined below explicitly. i) Child/Victim: The child or the victim is the person (of ages between 0 and 8 in this study) who experiences any form of violence described in the former section. ii) Perpetrator: Perpetrator is the person or a group of people who can be or which is composed of household member(s), stranger(s) or familiar(s) of any age (there are cases in which a child is applying violence against another child) and gender. iii) Parent/Caretaker: Parent or caretaker is the person or a group of people legally responsible for the child. Parent/Caretaker can be mother, father, a brother/sister of age +18, or someone who is seen as custodian to the child by laws. In some cases parent/caretaker and perpetrator definitions collide if parent/caretaker is committing violence against child/victim. iv) Household Members: Household members are the people sharing the same house or accommodation area (might be a dormitory and etc.) except the parent/caretaker and perpetrator. These people are involved in violence incidences as witnesses, reporters, and/or the people who are affected economically or psychologically from the violence act occurring at their house or accommodation area.

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v) Medical Services Staff: Medical services staff are the people at a hospital, medical clinic, ambulance, and etc. who are capable of taking care of the child/victim medically, or they are the people helping the ones that are mentioned here to perform their tasks to nurse the victim.

These people are basically doctors, nurses, psychiatrists, psychologists, dentists, medical technicians, laboratory assistants, secretariats, administrators and the other employees at the medical center involved in the incidence. Medical services staff may not be involved or may be partly included in a violence incidence according to its type and severity. vi) Police and Justice Services Staff: Police and justice services staff are the people who will take place in a violence incidence in case of a protective or legal action is necessary. These people are policemen and policewomen, judges, lawyers, public prosecutor, friends of the court, forensic specialists, and secretariats administrators and other employees at the police station and courthouse. Police and justice services staff may not be involved or may be partly included in a violence incidence according to its type and severity. vii) Social Services Staff: Social services staff are the people who are involved in a violence incidence in case of an action related with the replacement of the victim to a social services facilities or rehabilitation phase for the victim. These people are the social service experts, counselors, administrators and employees at social service departments of the government.

Social services staff may not be involved or may be partly included in a violence incidence according to its type and severity. viii) Transportation Services Staff: These are the people concerned with the transportation of the victims to facilities where they get medical, police and justice, and/or social services.

They are mainly ambulance or social services drivers, or any other driver providing the necessary transportation operation. ix) Nongovernmental Organizations Staff: These people are the counselors, experts and other employees working in a nongovernmental organization which may be involved in a sheltering or rehabilitation process of a victim independent from governmental social services.

Nongovernmental organizations staff may not be involved or may be partly included in a violence incidence according to its type and severity.

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2.2.2 Determination of Severity Degrees of Incidences After making a clear statement about violence against young children, abuse is divided into four main categories based on maltreatment type of incidence namely physical abuse, sexual abuse, psychological (emotional) abuse and neglect.

The following step is introducing severity definitions of maltreatment, scaling these categorical types, and measuring the severities of incidences. In this study, severities of incidences are used to find out a tangible weight of the abuse that defined the previous section for Turkey case. By this way, a risk matrix could be conducted with each type of maltreatment. In addition, the severity of incidences is constituted by levels of recognition which is helpful to construct the flowcharts of involved actors and sequence of bureaucracy.

As conclusion, the cost calculation of each incidence type is clearly overcome by these flowcharts.

To generalize, severity of maltreatment could be defined as the impact of the incidence on the victim that denotes the dimensions of the abuse. In several researches, measuring the severity of incidences is accomplished by the survey to the victim. According to, Read 1998, the longitude severities of abuse are classed as; suicidal, days in hospital, mental health act, intensive care unit. Another scaling about severity of abuse is given by, “the 4th National Incidence Study of Child Abuse and Neglect�, as severity of harm suffered which are fatal, serious harm such as life-threatening condition, long-term impairment or professional treatment aimed to prevent long-term effects, moderate harm includes injuries in observable form, and inferred harm which are not observable. On the contrary, the aim of this study is to reflect the current severity levels of maltreatment and increase the observability of the incidences where the major proportion is still hidden and prevents us to go for the big picture.

Thus, in this research the conceptual iceberg model shown in the following figure of the 1 st National Incidence Study of Child Abuse and Neglect (Sadlak, 2001) is taken as a base to reveal the classes of the severity of maltreatment.

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Level I

Level II

Level III

Level IV

29

Level V Figure 2.5 Levels of severity of violence against young children

In other words, the recognition of incidence, overestimate the type of abuse, by the professionals and non-professionals in the community is using as the severity of the incidences. The severity of maltreatment would have five levels namely (Figure 2.5), Level V; Not Known to Anyone (to be a secret between victim and perpetrator), Level IV; Known to individuals (neighbors, relatives, also parents), Level III; Known to civil servants, Level II; Known to police, courts, public health agencies, Level I; Known to official Child Protective Services (CPS). In Turkey case, child protective services are brought together under the Ministry of Family and Social Policies (MFSP). In fact the violent cases are reported only in the first three levels. As one goes down from Level I to Level V in the pyramid of Figure 2.5, the observability of the violent act to the society decreases.

2.2.3 Identifying the Actions Taken against the Incidences After determining the types of incidences and their associated severity degrees, the actions that are taken against these incidences are identified briefly. Since the violent act is not known to any official organization and it is kept as a secret between the victim and the perpetrator or just known to a group of people but not reported and since no medical or police action is taken at incidences of Severity Level 4 and 5, these incidences are neglected here, as their number and costs are almost impossible to be estimated. The following parts are dedicated to the actions taken against the cases, or the procedures followed in incidences of severity levels

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3, 2, and 1. These actions and the procedure are visualized in a single flowchart in Figure 2.6 (In Figure 2.2, “Y” stands for “Yes”, “N” stands for “No”, and the dashed regions named as 1 and 2 correspond to the actions and procedures applied within that area which are created for traceability).

The procedure starts with the occurrence of violent act which is known to civil servants. The victim may be brought to hospital, in which case the civil servants in the hospital inform the police as an obligation. When the police are involved in the situation, they summon an advocator and social investigator, and inform public prosecutor. The advocator and social investigator are legally needed for taking testimony phase. Then the social investigator prepares a report on victim‟s psychological situation, his/her social environment and the seriousness of the case, which is called “taking the photo of the victim”. If the social investigator is suspicious about sexual abuse, the victim is brought back to hospital for examination.

Whether the victim is brought back to hospital for medical examination or not, then he/she is brought to public prosecutor, which starts the investigation phase. The public prosecutor then decides on taking any precaution for the victim such as education, medical treatment, and etc. except accommodation. If such precaution necessary, it is taken by the concerned department.

Then, the public prosecutor decides whether to send the victim back to his/her living place or to Child Protective Services (CPS). If there exist enough evidences and the perpetrator is above 18, a lawsuit is filed in aggravated felony court. If the perpetrator is between 12 and 18, no lawsuit can be filed against a child under age 12 according to Turkish Legislation. After the court‟s final decision, the victim can be taken by Child Protective Services (CPS) or send back to his/her living place.

If there exists no evidence that the victim faced sexual abuse, the victim is brought to public prosecutor and the investigation phase that is described in the former paragraph is taken into consideration. The only difference is that if there is a necessity to file a lawsuit, perpetrator is above 18 and the crime involves serious wounding, a lawsuit is filed in court of first instance.

If the perpetrator is above 18 and there is no evidence of a serious wounding the lawsuit is filed in lower criminal court. If the perpetrator is between 12 and 18, the lawsuit is filed in juvenile felony court. The procedure finishes with the decision of accommodation place for victim.

Yeditepe University

30

Violent Act

Victim is brought to hospital

Victim is brought to police

Civil cervants inform police

Y

Hospitalization necessary

Police summans advocator & social investigator and informs public prosecutor

N Back to hospital for examination

Social investigator prepares a report

N

1

Y

Doubt for sexual abuse

1

Sent victim to hospital

Victim brought to public prosecutor & investigation starts

N

Y

Precaution needed

Y

Perpetrator above 18

Precaution taken (except accomodation)

N Serious wounding on victim

N File lawsuit in lower criminal court

Safe to send the victim back

Y

Y File lawsuit in juvenile felony court

File lawsuit in court of first instance

Send victim back to his/her living place

N Send victim to CPS department

2 Victim taken under protection of CPS

Y Send the victim to CPS

Enough evidence to file lawsuit

STOP

Y

N Send the victim back to his/her living place

N

Perpetrator above 18

Y

File lawsuit in aggravated felony court 2

Figure 2.6 Flowchart of the procedures in case of a violence incidence

N File lawsuit in juvenile aggravated felony court 2

References Alikasifoglu, M., Erginoz, E., Ercan, O., Albayrak-Kaymak, D., Uysal, O., Ilter, O., 2006, Sexual abuse among female high school students in Istanbul, Turkey, Child Abuse & Neglect, 30 247-255.

Ayan, S., Kocacık, F., 2009, Çocuk İstismarı: Sivas (Türkiye) Örneği, Uluslararası İnsan Bilimleri Dergisi, Cilt 6, Sayı 1, (953-968).

Başbakanlık Sosyal Hizmetler ve Çocuk Esirgeme Kurumu, UNICEF Türkiye, 2010, Türkiye‟de Çocuk İstismarı ve Aile içi Şiddet Araştırması: Özet Rapor, Ankara, Turkey.

BM Çocuklara Yönelik Şiddet Araştırması /Çocuklara Yönelik Şiddet Dünya Raporu, 2006; Convention on the Rights of Children, 1990, available online at: http://www.cocukhaklari.gov.tr/condocs//mevzuat_eng/UNConCR.pdf.

