by Kayla Kelley, Program Intern
During recovery, the last thing a sexual assault survivor should have to think about is bills. Yet for countless survivors, trauma continues in the form of unexpected payments and years of financial strain. In the United States, 1 in 4 women and 1 in 26 men reported completed or attempted rape victimization at some point in their lifetime (NISVS, 2023). In 2023, the state of Maryland recorded a rate of approximately 32 rape cases per 100,000 people (WPR, 2025). Sexual violence often leaves heavy burdens on survivors. These burdens are carried into their workplaces, classrooms, homes, and finances—potentially draining savings and disrupting their path to recovery.
Sexual violence is often linked to emotional and physical trauma, overlooking the long-term economic impact that can shape a survivor’s entire life. These experiences can leave a long economic trail that affects survivors' ability to work, learn, and gain financial empowerment for years or even decades after the assault. Understanding the true economic cost of sexual violence means recognizing that recovery is not just about survival, but about justice, support, and the ability to live free from ongoing economic harm.
The Centers for Disease Control and Prevention (CDC, 2017) published the study, “Lifetime Economic Burden of Rape Among U.S. Adults,” that concluded that $122,461 is the estimated lifetime cost of rape per victim. For child sexual abuse the average lifetime cost for survivors is $282,734 per female victim (CDC, 2018). These alarming statistics highlight that the impact of sexual violence extends far beyond immediate trauma, creating long-term financial consequences for survivors. Economic burdens faced by survivors include medical costs, loss of productivity and income, legal expenses, educational disruptions, and mental health costs. In the U.S., the total population economic burden of rape is estimated at $3.1 trillion. This includes about $1.2 trillion in medical care, $1.6 trillion in lost work and productivity among victims and perpetrators, $234 billion in criminal justice costs, and $36 billion in other costs (CDC, 2017).
Survivors of sexual assault often need a variety of medical services, such as emergency treatment, pregnancy and HIV testing and prophylaxis, screening for sexually transmitted infections, and in some cases, abortions. According to the Violence Against Women Act (VAWA) of 1994, survivors who seek medical attention after a sexual assault must not be billed for the forensic exam and evidence collection, often referred to as a sexual assault evidence kit or rape kit. Although the forensic exam and immediate follow-up care are free, survivors who choose not to have evidence collected have to cover their own medical costs. Additionally, while certain follow-up services may be provided by a Forensic Nurse Examiner, long-term medical care would be the survivor's financial responsibility.
VAWA covers the forensic exam itself, but it allows hospitals to bill survivors for other services (NEJM, 2022). Consequently, survivors can face high out-of-pocket costs and significant medical debt. To address this, Maryland’s Sexual Assault Reimbursement Unit under the Governor’s Office of Crime Prevention and Policy (GOCCP) was created to provide reimbursement for medical exams, evidence collection, and emergency care for people who have experienced rape, sexual assault, or child sexual abuse (GOCCP, n.d.). It is important to note that only exams conducted within 15 days of the assault are reimbursed (MD Criminal Procedure Code, 2024, §11-1007).
Programs like Maryland's SARU are crucial in helping survivors overcome financial barriers. Financial barriers often deter survivors from seeking medical care and forensic exams. By reducing these costs, states can help ensure survivors receive immediate treatment and maintain access to trauma-informed services. Survivors may be unaware of available resources, highlighting the need for improved outreach and education. Survivors can also face mental health challenges like anxiety, depression, eating disorders, and post-traumatic stress disorder, which may require them to seek counseling and other mental health treatments and medications. Maryland survivors can receive counseling at Maryland Rape Crisis Centers for free, but other mental health services may require survivors to pay out of pocket. Survivors in Maryland also have the option to seek reimbursement for mental health treatment costs through GOCPP's Criminal Injuries and Compensation Board (CICB) but reimbursement is not guaranteed.
Beyond the physical and psychological effects, survivors also can experience significant disruptions in their work and education. According to a report by the International Center for Research on Women (ICRW, 2016), 50% of sexual assault survivors lost or were forced to quit their jobs within the year following the assault. During adolescence and early adulthood, sexual violence can interfere with a young person's path to success. Survivors may struggle to maintain academic ambition, become less engaged in school and extracurricular activities and limit their future aspirations. Survivors also may miss days of school, transfer schools or drop out. For many, trauma affects the ability to concentrate and function in the same environments, leading to lost opportunity and making it difficult to rebuild a sense of normalcy.
While interruptions to work and school can have significant financial consequences, survivors may also face additional economic strain in seeking justice. According to Wider Opportunities for Women (WOW), interactions with the police and courts can be costly, requiring fees, time off work, as well as expenses for childcare and transportation to law enforcement interviews and court. Victim advocates may not always have the resources or tools to navigate legal pathways for economic relief or connect survivors to financial resources (WOW, 2014). For low-income survivors, these barriers can make justice feel out of reach. MCASA’s Sexual Assault Legal Institute (SALI) provides free legal services to Maryland survivors statewide.
Measuring the true costs of sexual violence at the national, local, and individual level can help advocates identify effective solutions. Increasing funding for survivor programs is essential. It supports public awareness campaigns, outreach to underserved populations, and access to medical, legal, and mental health services, ensuring survivors have the resources they need. While policymakers can improve laws and regulations, effective implementation requires collective action: schools and workplaces must provide accommodations, communities must raise awareness of financial and legal resources, and service providers must ensure survivors can access support and resources. Only through collective action can survivors be free from financial harm and live full lives.
Resources for Survivors & Advocates in Maryland:
References
Basile, Kathleen C., et al. (2022). The National Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Sexual Violence. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Retrieved here.
Dickman, Samuel L., et al. (2022, Sept 14). Uncovered Medical Bills after Sexual Assault. The New England Journal of Medicine. Retrieved here.
Duggan, Áine, Cooper, Gail. (2015) Gender Stat: Sexual Violence, Work and Financial Precarity. International Center for Research on Women. Retrieved here.
Cora, Peterson, et al. (2017). Lifetime Economic Burden of Rape Among U.S Adults. American Journal of Preventative Medicine. Retrieved here.
Economic Impact of Sexual Violence (2025). Maryland Coalition Against Sexual Assault. Retrieved here.
Letourneau, Elizabeth J., et al. (2018). The economic burden of child sexual abuse in the United States. Centers for Disease Control and Prevention. Retrieved here.
MD Criminal Procedure Code § 11-1007 (2024). Retrieved here.
Sexual Assault in Maryland. (2024). Maryland Coalition Against Sexual Assault. Retrieved here.
Sexual Assault Reimbursement Unit. (n.d). Governor’s Office of Crime Prevention and Policy. Retrieved here.
The Court’s Guide to Safety and Economic Security for Victims of Violence Against Women. (2014). Wider Opportunities for Women (WOW). Retrieved here.
Zweig, Janine, et al. (July 2021). Paying for Sexual Assault Medical Forensic Exams: How States and Jurisdictions Pay for Exams So Survivors Do Not Have To. Urban Institute. Retrieved here.
