Background Violence against Women and Girls (VAWG) is widely recognized as a violation of human rights and a challenge to public health. In recognition of the dearth of knowledge of the impacts and costs due to VAWG, particularly in fragile and developing contexts, the UK Department for International Development (DFID) funded this research to investigate the social and economic costs of VAWG in Ghana, Pakistan and South Sudan (2014–2019), as part of its wider What Works to Prevent Violence research and innovation programme.

Methods This study used a mixed method approach including both quantitative surveys of individual women, households, and businesses, and qualitative inquiry methods including key informant interviews, participatory focus groups, and individual in-depth interviews. The direct health-related effects on women are measured by the out of pocket health expenditure incurred by women experiencing violence. The indirect mental health-related effects are quantified by productivity loss which is estimated as women missing work, being late at work or being not being mentally present at work. The study also estimates various health-related scores: Depression, Disability and Acute Illness scores, and compares women who experience violence and who do not.

Results In all the three countries, this study finds health expenditure to be the predominant out of pocket cost incurred by women experiencing violence. Women who experience violence also have statistically significant higher depression, disability and acute illness scores, and thus indicate the broader health impacts of VAWG. These health impacts affect the overall productivity of women experiencing violence. Approximately 80 million productivity work days in Pakistan, 65 million productivity work days in Ghana, and 8.5 million productivity work days in scaled population of South Sudan are lost due to women experiencing any violence. The productivity loss indicates the significant impact VAWG has on the overall economy.

Conclusion The results of this study on the socioeconomic cost of VAWG highlight the need for crucial action by a wide range of actors, from local authorities and community leaders to national government. Moreover, the results suggest the potential burden that VAWG places on the health sector in the countries studied. The health and economic impacts outlined in this study together build a strong economic case for investment by government and donors in the prevention of VAWG.