Declaration of the Rights of the Child G.A. res. 1386 (XIV), 14 U.N. GAOR Supp. (No. 16) at 19, U.N. Doc. A/4354 (1959).

European Convention on the Exercise of Children's Rights, 1996, available online at: http://www.cocukhaklari.gov.tr/condocs//mevzuat_eng/EuConCR.pdf.

Güler, N., Uzun, S., Boztaş, Z., Aydoğan, S., 2002, The Behaviours of Mothers who Perform Physical or Emotional Abuse/Neglect of Their Children, Cumhuriyet Üniversitesi Tıp Fakültesi Dergisi, 24 (3), 128-134.

Güner, S. I., Güner, S., Sahan, M. H., 2010, Çocuklarda sosyal ve medical bir problem; istismar, Van Tıp Dergisi, 17 (3), 108-113.

Halk Sağlığı Uzmanlığı Derneği Çocuk Sağlığı Çalışma Grubu, 2011, Türkiye‟de Çocuk Sağlığının Durumu, Ankara, Türkiye.

Koç, F., Aksit, S., Tomba, A., Aydın, C., Koturoğlu, G., Korkmaz Çetin, S., Aslan, A., Halıcıoğlu, O., Erşahin, Y., Turhan, T., Çelik, A., Şenol, E., Kara, S., Solak, U., 2012, Demographic and clinical features of child abuse and neglect cases: one-year experience of The Hospital-Based Child Protection Team of Ege University, Turkey, Turkish Archives of Pediatrics, 47, 121-125.

Koçak, M., 2012, Çocuk İstismarı: İhbar ve Soruşturma Mekanizmaları, Uluslararası Aile Konferansı II: Ail eve Şiddet – Tebliğler (283-301).

OECD, 2009, Comparative Child Well-being across the OECD, Doing Better for Children, Chapter 2, 21-63.

OECD Social Policy Division - Directorate of Employment, Labor and Social Affairs, 2012a, Population by age of children and young adults, and youth-dependency ratio, available online at http://www.oecd.org/els/family/SF1.4%20Population%20by%20age%20of%20child ren%20and%20youth%20dependency%20ratio%20-%20update%20021112.pdf OECD, 2012b, Health Data 2012 –Frequently Requested Data, available online at http://www.oecd.org/els/health-systems/oecdhealthdata2012-frequentlyrequesteddata.htm OECD Social Policy Division - Directorate of Employment, Labor and Social Affairs, 2012c, Child poverty, available online at http://www.oecd.org/els/soc/CO2.2%20Child%20pover ty%20-%20update%20270112.pdf

32

Oral, R., Can, D., Kaplan, S., Polat, S., Ates, N., Cetin, G., Miral, S., Hanci, H., Ersahin, Y., Tepeli, N., Bulguc, A. G., Tiras, B., 2001, Child abuse in Turkey: an experience in overcoming denial and a description of 50 cases, Child Abuse & Neglect 25, 279-290.

Ovacık, A. C., 2008, Aile İçi Şiddetin Erkek Çocuğun Şiddet İçeren Suç İşleme Davranışına Etkileri, İstanbul, Turkey.

Page, A. Z., İnce, M., 2008, Aile İçi Şiddet Konusunda Bir Derleme, Türk Psikoloji Yazıları, 11 (22), 81-94.

Sadlak, A. J., 2001, A History of the National Incidence Study of Child Abuse and Neglect, Rockville, MD, The USA. T.C. Başbakanlık Kadın Statüsü Genel Müdürlüğü, 2009, Türkiye‟de Kadına Yönelik Aile İçi Şiddet, Ankara, Turkey.

Tıraş, Ü., Dilli, D., Dallar, Y., Oral, R., 2009, Evaluation and follow-up of cases diagnosed as child abuse and neglect at a tertiary hospital in Turkey, Turk J Med Sci 39 (6): 969-977.

TURKSTAT, 2006, Aile ve Sosyal Araştırmalar Genel Müdürlüğü Aile Yapısı Araştırması.

TURKSTAT, 2013, Nüfus Projeksiyon ve Tahminleri, available online at http://www.tuik.gov.tr/VeriBilgi.do?alt_id=39.

UNICEF, 2011, Türkiye‟de Çocukların Durumu Raporu.

UNICEF/Parlamentolar arası birlik: Çocuklara yönelik şiddetin ortadan kaldırılması.

Yılmaz, I. T., 2008, Çocuk İstismarı ve Yaygınlığı ve Dayanıklılıkla İlişkili Faktörler, Ege University, Turkey.

Zoroglu, S. S., Tuzun, U., Sar, V., Tutkun, H., Savas, H. A., Ozturk, M., Alyanak, B., Erocal Kora, M., 2003, Suicide attempt and self-mutilation among Turkish high school students in relation with abuse, neglect and dissociation, Psychiatry and Clinical Neurosciences, 57, 119–126.

33

Chapter 3 : Methodology 34 This chapter deals with the methods used to estimate the total cost of violence against young children in Turkey. Thus, the section starts with introducing and explaining the cost estimation methodologies and continues by demonstrating the most prominent approaches in the literature. The mentioned approaches are extended and illustrated via using Fang et. al.,‟s (2012) and Walby‟s (2004) studies. Afterwards, the costs are designated and detailed based on Turkey, properly, and mathematical models of each costs are constructed and annotated. By the aggregation of the costs entire model is completed for Turkey case.

3.1 Two approaches for violence cost estimation When the existing studies are analyzed deeply, one can easily see the lack of reliable cost estimation methodology on child maltreatment or other types of violence. The main problem in the existing studies is the lack of transparency in inputs that are used for estimation. As well as this significant issue, the calculations also include many assumptions and ignore an important number of cost types which actually should be considered in cost estimations on topics of child maltreatment, domestic violence, and violence against women; in fact, in most of the studies the indirect costs and the long-term costs of violence are omitted. For Turkey, there is no such study for estimating the cost of violence against young children; therefore, a new methodology of enumeration should be developed.

Among the existing studies in literature, the most promising ones for Turkey seems to be Walby‟s study on cost of domestic violence in England and Wales (2004), and Fang et. al.‟s paper on cost of child maltreatment in the USA (2012). Indeed, there are two major perspectives for estimating cost of violence: prevalence-based and incidence-based. In prevalence-based approach direct and indirect costs which exist in a period (in most cases 1 year) are estimated without considering the initiation of the incidence or its frequency. In

contrast, incidence-based approach reflects the total lifelong costs of violence incidences which occur in a definite time span (in most cases 1 year). This approach only deals with the incidences whose beginning coincides with the time span of interest.

Walbyâ€&#x;s study is an example for prevalence-based approach whereas Fang et. alâ€&#x;s could be considered as an incidence-based approach.

3.1.1 Prevalence-Based Method (Walby’s Approach) In her study, Walby (2004) implements and develops the method of Brand and Price (2000) to estimate the cost of domestic violence in England and Wales for 2001. Her method suits with prevalence-based approach in which the costs are estimated for a time period of one year regardless of the initiation time of the incidences.

The study includes three major categories of costs namely: public services costs, lost economic output, and human cost of pain and suffering. Public services costs consist of expenditures related with criminal justice system, the health care system, social services, housing and refuges services, and civil legal services. Walby treats loss economic output as a result of the disruption of employment and she tries to estimate the human cost of pain and suffering by use of willingness to pay methods. The data used in the study are gathered via some surveys which aim to determine the prevalence of domestic violence by using sampling methods. Overall costs of above mentioned services are taken from service providers.

Walby first calculates the costs of crimes of homicide, serious wounding, rape and assault by penetration, common assault, sexual assault and other wounding. Then, she correlates the domestic violence types with the crime categories to make a reasonable cost comparison.

After figuring out the prevalence of domestic violence, she continues with detecting the number of victims who use the formerly explained services. By multiplying the individual costs of using the services separately according to the correlated crime type and the exact number of victims colliding with that category, the cost using that specific service is estimated. Finally, Walby adds up all these service costs to show the economic burden of domestic violence in 2001 in England and Wales. Table 3.1 summarizes the extent of domestic violence and comparing classifications and Table 3.2 illustrates the estimated cost of domestic violence.

35

Comparable crime category

Number of victims

Homicide

125

Serious woundings

95 000

Rape, assualt by penetration, 610 000 common and sexual assualt Other wounding

1046 000

Table 3.1 The extent of domestic violence and comparing classifications (Walby, 2004)

Type of cost

Cost £billions

All services

3 111

Economic output

2 672

Human and emotional

17 086

Total

22 869

Table 3.2 The estimated cost of domestic violence (Walby, 2004)

3.1.2 Incidence – Based Approach (Fang’s Method) Fang et.al., (2012) try to estimate the average life time costs of violence against children per victim and total life time costs for all new cases occurred in 2008 by implementing an incidence-based method. In their study, they support the opinions that child maltreatment has devastating outcomes for victims such as behavioral problems (Felitti et.al. 1998, Repetti et.al. 2002), mental health disorders (Holmes & Sammel, 2005), increased risk of chronic diseases (Felitti et.al. 1998), increased risk for adult criminality (Fang & Corso, 2007), lower levels of adult economic well-being(Currie & Widom, 2010). Being aware of the above mentioned consequences of child maltreatment, Fang et.al., think that predicting the economic burden of child abuse may help to attract the public and government‟s opinion about the severity of the issue.

