Invisible costs of care: Health consequences for women supporting survivors of intimate partner violence in South America

Abstract

This study examines the often-overlooked health consequences experienced by women who provide informal support to survivors of intimate partner violence against women (IPVAW) in their communities. In contrast, extensive research has documented the physical and psychological impacts of violence on survivors; far less attention has been paid to the invisible costs borne by supporters—neighbors, friends, coworkers, or relatives—who are repeatedly exposed to traumatic disclosures and the demands of caregiving. Grounded in the complementary frameworks of Secondary Traumatic Stress, Vicarious Trauma, Compassion Fatigue, and Allostatic Load, this study conceptualizes the “cost of caring” as the cumulative psychological and physiological burden of informal caregiving. Unlike previous research that has focused mainly on professional providers, our analysis highlights the experiences of women embedded in gendered, community-based care networks. A two-phase cross-sectional probabilistic household survey design was implemented in two South American countries with a high prevalence of IPVAW. The exploratory phase was conducted in a high-incidence district in Peru (n = 507), followed by a confirmatory phase using a nationally representative sample in Ecuador (n = 2,501). Standardized instruments measured support intensity, emotional and physical morbidity, and personal victimization. Multivariate analyses, controlling for sociodemographic and violence-related covariates, showed that women providing support to IPVAW survivors reported significantly higher levels of emotional morbidity (β = .075–.083) and physical morbidity (β = .038–.058), even after adjusting for their own experiences of violence. Findings reveal a robust and statistically significant association between informal caregiving and increased health burden, underscoring that the impacts of violence extend beyond survivors to those who sustain them. By making these hidden costs visible, this study contributes to both the social support literature and the IPVAW field, reframing community-level caregiving as a critical public health issue. Although causal inference is limited by the cross-sectional design, the consistency of results across two countries strengthens the external validity and global relevance of the phenomenon.