Fang et.al., examined the short and long term health care costs, productivity loss costs, child welfare costs, criminal justice costs, special education costs for non-fatal maltreatment cases, and medical costs and productivity losses costs for fatal maltreatment cases. In order to estimate these costs, they used incidence-based approach in which the total life time costs incurring from new cases are analyzed. This method actually deals with the incremental costs of the components that are mentioned above; that is for instance, the difference between the

36

criminal justice expenditures that a person with a history of child maltreatment and those expenditures of a person who did not face any violence case in his/her childhood. For the analyses, secondary data are used in most of the cases, but some reports or papers on economic burdens of child maltreatment are also included in some inadequate data. Here, they used US dollars which are adjusted to year 2010 via GDP deflator for cost estimations and modifications on future costs are applied by using cut rates of 3 percent and 7 percent to calculate the present values.

Fang et.al., state that the median age for child maltreatment cases in 2008 is 6 year old. They used this information to estimate the average life time costs per victim; that is, they calculate the costs for a person to occur between the ages of 6 and 64 years old (between the ages of median age of child maltreatment and average retirement age). In 2008, they claim that 772000 cases are determined in the USA of which three quarters of the incidences, 579000, are new and 1740 fatal cases occurred. Table 3.3 illustrates the resulting costs of child maltreatment per case and Table 3.4 represents the total life time cost of child maltreatment in 2008 in the USA. Cost type

Average lifetime cost per victim (in 2010 dollars) Cut rate = 3 %

Cut rate = 7 %

Non-fatal

$210 012

$97 952

Fatal

$1 272 900

$339 367

Table 3.3 The average lifetime cost per victim of fatal and non-fatal child maltreatment (Fang et.al., 2012)

Cost type

Average lifetime cost per victim (in 2010 dollars) Cut rate = 3 %

Cut rate = 7 %

Non-fatal

$121 596 948 000

$56 714 208 000

Fatal

$2 214 846 000

$590 498 580

Total

$123 811 794 000

$57 304 706 580

Table 3.4 Total lifetime costs of child maltreatment, 2008, United States (Fang et.al., 2012)

3.2 Costs to be Included for Turkey Case With regarding the existing literature and Figure 2.1 related to the actions taken against the violence incidences, cost types are determined in this section. These costs are used in the mathematical formulation for estimating the financial consequences of violence against young children in Turkey. Costs are thought to be made up of four categories namely: healthcare

37

costs, police and justice systems costs, social services costs, and productivity losses which are explained in a detailed manner in the following paragraphs.

3.2.1 Healthcare Costs Healthcare costs are the costs that stand for the financial expenditures related with physical and psychological treatment of the victims at a medical center or at their accommodation areas. These costs include the amount paid for the medical staff for the treatment operation by the government, the responsible organization, victimâ€&#x;s caretaker or etc., the amount spent for transporting the victim to the medical center or transferring him/her between the medical centers or transferring the medical staff to the incidence area, the amount paid for the medicines used for treatment, hospitalization costs, follow-up treatment costs and etc.

3.2.2 Police and Justice Systems Costs These are the costs related with the amounts paid for police and justice systems staff involved in a violence incidence by the government, expenditures related with the transportation of the victim and the perpetrator to the police stations, courts, or prisons and such kind of facilities, costs associated with the imprisonment of the perpetrator; costs for prosecution , the judicial operations and criminal investigations, and etc.

3.2.3 Social Services Costs These costs are the ones related with the expenditures spent for any kind of social service in case of a violence incidence against a young child. The amounts paid for the social services staff for their actions by the government, transportation costs regarding the transfer processes, housing costs if a replacement action is necessary constitute these categories, and this list can be extended to some other costs as well.

3.2.4 Productivity Losses Cost of pain, suffering, loss of quality in life, and cost of behavioral problems are included in this category. This type of costs are seem to be quite difficult to estimate as there is no direct financial amount related to emotional conditions of a child. However, these costs can be calculated by determining the productivity losses of victimsâ€&#x; future life. According to Conrad (2006), the children exposed to any type of maltreatment struggle to overcome some difficulties such as cognitive deficits, unstable peer relationship, low self-esteem, behavioral problems and so on. The consequences of these problems decrease time span of education and

38

adulthood earnings. The studies report that children who were abused are more likely to exhibit lower IQ and learning problems and also higher unemployment rates and lower earnings (Curri and Widom, 2010; Gilbert et. al., 2009; Hyman, 2000; Daro, 1988).

3.3 A Linear Additive Model for Turkey Case Based on Walby (2004) and Fang et. al.â€&#x;s (2012) studies, a linear additive model for estimating total cost of violence against young children in Turkey could be proposed. A robust methodology for calculating the related costs for healthcare services, police and justice system services, social services, and productivity losses are given in the following pages together with the linear additive model to aggregate these costs.

3.3.1 Cost Calculations In the following sub-sections, calculation methodology of each classified cost type is explained in details using illustrative equations.

3.3.1.1 Rate of maltreatment for ages between 0-8 Notifications used in section 3.3.1.1 : Percent of maltreatment between ages a and b in 1000 children in US : Child population between ages a and b in US : Number of victims recorded aged between a and b in US : Total child population in US : Rate of child maltreatment who are aged between a and b in US : Number of child victims aged between a and b in Turkey : Rate of maltreatment ages between a and b in Turkey Equations for rate of maltreatment Published data by Turkish government about child abuse and neglect do not cover the age ranges of maltreated children as needed. To clarify, ages grouped as less than 11, between 12 and 14, and 15 through 17 in TURKSTAT. Since aim of this research drawing a picture for maltreated children less than 8, a new parameter, rate of maltreatment ages between 0 and 8, becomes the current issue.

39

Hence maltreatment characteristics of US is similar to Turkey‟s, US data is used to inference the rate of maltreatment in Turkey between ages 0 and 8. Calculations between equations (1) and (7) are constructed for estimation about rate of child maltreatment between ages 0 and 8 in US by published data in US statistics. ∑

(1) ∑

(2) ∗

∗

∗ ∗

(3) ∗

∗

(4) (5) (6) (7)

The following equations till the end of this sub-section illustrate calculations for rate of violence against young children in Turkey. Main logic under these computations is assuming the rates of maltreatment between same age groups in two countries as directly proportioned.

(8) ∗ 3.3.1.2 Calculating Healthcare Services Costs Notifications used in section 3.3.1.2 i: Service type (i = 1,2,3,4; 1 for healthcare services, 2 for police, 3 for justice system services, 4 for social services) : Total cost of ith service for reference year : Number of patients who visit medical services in 2003 : Population of Turkey in 2003 : Average medical visits per person annually : Healthcare and medical expenditure/person annually Uh: Unit healthcare and medical expenditure per visit : Number of victims who are under 17 brought to hospitals : Rate of 0-8 aged victims among reported child victims in Turkey

(9)

40

Equations for healthcare service cost In order to calculate the healthcare services costs, first, total number of victims aged 0-17 that are brought to hospital is multiplied with the rate of children who are of ages between 0 and 8 to estimate the target population for this study. Then, general health and medical expenditure per person per year is proportioned with average number of visits to a medical center as a patient per person per year to find out the unit cost of each medical visit. By multiplying this unit cost with estimated number of victims of ages between 0 and 8 who are taken to medical 41

service, the health care service cost is calculated.

(10) (11) ∗

∗

(12)

3.3.1.3 Calculating Police Services Costs Notifications used in section 3.3.1.3 i: Service type (i = 1,2,3,4; 1 for healthcare services, 2 for police, 3 for justice system services, 4 for social services) : Total cost of ith service for reference year : Child population in Turkey in 2011 : Child population in İstanbul in 2011 : Number of children police in İstanbul : Estimated number of children police in Turkey : Total number of police in Turkey : Budget of Directorate General of Security : Budget of Children Bureau in DGS : Number of victims aged 0-17 : Total number of children brought to police : Rate of 0-8 aged victims among reported child victims in Turkey Equations for police service cost Due to the fact that, number of children police and budget of bureau are not shared officially by authorities, these numbers are tried to be estimated by using available information; that is, the number of children police in İstanbul is projected as in equation 13.

( ⁄ )∗

(13)

After that, with equation 14, the budget of Children Bureau is derived from directly proportioning the number of children police to the budget of directorate general of security per policeman. (

⁄ )∗

(14)

Next step is estimating the total police service cost for abused children of ages between 0 and 8. It should be borne in mind that not only child maltreatment victims are in the scope of children police. Thus, a rate of being victim among the total number of children served by children bureau should be considered. This new number is multiplied by rate of victims who are between 0 and 8 to get the target population. Then, total police service cost for victims aged between 0 and 8 could be shown as in equation 15. (

⁄ )∗

∗

(15)

3.3.1.4 Calculating Justice System Services Costs Notifications used in section 3.3.1.4 i: Service type (i = 1,2,3,4; 1 for healthcare services, 2 for police, 3 for justice system services, 4 for social services) : Total cost of ith service for reference year : Rate of 0-8 aged victims among reported child victims in Turkey : Budget of Justice System : Total number of lawsuits : Justice system expenditure per lawsuit annually : Number of children who are brought to police as witness Equations for justice system cost The cost related with courts‟ workload and prosecution process for child maltreatment cases is enumerated by calculating a unit cost for justice system by using total budget of justice system and number of lawsuits in a year as in equation 16.

42

⁄

(16)

Since justice system statistics in Turkey do not highlight the number of lawsuits and perpetrators about child abuse and neglect, the number of lawsuits is assumed by statistics on number of children brought to police as a witness by accepting the witnessing as a type of violence that child is exposed to. With this manner, the number of witness children is used to inference the total number of lawsuits about child maltreatment which is shown in equation 43

17. ∗

∗

(17)

3.3.1.5 Calculating Social Services Costs Notifications used in section 3.3.1.5 i: Service type (i = 1,2,3,4; 1 for healthcare services, 2 for police, 3 for justice system services, 4 for social services) : Total cost of ith service for reference year : Rate of 0-8 aged victims among reported child victims in Turkey : Average ages of each type of child maltreatment : Probability of facing maltreatment for children : Expected age of any type of maltreatment between ages 0 and 8 : Total number of children in Child Protective Service : Budget of Directorate of CPS : CPS expenditure per child annually : Number of victims who are sent to CPS by police : Growth rate of Turkey : Interest rate in Turkey : Social discount rate for Turkey Economic discount rate for Turkey : Best case total expenditure of social service for children taken under protection in 2011 : Worst case total expenditure of social service for children taken under protection in 2011 : Best case expenditure for CPS annually

: Worst case expenditure for CPS annually Equations for social service cost Before formulating social service cost, the average length of time that an abused child spends in CPS should be taken into account because children who are protected by CPS require continuous expenditures rather than annual costs. Each year, new victims are accumulated to the system until they reach adulthood. The expected maltreatment age is enumerated as illustrated in following Table 3.5 and Table 3.6 using the data on Child Maltreatment Report, 44

2011.

Medical Neglect

Neglect age

P(age)

Physical Abuse age

P(age)

Psychological Mal. age

P(age)

Sexual Abuse

age

P(age)

age

P(age)

<2

0.544562

<2

0.444536

<2

0.422540

<2

0.363744

<2

0.081631

3-5

0.241668

3-5

0.307023

3-5

0.286881

3-5

0.330617

3-5

0.424727

6-8

0.213771

6-8

0.248440

6-8

0.290579

6-8

0.305639

6-8

0.493643

Table 3.5 Statistics on different abuse types based on ages

By referring the general statistical expression, expectation of an event is calculated by using the probability of being abused at that specific age. (age) Medical Neglect

3.00

0.0191

Neglect

3.41

0.6747

Physical Abuse

3.60

0.1508

Psychological Abuse

3.82

0.0772

Sexual Abuse

5.23

0.0780

Table 3.6 Probability of being abused at a specific age

Expected age of any type of maltreatment is computed by the following equation as; ∑

∗

(18)

Child Protective Service expenditure per child per year is computed by dividing the budget of directorate of CPS to the total number of children in CPS at the same year. ⁄

(19)

Total cost of CPS for the reference year shown in following equation could be found by using total number of children who are sent to CPS ages between 0 and 8 in the same year. ∗

∗

(20)

As mentioned before, social service is a contiguous process until adulthood, thus expected age of maltreatment is used to find an expected time to be under protection of CPS. If a cost occurs over for a long time period, say more than one year, the discount rate is used as a descriptive parameter for the present value of this cost. In this manner, two different perspectives are referred in the study; economic and social discount rates. Social discount rate is useful for pessimistic economic scenario where economic discount rate is for optimistic scenario due to the fact that, it is hard to claim that Turkish economy is stable. ∑

∗

(21)

∑

∗

(22)

∑

[

∗

]

∑

[

∗

]

(23)

(24)

3.3.1.6 Calculating Productivity Losses Notifications used in section 3.3.1.6 : Median annual wage per person : Average annual wage per person : Total cost of productivity losses for fatal cases by using economic discount rate and median wage per person : Total cost of productivity losses for fatal cases by using social discount rate and median wage per person : Total cost of productivity losses for fatal cases by using economic discount rate and average wage per person : Total cost of productivity losses for fatal cases by using social discount rate and average wage per person (

)

: Total cost of productivity losses for non-fatal cases by economic discount

rate, minimum rate of productivity loss and median wage per person

45

(

)

: Total cost of productivity losses for non-fatal cases by economic discount

rate, maximum rate of productivity loss and median wage per person (

)

: Total cost of productivity losses for non-fatal cases by economic discount

rate, minimum rate of productivity loss and average wage per person (

)

: Total cost of productivity losses for non-fatal cases by economic discount

rate, maximum rate of productivity loss and average wage per person (

)

: Total cost of productivity losses for non-fatal cases by social discount rate,

minimum rate of productivity loss and median wage per person (

)

: Total cost of productivity losses for non-fatal cases by social discount

rate, maximum rate of productivity loss and median wage per person (

)

: Total cost of productivity losses for non-fatal cases by social discount rate,

minimum rate of productivity loss and average wage per person (

)

: Total cost of productivity losses for non-fatal cases by social discount rate,

maximum rate of productivity loss and average wage per person : Best case productivity loss for a fatal victim annually based on median wage : Worst case productivity loss for a fatal victim annually based on median wage : Best case productivity loss for a fatal victim annually based on average wage : Worst case productivity loss for a fatal victim annually based on average wage : Minimum percentage of productivity loss : Maximum percentage of productivity loss (

)

: Best case productivity loss cost for a non-fatal victim based on median wage

and minimum productivity loss percentage (

)

: Best case productivity loss cost for a non-fatal victim based on median wage

and maximum productivity loss percentage (

)

: Best case productivity loss cost for a non-fatal victim based on average wage

and minimum productivity loss percentage (

)

: Worst case productivity loss cost for a non-fatal victim based on median wage

and minimum productivity loss percentage (

)

: Best case productivity loss cost for a non-fatal victim based on average wage

and maximum productivity loss percentage

46

(

)

: Worst case productivity loss cost for a non-fatal victim based on median

wage and maximum productivity loss percentage (

)

: Worst case productivity loss cost for a non-fatal victim based on average

wage and minimum productivity loss percentage (

)

: Worst case productivity loss cost for a non-fatal victim based on average

wage and maximum productivity loss percentage : Number of non-fatal child abuse and neglect victims based on minimum prevalence rate in Turkey

47

: Number of non-fatal child abuse and neglect victims based on maximum prevalence rate in Turkey : Number of fatal child abuse and neglect victims : Maximum productivity loss expenditure annually : Minimum productivity loss expenditure annually Equations for productivity loss cost There are various perspectives to find out productivity losses such as considering education duration and graduation degree, employment, owning bank account, stock, home, and so on.

However, in Turkey, no secondary data are available on adults who are abused in their childhood. Thus, gross wage is accepted as a cumulative conclusion of education, job and wellness of life. Productivity losses are examined based on the mortality impact of violence against children: fatal and non-fatal cases. The productivity loss cost of VAC resulting with death is computed by multiplying the average working years, average or median of annual gross wage of a person in Turkey, and the number of fatal victims. Equations 25 to 32 illustrate cost of productivity losses generated by fatal acts based on two approaches.

∑

*

∑

∗

(25)

∑

∗

(26)

∑

∗

(27)

∑

∗

(28)

∗

+

(29)

∑

∗

*

+

∑

*

∗

+

∑

*

∗

+

(30) (31) (32)

On the other hand, the cost of productivity loss for non-fatal acts is enumerated by multiplying average working years, average or median of annual gross wage of a person in Turkey and the percentage of estimated losses with number of non-fatal victims. The percentage of estimated losses is examined in literature by different applications. While Hyman (2000) affirms that the women who experienced sexual abuse in their childhoods earn approximately 11.5 percent less than those who had not such an experience; Curri and Widom (2010) state that earning loss of victims about 15 percent in the USA. These values create upper and lower bands for productivity loss estimations of non-fatal victims based on the following equations. (

)

∑

[

∗

∗

]

(33)

(

)

∑

[

∗

∗

]

(34)

(

)

∑

[

∗

∗

]

(35)

(

)

∑

[

∗

∗

]

(36)

(

)

∑

[

∗

∗

]

(37)

(

)

∑

[

∗

∗

]

(38)

(

)

∑

[

∗

(

)

∑

[

∗

(

)

(

)

(

∗ ∗

]

(39)

]

(40)

)

(41) (

)

(42)

48

(

)

(

)

(

)

(

)

(

)

(

)

(

)

(43) (

)

(44) (

)

(45) (

)

(46) (

)

(47) (

)

(48)

Total productivity losses based on average and median annual gross wages for best and worst cases are formulated in equations 49 and 50 as; [

∗

]

[(

)

∗

]

(49)

*

∗

+

[(

)

∗

]

(50)

3.3.2 Aggregation of Costs Notifications used in section 3.3.2 i: Service type (i = 1,2,3,4; 1 for healthcare services, 2 for police, 3 for justice system services, 4 for social services) : Total cost of ith service for reference year : Maximum productivity loss expenditure annually : Minimum productivity loss expenditure annually : Best case total expenditure of social service for children taken under protection in 2011 : Worst case total expenditure of social service for children taken under protection in 2011 : Maximum grand total cost of expenditures annually in Turkey : Maximum grand total cost of expenditures annually in Turkey

49

Equations for aggregation of costs The total cost of violence against young children in Turkey can be estimated via the linear additive model shown in equation 51 and 52 for minimum and maximum cost amounts. â&#x2C6;&#x2018;

+

â&#x2C6;&#x2018;

(51) (52)

These equations basically imply to add up all costs related with healthcare service systems, police and justice services, social services, and productivity losses.

50

References Conrad, C., 2006, Measuring costs of child abuse and neglect: A mathematic model of specific cost estimations, Journal of Health and Human Services Administration, 29(1), 103–123.

Currie, J., and Widom, C. S.,2010, Long-term consequences of child abuse and neglect on adult economic well-being, Child Maltreatment, 15(2), 111–120.

Daro, D., 1988, Confronting child abuse: Research for effective program design. Macmillan, Inc New York, the USA. Fang, X., and Corso, P. S., 2007, Child maltreatment, youth violence, and intimate partner violence developmental relationships, American Journal of Preventive Medicine, 33(4), 281– 290.

Fang, X., Brown, D. S., Florence, C. S., and Mercy, J. A., 2012, The economic burden of child maltreatment in the United States and implications for prevention, Child Abuse & Neglect, 36, 156-165.

Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., and Marks, J.S., 1998, Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults, The Adverse Childhood Experiences (ACE) Study American Journal of Preventive Medicine, 14 (4), 245–258.

Gilbert, R., Spatz Widom, C., Browne, K., Fergusson, D., Webb, E., and Janson, J., 2009, Burden and consequences of child maltreatment in high-income countries, The Lancet, 373, 68-81.

Holmes,W.C., and Sammel,M. D., 2005, Brief communication: Physical abuse of boys and possible associations withpoor adult outcome, Annals of Internal Medicine, 143(8), 581–586.

Hyman, B., 2000, The Economic Consequences of Child Sexual Abuse for Adult Lesbian Women, Journal of Marriage and Family, 62 ( 1), 199-211.

Repetti, R. L., Taylor, S. E., and Seeman, T. E., 2002, Risky families: Family social environments and the mental and physical health of offspring, Psychological Bulletin, 128(2), 330–366.

Walby, S., 2004, The Costs of Domestic Violence, Women and Equality Unit, Department of Trade and Industry, London, UK.

51

Chapter 4 Results

52

For estimating the economic burden of child maltreatment in Turkey, the included costs are identified in previous section under two major cost types, namely, service expenditure and productivity loss costs. The service expenditure cost has a composite structure that contains costs of various services detailed in methodology section. The productivity loss calculations defined in the methodology section (Chapter 3) in detail are done for four sub-cases under two main categories. These categories are the child abuse or neglect results with mortality of victim or not. Due to the fact that the data obtained about the number of victims covers the children aged between 0 and 11, estimation for the ratio of numbers of victims between ages 0-8 to 0-11, based on the US data is accomplished. This ratio is calculated by proportioning the number of victims aged between 0 and 8 to the total number of child victim (0-17). Since the available data is according to age group 0 to 11, an interpolation is needed for our target population; that is the children of ages between 0 and 8. The number of victims in target population is drawn by multiplying the US population under 8 and rate of maltreatment between ages 0-8. The total number of children who are exposed to maltreatment in US is found by multiplying the total number of children in US and percentage of total maltreated children in US. This operation is shown below in Table 4.1.

According to the explanations and the given data, the rate of victims aged between 0 and 8 amongst the reported child victims (

) in US is determined as 0.28 as it is illustrated in

Table 4.1. But, this value should be dimensioned to Turkey for an accurate solution. In this case, rate of victims aged between 0 and 8 in Turkey (

) is found out by directly

proportioning the rates of children maltreated under 11 and under 8 in US ( Turkey (

) and

). Table 4.2 shows that rate of victims who are aged between 0 and 8

constitutes a value of 0.21 among all child maltreatment victims.

Definition

Value Calculation

Percent of maltreatment between ages 0 and 8 in 1000 children in US

27.475

Child population between ages 0 and 11 in US

34

Reference Forum on Child and Family Statisticsa

Equation 1 Forum on Child and Family Statisticsb

Child population between ages 0 and 8 in US

36.6

Child population between ages 0 and 11 in US

48.9

Equation 2

-

100,5585

Equation 3

-

Number of victims recorded aged between 0 and 8 in US Percent of maltreatment between ages 0 and 11 in 1000 children in US

4.73 millions

Total child population in US

74.1 millions

-

Forum on Child and Family Statisticsa

-

Forum on Child and Family Statisticsb

Number of victims recorded aged between 0 and 11 in US

166,2600

Equation 4

-

Number of victims recorded aged between 0 and 17 in US

350,4930

Equation 5

-

0.47436

Equation 6

-

0.28

Equation 7

-

Rate of child maltreatment who are aged between 0 and 11 in US Rate of child maltreatment who are aged between 0 and 8 in US Table 4.1 US child maltreatment data

Definition

Value

Number of child victims aged between 0 and 17 in Turkey

76,428

Number of child victims aged between 0 and 11 in Turkey

26,686

Rate of maltreatment ages between 0 and 11 in Turkey

0.349165

Equation 8

-

Rate of child maltreatment who are aged between 0 and 11 in US

0.47436

-

-

0.21

Equation 9

-

Rate of maltreatment ages between 0 and 8 in Turkey Table 4.2 Turkish child maltreatment data

Calculation Reference TURKSTATa

-

-

TURKSTATa

53

The ratio found in Table 4.2 is used in several cost calculations related to service expenditures and productivity losses. The following parts of this chapter are dedicated to these cost estimations.

4.1

Service Expenditure Costs

Service expenditure costs are the aggregation of costs occurring due to services which are provided by the government for a child maltreatment victim. These service costs are namely; health care system costs, police and justice systems costs and social service costs (only in CPS).

4.1.1 Health Care Service Costs The unit cost of health care service is found as the health and medical expenditure per visit by the available data in 2003, and this monetary value is converted to the corresponding value in 2012 in TL. To accomplish this aim, first, the average visit to a medical center as patient per person year (

) is calculated via proportioning the total number of patients (

) in a

year to total number of population (Pop). Then, by dividing the published data by research of Development Bank of Turkey, annual health and medical expenditure per person (

) to

annual average visit to a medical center as patient per person, the unit cost of health care service is found as 131 TL in 2003, and 293 TL in 2012. The above mentioned process is summarized in Table 4.3.

Definition

Value

Equation References TURKSTATb

-

Population of Turkey in 2003

66,873,000

Number of patients who visit medical services in 2003

129,733,118

-

Türkiye Kalkınma Bankası (2005)

Healthcare and medical expenditure/person annually

153.5

-

Türkiye Kalkınma Bankası (2005)

Average medical visits per person annually

1.94

Equation 10

-

Unit healthcare and medical expenditure per visit (TL of 2003)

131.0602

Equation 11

-

Unit healthcare and medical expenditure per visit (TL of 2012)

293.22

1 TL in 2003 = 2.2373 TL in 2012

-

Table 4.3 Calculation of unit cost of healthcare service

54

The number of victims brought to hospital who are of ages between 0 and 11 is found from TURKSTATa. Multiplying this number with the rate of victims whose ages are between 0 and 8, gives the estimated number of victims brought to hospital that are aged between 0 and 8.

Then, total health care service cost of child abuse and neglect is determined by multiplying the determined unit health care cost and the estimated number of victims ages between 0 and 8 as shown in Table 4.4.

Definition

Value

Number of victims who are under 17 brought to hospitals

88,582

-

TURKSTATa

0.21

-

-

Rate of maltreatment ages between a and b in Turkey Total cost of healthcare service for reference year (TL of 2012)

Equation References

5,454,559.29 Equation 12

-

Table 4.4 Total cost of healthcare service

By this way, the total health care cost spent for children of ages 0 to 8 who are maltreated is figured out to be 5,454,559.29 TL. 4.1.2 Police Costs Since there is no valid data about budget and total number of children police in Turkey, an estimation approach is used based on available data. According to available data namely, number of children police in Ä°stanbul province ( ), children population in Ä°stanbul ( ) and children population in Turkey ( ) are utilized to estimate total number of children police in Turkey (

) and as it is illustrated in Table 4.5. As it can be seen in this table, the number of

children police in Turkey is forecasted to be 5,619.84.

This estimated number is used to find out the budget of Children Bureau in Police (

) by

multiplying the total budget of Directorate General of Security (B) with the proportion of the estimated total number of children police to total number of police in Turkey (

â &#x201E; ) Table

4.6 summarizes this process and the budget of Children Bureau is found out to be 258,472,160 TL.

55

Definition

Value

Child population in Turkey in 2011

25,204,158.00

Child population in İstanbul in 2011

4,260,607.00

Equation

Reference

-

TURKSTAT b

-

TURKSTAT b

Number of children police in İstanbul

Equation 13

5,619.84

Estimated number of children police in Turkey

İstanbul Emniyet Müdürlüğü

-

950.00

-

56

Table 4.5Calculation of number of children police in Turkey

Definition

Value

Equation

230,000

-

Yeni Asır (2012)

10,578,334.40

-

Turkish Ministry of Finance

Total number of police in Turkey Budget of Directorate General of Security(1000TL)

Budget of Children Bureau in DGS (1000TL)

258,472.16

Equation 14

Reference

-

Table 4.6 Budget of Children Bureau

The published data on TURKSTATa gives the total number of children brought to police ( ) in year 2011, and number of victims aged between 0 and 11. Due to the fact that the target population of this research is victims under age 8, this struggle is managed by the rate of maltreated children aged between 0 and 8 in Turkey (

) which is estimated at the

beginning of this section in Table 4.2.

Definition

Value

Equation

Reference

Number of victims aged 0-17

27,761

-

TURKSTATa

204,040

-

TURKSTATa

-

-

Total number of children brought to police Rate of 0-8 aged victims among reported child victims in Turkey

0.21

Budget of Children Bureau in DGS (1000TL)

258,472.16

Equation 15

-

Total cost of police service for reference year

23,564.77

Equation 16

-

(1000 TL) in 2011 Total cost of police service for reference year (1000 TL) in 2012 Table 4.7 Total police system cost

26,064.99 1 TL in 2011 = 1.1061 TL in 2012

Central Bank of Turkey

In this manner, the total police service cost of government for children of ages between 0 and 8 who are maltreated is estimated to be 26,064,994.14 TL as it is shown in Table 4.7.

4.1.3 Justice System Costs

In this section, annual justice system expenditure per lawsuit (UJS) is computed by the ratio of total budget of justice system (BJS) to the total number of lawsuits in Turkey in year 2010.

Table 4.8 suggests that annual cost related with a lawsuit is estimated to be 572 TL. 57 Definition

Value

Equation

Reference

Total number of lawsuits

6,619,412

-

TURKSTATc

Budget of Justice System

3,783,866,000

-

Turkish Ministry of Finance

Justice system expenditure per lawsuit annually

572

Equation 17

-

(TL/lawsuit.year) Table 4.8 Average unit cost of a lawsuit

With this manner, each lawsuit burden is found as 572 TL annually. The rate of maltreated children is found by using the data available on TURKSTATa, number of children who are brought to police as witnesses by assuming that these children are exposed to maltreatment or witness a violence case. Moreover, the expected time of a lawsuit (

) in Turkey is reported

as 506 days that means approximately 1.38 years. Thus, the cumulative expenditure of justice system for a lawsuit on violence against young children is obtained as in Table 4.9 for year 2010.

Due to the fact that, our reference year is 2012, this monetary value should be converted to 2012 monetary values. The illustration of this conversion is last line of Table 4.9, which asserts that total justice system costs related to violence against young children is 754,649 TL in 2012 values. Since average time of a lawsuit in Turkey, this value reaches 1,046,170.75 TL, approximately.

Definition

Value

Equation

Reference

Number of children who are brought to police as witness

5,418

-

TURKSTATa

Rate of 0-8 aged victims among reported child victims in Turkey

0.21

-

-

Justice system expenditure per lawsuit annually

572

-

-

(TL of 2010) Total cost of justice service for reference year (TL of 2010)

650,391.00

Equation 18

-

Total cost of justice service for reference year (TL of 2012)

754,649.00

1 TL in 2010 = 1.1603 TL in 2012

-

58

Table 4.9 Total justice system cost

4.1.4 Social Service Costs For the estimation of total Child Protective Service (CPS) expenditures for victim per year, available parameters are total number of children in CPS ( CPS (

) and budget of directorate of

). With this background, annual unit CPS expenditure per child (

) is

determined by dividing budget of directorate of CPS to total number of children in CPS (

) which is illustrated in Table 4.10.

Definition

Value

Equation

Reference

558,309,375.28

-

Turkish Ministry of Finance

Total number of children in Child Protective Service

40,378

-

Turkish Ministry of Family and Social Policies (2013)

CPS expenditure per child annually (TL of

13,827.07

Equation 19

-

Budget of Directorate of CPS (TL of 2011)

2011) Table 4.10 Unit cost of CPS

Total expenditure of CPS for victims in 2011 (ECPS,2011) is extracted by multiplying unit CPS expenditure by number of victims who are sent to CPS in 2011 (nCPS). As it can be figured out from Table 4.10, annual total expenditure for victims of child maltreatment is found out to be 24,072,926.40 TL in 2011. However, required cost is the total expenditure of CPS for victims who are under 9, this result is developed with rate of victims who are between 0 and 8 (

). Table 4.11 summarizes total expenditure for targeted victims.

Definition

Value

Equation

Reference

13,827.07

-

-

Number of victims who are sent to CPS by police

1741

-

TURKSTATa

Rate of maltreatment ages between a and b in Turkey

0.21

-

-

Equation 20

-

CPS expenditure per child annually (TL/victim.year)

Total cost of CPS for reference year (TL for year 2012)

5,591,683.21

59

Table 4.11 Annual cost of social services

It is obvious that the victims are served until being an adult by CPS instead of being served for just one year. Hence this cost could not be considered as a one-time-cost, total CPS expenditure for a victim for his/her childhood period should be computed. In this calculation, expected age of maltreatment (µage) plays a big role. In this report, it is assumed that the total service time of CPS to a victim is difference between adulthood age (age 18) and expected age of maltreatment (µage). Eventually, childhood-long CPS expenditure for a victim, and the total burden of victims who are sent to CPS in 2011 outlined in Table 4.12.

Definition

Value

Equation

5,591,683.21

-

Growth rate of Turkey

2.08%

-

Interest rate in Turkey

10%

Total cost of CPS (TL for year 2012)

Social discount rate for Turkey Economic discount rate for Turkey

5.06%

Reference Ökten Ökten

-

Halicioglu and Karatas,2011 Halicioglu and Karatas,2010

12.94% 64,360,120.74

Equation 21

-

Worst case total expenditure of social service 98,173,561.49 for children taken under protection in 2011

Equation 22

-

Best case expenditure for CPS annually (TL/year)

5,850,920.07

Equation 23

-

Worst case expenditure for CPS annually (TL/year)

8,924,869.23

Equation 24

-

Best case total expenditure of social service for children taken under protection in 2011

Table 4.12 Total and average costs of social services

4.2

Productivity Loss

In productivity loss estimations, several parameters could change the burden of child abuse and neglect. At first, the cases are aparted according to result of maltreatment according to the result of maltreatment. This means if child is death as consequently, it is called fatal cases, and otherwise called as non-fatal cases.

4.2.1 Fatal Cases The productivity loss for fatal cases appraises the life-long earning of a victim who is exposed to maltreatment resulting with mortality. The loss earnings could be computed in two different perspectives via two different parameters. These perspectives, social discount rate and economic discount rate, are explained in Chapter 3. In order to clarify the perspectives, the calculations by social discount rate called as best case scenario, and instead of economic discount rate worst case scenario is used. In addition, the parameters, median annual wage of a person (

) and average annual wage of a person (

), are used for each perspective.

Minimum and maximum total productivity loss costs for fatal cases are calculated by multiplying the unit costs with the number of fatal victims. Table 4.13 summarizes this process.

Definition

Value

Equation

Reference

Median annual wage per person

12,808.00

-

TURKSTATd

Average annual wage per person

23,208.00

-

TURKSTATd

Growth rate of Turkey

2.08%

-

Ă&#x2013;kten

Social discount rate for Turkey

5.06%

-

Halicioglu and Karatas,2011

10%

-

Ă&#x2013;kten

12.94%

-

Halicioglu and Karatas,2010

Interest rate in Turkey Economic discount rate for Turkey Total cost of productivity losses for fatal cases by using economic discount rate and median wage per person

489,552.33

Equation 25

-

Total cost of productivity losses for fatal cases by using social discount rate and median wage per person

903,355.37

Equation 26

-

60

887,065.16

Equation 27

-

1,636,873.17

Equation 28

-

Annual cost of productivity losses for fatal cases by using economic discount rate and median wage per person

10,878.94

Equation 29

-

Annual cost of productivity losses for fatal cases by using social discount rate and median wage per person

20,074.56

Equation 30

-

Annual cost of productivity losses for fatal cases by using economic discount rate and average wage per person

19,712.56

Equation 31

-

Annual cost of productivity losses for fatal cases by using social discount rate and average wage per person

36,374.96

Equation 32

-

Total cost of productivity losses for fatal cases by using economic discount rate and average wage per person Total cost of productivity losses for fatal cases by using social discount rate and average wage per person

61

Table 4.13 Unit cumulative and annual productivity loss cost per fatal case

4.2.2 Non-Fatal Cases The productivity loss of non-fatal cases is also examined under two main scenarios and by using median and average wages. Besides these parameters and conditions, a new concept comes up; the percentage of productivity loss. This loss could not be determined as a rigid number; it differs to victim, severity level and type of violence due to the fact that an interval is designated as between 11 and 15 according to the literature. Mathematical expressions and unit costs of each perspective are extracted as shown below.

Definition

Value

Equation

Reference

Median annual wage per person

12,808.00

-

TURKSTATd

Average annual wage per person

23,208.00

-

TURKSTATd

2.08%

-

Ă&#x2013;kten

Growth rate of Turkey

Social discount rate for Turkey Interest rate in Turkey Economic discount rate for Turkey Minimum percentage of productivity loss

5.06%

-

Halicioglu and Karatas,2011

10%

-

Ă&#x2013;kten

12.94%

-

Halicioglu and Karatas,2010

11%

-

Hyman,2000

15%

-

Currie and Widom, 2010

62 Maximum percentage of productivity loss Total best case productivity loss cost for a nonfatal victim based on median wage and minimum productivity loss percentage

53,850.76

Equation 33

-

Total best case productivity loss cost for a nonfatal victim based on median wage and maximum productivity loss percentage

73,432.85

Equation 34

-

Total best case productivity loss cost for a nonfatal victim based on average wage and minimum productivity loss percentage

97,577.17

Equation 35

-

Total best case productivity loss cost for a nonfatal victim based on average wage and maximum productivity loss percentage

133,059.77

Equation 36

-

Total worst case productivity loss cost for a nonfatal victim based on median wage and minimum productivity loss percentage

99,369.09

Equation 37

-

Total worst case productivity loss cost for a nonfatal victim based on median wage and maximum productivity loss percentage

135,503.31

Equation 38

-

Total worst case productivity loss cost for a nonfatal victim based on average wage and minimum productivity loss percentage

180,056.05

Equation 39

-

Total worst case productivity loss cost for a nonfatal victim based on average wage and maximum productivity loss percentage

245,530.98

Equation 40

-

Annual best case productivity loss cost for a non-fatal victim based on median wage and minimum productivity loss percentage

1,196.68

Equation 41

-

Annual best case productivity loss cost for a non-fatal victim based on median wage and maximum productivity loss percentage

1,631.84

Equation 42

-

Annual best case productivity loss cost for a non-fatal victim based on average wage and minimum productivity loss percentage

2,168.38

Equation 43

-

Annual worst case productivity loss cost for a non-fatal victim based on median wage and minimum productivity loss percentage

2,208.20

Equation 44

-

Annual best case productivity loss cost for a non-fatal victim based on average wage and maximum productivity loss percentage

2,956.88

Equation 45

-

Annual worst case productivity loss cost for a non-fatal victim based on median wage and maximum productivity loss percentage

3,011.18

Equation 46

-

Annual worst case productivity loss cost for a non-fatal victim based on average wage and minimum productivity loss percentage

4,001.25

Equation 47

-

Annual worst case productivity loss cost for a non-fatal victim based on average wage and maximum productivity loss percentage

5,456.24

Equation 48

-

63

Table 4.14 Unit cumulative and annual productivity loss cost per non-fatal case

As shown in Table 4.14, unit productivity loss costs for non-fatal victims are estimated in a bound of 53,850.76 and 245,530.98 Turkish Liras of 2012 per person. Since the aim of this research is estimating total amount for whole victims, these numbers are multiplied by the number of non-fatal victims. Then, maximum and minimum bound of productivity loss cost of fatal victims should be summed up with maximum and minimum monetary values of productivity loss for non-fatal victims respectively. During this process, the prevalence rate of child abuse and neglect must be determined. In this study, based on literature about prevalence rate of violence against young children in Turkey, a minimum and maximum rate is chosen. According to ZoroÄ&#x;lu et. al., this rate is approximately %34. Another study published by Genç Hayat Foundation (2012) claims that rate of child abuse and neglect is nearly %74. With this manner, upper and lower bounds of life-long cumulative productivity loss burden of child abuse and neglect against young children in Turkey are estimated. Table 4.15 illustrates the minimum and maximum total productivity loss costs.

Definition

Value

Equation

Reference

Total cost of productivity losses for fatal cases by using social discount rate and average wage per person

1,636,873.17

-

-

Total worst case productivity loss cost for a non-fatal victim based on average wage and maximum productivity loss percentage

245,530.98

-

-

Total cost of productivity losses for fatal cases by using economic discount rate and median wage per person

489,552.33

-

-

Total best case productivity loss cost for a non-fatal victim based on median wage and minimum productivity loss percentage

53,850.76

-

-

272

-

Gündem Çocuk Derneği Çocuk Hakları Merkezi (2012)

Number of non-fatal child abuse and neglect victims based on minimum prevalence rate in Turkey

209,046

-

Zoroğlu et. al

Number of non-fatal child abuse and neglect victims based on maximum prevalence rate in Turkey

448,834

-

Genç Hayat Yayınları (2012)

64

Number of fatal child abuse and neglect victims

Minimum productivity loss expenditure

11,390,443,522.27

Equation 49

-

Maximum productivity loss expenditure

110,647,879,153.63

Equation 50

-

Table 4.15 Best and worst case total productivity loss costs

4.3

Aggregation of Costs

Based on Chapter 3, a grand total for economic burden of maltreatment against young children in Turkey is founded. Table 4.16 summarizes the mentioned cost types, upper and lower bounds of these costs and monetary values in 2012. Grand total cost calculations in mentioned table are computed by referring the equations (51) and (52).

Unit Costs (TL of 2012)

Number of Victims

Total (TL of 2012)

Healthcare Cost

293

18,602

5,454,494.78

Justice system

663

1,138

754,789.88

Police System

1,401

18,602

26,819,334.88

Social Service

Min Case

268,233

366

98,173,561.49

Max Case

175,847

366

64,360,120.74

489

272

133,158,234.78

1,636,873

272

445,229,501.41

Productivity Loss Min Case Fatal Max Case Productivity Loss Min Case Non-Fatal

53,850

209,046

11,257,285,287.49

Max Case

245,530

448,834

110,202,649,652.22

Grand Total

Min Case

11,487,832,262.55

Max Case

110,779,081,334.66

Table 4.16 Summary of all costs of child maltreatment in Turkey

4.4

Other Long-Term Consequences

The previous sections serve to estimate total cost of child abuse and neglect that could be called as tangible costs. However, the long term impact of violence against young children is tried to be estimated by only taking life-long productivity loss costs into consideration. Beside life-long productivity loss costs, other long-term consequences of violence must also be considered for a real assumption of burden. Several studies emphasize relation of adult socioeconomic well-being, mental and physical health problems and childhood victimization.

Some others reflect the correlation between violent criminal behaviors of adults who are exposed to violence in their early ages.

Springer et. al., (2007) examine the longitudinal physical and psychological results of childhood physical abuse experiences in a population-based sample in the USA. According to the study, 234 of 2000 adults report exposed to physical violence in their childhood. 15 percent of them declare worse health conditions than non-abused ones based on the

65

determined scale. The research states that physical abuse escalates medical symptoms 16 percent, depression 19 percent, anger 22 percent, and anxiety 21 percent in adulthood.

English et. al., (2002) develop a report about adult and juvenile criminals in the USA by discriminating them according to their childhood abuse experiences. As it can be seen from Figure 4.1, total number of adult arrests for violence is found to be 8.7 percent for non-abused criminals, where this number turns out to be 23 percent in abused cases. In juvenile criminals, number of total arrest for violence is 0.8 percent among non-abused children, while this 66

number is obtained as 8.8 percent for abused cases.

40,00% 20,00% Abused 0,00%

Non-abused

Figure 4.1 Impacts of child abuse on committing crime

Zielinski (2009), examines the adult socioeconomic well-being among victims and nonvictims of child abuse in the USA and finds significant differences in employment and income levels of two different groups.

40,00% 30,00% 20,00%

10,00% 0,00%

Non-abused Abused

67

Figure 4.2 Impacts of child maltreatment on income levels

Figure 4.2 shows that 8.7 percent of abused cases are unemployed while this ratio is 5.7 percent for non-abused ones. Zielinski reports that those who earn below poverty level are 17.3 percent in abused people whereas 8.7 percent of non-abused individuals earn below poverty level.

Currie and Widom (2010), analyze longitudinal effects of child maltreatment on adults by classifying economic well-being in five perspectives as employment, owning a bank account, stock, a vehicle, and a home.

100,00% 50,00% Abused 0,00%

Figure 4.3 Impacts of child maltreatment on economic well-being

Non-abused

Figure 4.3 illustrates that in each well-being perspective, victimization has a significant impact. While there are several studies showing the long-term impacts of child maltreatment in the USA, this types of costs are omitted in this study due to lack of data and interest.

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References Central Bank of Turkey, available online at http://www3.tcmb.gov.tr/enflasyon/enflas yonyeni.php Currie, J., and Widom, C. S.,2010, Long-term consequences of child abuse and neglect on adult economic well-being, Child Maltreatment, 15(2), 111–120.

Forum on Child and Family Statisticsa, available online at http://www.childstats. gov/americaschildren/tables/fam7a.asp Forum on Child and Family Statisticsb, stats.gov/americaschildren/tables/pop1.asp

available

online

at

http://www.child

Genç Hayat Yayınları, 2012, Çocukların Ev İçinde Yaşadıkları Şiddet Araştırması, İstanbul, Turkey Gündem Çocuk Derneği Çocuk Hakları Merkezi, 2012,Türkiye‟deki Çocukların Yaşam Hakkı 2012 Raporu, Turkey Halicioglu, F. and Karatas, C., 2010, Estimation of economic discounting rate for practical project appraisal: the case of Turkey, Munich Personal RePEc Archive Halicioglu, F. and Karatas, C., 2011, A social discount rate for Turkey, Springer Science+Business Media Hyman, B., 2000, The Economic Consequences of Child Sexual Abuse for Adult Lesbian Women, Journal of Marriage and Family, 62 ( 1), 199-211. İstanbul Emniyet Müdürlüğü, available online at http://www.cocukpolisi.iem.gov.tr/Haberler Detay.aspx?ID=116 Ökten, Z., Yeditepe University Department of Economics, Turkey Turkish Ministry of Family and Social Policies, 2013, Kuruluşlarda Mevcut Durum Bilgisi: Yıl 2012, ay 1 Turkish Ministry of Finance, available online at http://www.bumko.gov.tr/TR,926/butcekanunu-ve-ekleri.html TURKSTATa , available online at http://tuikapp.tuik.gov.tr/cocuksucdagitimapp/cocuksuc.zul TURKSTATb, available online at http://www.tuik.gov.tr/PreIstatistikTablo.do?istab_id=1633 TURKSTATc, available online at http://www.tuik.gov.tr/VeriBilgi.do?alt_id=1070 TURKSTATd, available online at http://www.tuik.gov.tr/PreHaberBultenleri.do?id=408 Türkiye Kalkınma Bankası, 2005, Yataklı Tedavi Kurumları Sektör Araştırması, Turkey.

Yeni Asır, 2012, available online at http://www.yeniasir.com.tr/UcuncuSayfa/ 2012/09/16/ozel-guvenlikcilerin-sayisi-polise-yaklasti

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70

Chapter 5 Cost Comparison The previous chapter was dedicated to calculating the cost of violence against young children in Turkey based on the methodology described in former sections. This chapter deals the validation of the cost results obtained in chapter 4 by comparing the estimated cost with an EU country. That is, a what-if scenario is developed by assuming that the prevalence and incidence amounts of child maltreatment in selected EU country equal to violence against young children in Turkey. Here, the unit service and productivity loss costs due to child maltreatment of the selected country are used in cost calculation. The obtained result is compared with the cost of violence against young children in Turkey.

5.1

Obtaining the Unit Costs for Comparison

For comparison, UK is selected because of the fact that cost calculation methodology for Turkey is inspired of Walbyâ&#x20AC;&#x;s (2004) study on cost of domestic violence in UK. Among the many cost types mentioned in Walbyâ&#x20AC;&#x;s study, healthcare costs, police and justice system costs, social service costs and productivity loss costs for fatal and non-fatal cases are highlighted since only these costs are available in Turkey. As one can easily notice cost calculations for Turkey treat police system and justice system costs separately, however Walby combined these two service costs for UK. Another significant difference between Turkey and UK cases is that for Turkey, social service, fatal and non-fatal productivity loss unit costs are evaluated in two major perspectives by using economic discount rate and social discount rate and these correspond to do minimum and maximum monetary values. Table 5.1 illustrates the unit service and productivity loss costs of UK and Turkey (1 euro taken as 2,35 TL).

Cost Type

Unit Cost in Unit Cost in Unit Cost in Unit Cost in UK (in TL)

Turkey

(in UK (in Euro)

TL)

Turkey Euro)

Healthcare System

10,490.23

293.22

4,463.93

124.77

Police System

6,404.38

1,401.17

2,725.27

596.24

663,26

Justice System

282.24

62,399.89

175,847.32

26,553.14

74,828.65

Max.

62,399.89

268,233.77

26,553.14

114,142.03

Min.

3,672,670.44 489,552.33

1,562,838.49

208,320.14

Max.

3,672,670.44 1,636,873.17

1,562,838.49

696,541.77

Min.

512,023.02

53,850.76

217,882.14

22,915.22

Max.

512,023.02

245,530.98

217,882.14

104,481.27

Social Service Min.

(in

System

Productivity

71

Loss for Fatal Cases Productivity Loss for NonFatal Cases

Table 5.1 Unit Costs for UK and Turkey

5. 2

Obtaining the Total Costs for Comparison

A scenario based on what the total burden of child maltreatment in UK would be if the number of violent cases in UK equals to the number of violent cases in Turkey is created.

That is, 18602 victims use healthcare service system, 18602 victims use police and justice system, and 366 victims use social service system. As well as these, 272 deaths (aged between 0 and 8) are recorded and minimum 209046; maximum 448834 children are estimated to be affected by violence which results in losses in their lifelong productivity. Combining these numbers of violent cases with the unit costs shown in Table 5.1, total cost of violence against young children in UK is enumerated for comparison and validation purposes. The results are shown in Table 5.2.

Total Cost in Total

Cost Type

Cost

in Total Cost in Total

Cost

in

UK(1000TL)

Turkey(1000TL) UK(1000Euro)

Turkey(1000Euro)

Healthcare System

195,139

5,454

83,037

2,321

Police System

119,134

26,819

50,695

11,412

754

Justice System Social Service

321

Min.

22,838

64,360

9,718

27,387

Max.

22,838

98,173

9,718

41,775

System

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Productivity Loss

Productivity

Non-Fatal

998,966

133,158

425,092

56,663

Max.

998,966

445,229

425,092

189,459

Min.

107,036,364

11,257,285

45,547,389

4,790,334

Max.

229,813,340

110,202,649

97,792,910

46,894,744

Min.

108,372,442

11,487,832

46,115,932

4,888,439

Max.

231,149,418

110,779,081

98,361,454

47,140,034

for

Fatal Cases

Loss

Min.

for

Cases GRAND TOTAL

Table 5.2 Total Service Cost for UK and Turkey based on Incidence numbers in Turkey

To sum up, calculations shown in above give the upper and lower limits of grand total expenditures for child maltreatment for Turkey and UK based on incidence number in Turkey. For Turkey, total cost of violence against young children is between 4,888,439 and 47,140,034 billion euros. While for UK, these expenditures escalate between 46,115,932 and 98,361,454 billion euros. This means only the upper limit of Turkey catches the lower limit cost of UK. The deviations between limits of expenditures in two countries arise because of the economic characteristics. In detail, based on gross domestic products, the UK is the sixth country with 2,246 billion dollars, and Turkey is seventeenth with 735 billion dollars.

Consequently, budgets of departments in government is effected such as; in 2012-2013, Department of Health in UK allocate £ 5,45 billion only for local public health (UK, Department of Health) whereas total budget of Ministry of Health is approximately £ 4.91 billion in Turkey (Turkish Ministry of Finance). Also, total budget of Ministry of Justice in the UK is given as £ 9 billion (UK, Ministry of Justice), while allocated budget for justice system in Turkey is £ 1.80 billion in 2012.

References Turkish Ministry of Finance, available online at http://www.bumko.gov.tr/TR,926/butcekanunu-ve-ekleri.html United Kingdom Ministry of Justice, available online at https://www.gov.uk/government/ organisations/ministry-of-justice United Kingdom

Department

of Health,

available online at

https://www.gov.uk/

government/news/5-45-billion-budget-for-local-public-health-services-announced

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Chapter 6 Conclusion In this report, the cost of violence against young children in Turkey is estimated. As expected, the findings strongly support that the violence against young children has serious burdens on children in the short-run and also longitudinal consequents on society. The aim of this research is to measure these outcomes in a concrete way so that the interest of public opinion and governance is aroused.

In the first chapter, the significance of the topic is stated which is followed by examining the existing studies all around the world. The definition of violence against children is given and violence is categorized into four groups; namely physical violence, sexual violence, emotional violence, and neglect.

The second chapter is dedicated to violence against children in Turkey. To our knowledge, there exists no research on cost estimation on any violence type in Turkey; in fact the existing studies in literature deal only with the significance, impacts and prevalence of violence. In chapter 2, the procedures applied in Turkey in case of a violent act against a child are defined and they are summarized via a flowchart.

In chapter 3, a linear additive mathematical model is suggested to estimate the cost of violence against young children in Turkey. The model is based on combining both incidence and prevalence approaches in literature which seems to be a novel approach for child maltreatment cost estimates in Turkey.

Chapter 4 is dedicated to demonstrate the proposed methodology of chapter 3. By combining minimum and maximum prevalence values and economic parameters with unique unit costs of services described in chapter 2, best and worst case cost estimations are enumerated. Best case child maltreatment cost is turned out to be 11.5 billion Turkish Liras of 2012 which is

74

equivalent to 4.8 billion Euros. Worst case cost is obtained as 110.5 billion Turkish Liras of 2012, and this amount corresponds to 47.2 billion Euros.

The magnitude and importance of the problem is strongly supported by the fact that; 2 bridges across Bosphorus, 5 bridges over İzmit Bay, medical equipment for more than 1100 fully fledged hospitals or approximately 650 wind turbines of 1MW can be constructed with the minimum money spent due to violence against young children in Turkey. The maximum cost corresponds to 24 bridges across Bosphorus, 56 bridges over İzmit Bay, medical equipment for more than 11000 fully fledged hospitals or approximately 6200 wind turbines of 1MW. It is difficult to control the results obtained in Turkey by comparing these to the results of a developed country in the Western World since Turkey is still considered to be a developing country. In order to be able to make a significant comparison, the UK is chosen as the control case and the parameters of the UK related to the costs of services and actions used in the incidence of violence against children are collected to obtain unit costs. When these unit costs are combined with incidence and prevalence values of Turkey, minimum cost of violence against young children turns out to be 108 billion Turkish Liras of 2012, which equals to 46 billion Euros. Maximum burden of child maltreatment is obtained as 231 billion Turkish Liras of 2012 that corresponds to 98 billion Euros. The difference between the cost values of Turkey and the UK may be explained with the differences in economic structure of two countries as well as the diversifications in allocated budgets for related services in Turkey and the UK. Beside these, one of the roots of this difference may be due to the differences in perceptions of the two societies on child maltreatment.

Major challenges that are faced during the study are; the lack of appropriate data due to nonexistence of a healthy recording system for child abuse, misperception of violence against children by social environment and unwillingness to declare the incidences. In the case of insufficient data, some statistical estimation and expert opinion based methods are employed.

Since a direct measurement in data estimation is not applicable in some cases, data for similar situations and/or other countries are examined and included when suitable. One of the most serious obstacles is that most of the governmental organizations in Turkey resist sharing the raw data that they have collected, and most of the personnel in these organizations seem to underestimate the significance of computing the cost of violence against children.

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As a future work, a cost estimation study may be performed by using primary data obtained from surveys instead of collecting secondary data and expert opinions. As well as this, fuzzy set theory may be applied to overcome the confusions related with the differences in large gaps between minimum and maximum cost scenarios. Furthermore, longitudinal costs of violence against young children on education, family life, and crime may be estimated for Turkey. In fact, a risk matrix for the tendency of committing a crime for those who were exposed to violence in their childhood could be constructed.

76 All in all, violence against young children in Turkey is an extremely significant issue that should be taken into account by government and society as it is reflected by its related costs.

One should bear in mind that the long term consequences of child maltreatment are much more crucial than its short term impacts and preventive actions should be very carefully considered.