Gender Differences in Homicide of Neonates, Infants, and Children under 5 y in South Africa: Results from the Cross-Sectional 2009 National Child Homicide Study

Abstract

BackgroundHomicide of children is a global problem. The under-5-y age group is the second largest homicide age group after 15–19 y olds, but has received little research attention. Understanding age and gender patterns is important for assisting with developing prevention interventions. Here we present an age and gender analysis of homicides among children under 5 y in South Africa from a national study that included a focus on neonaticide and infanticide.Methods and FindingsA retrospective national cross-sectional study was conducted using a random sample of 38 medico-legal laboratories operating in 2009 to identify homicides of children under 5 y. Child data were abstracted from the mortuary files and autopsy reports, and both child and perpetrator data data were collected from police interviews. We erred towards applying a conservative definition of homicide and excluded sudden infant death syndrome cases. We estimated that 454 (95% CI 366, 541) children under the age of 5 y were killed in South Africa in 2009. More than half (53.2%; 95% CI 46.7%, 59.5%) were neonates (0–28 d), and 74.4% (95% CI 69.3%, 78.9%) were infants (under 1 y), giving a neonaticide rate of 19.6 per 100,000 live births and an infanticide rate of 28.4 per 100,000 live births. The majority of the neonates died in the early neonatal period (0–6 d), and abandonment accounted for 84.9% (95% CI 81.5%, 87.8%) of all the neonates killed. Distinct age and gender patterns were found, with significantly fewer boy children killed in rural settings compared to urban settings (odds ratio 0.6; 95% CI 0.4, 0.9; p = 0.015). Abuse-related killings and evidence of sexual assault were more common among older girls than in all other age and gender groups. Mothers were identified as the perpetrators in all of the neonaticides and were the most common perpetrators overall (71.0%; 95% CI 63.9%, 77.2%). Abandoned neonates were mainly term babies, with a mean gestational age of 38 wk. We did not have information on abandonment motives for all newborns and did not know if babies were abandoned with the intention that they would die or with the hope that they would be found alive. We therefore considered all abandoned babies as homicides.ConclusionsHomicide of children is an extreme form or consequence of violence against children. This national study provides one of the first analyses of neonaticide and infanticide by age and gender and shows the failure of reproductive and mental health and social services to identify and help vulnerable mothers. Multi-sectoral prevention strategies are needed.

Child deaths in South Africa: Lessons from the child death review pilot

“…This finding is supported by the national child homicide study showing that SA had one of the highest reported rates of neonaticide globally. [9] Neonaticide is the killing of a newborn within the first 6 days of life, and infanticide the killing of a child in the first year of life. Both these acts are a form of child abuse, whether the killing was deliberate or the death due to a deliberate omission of care, e.g.…”

“…when a baby is abandoned without care, protection or supervision. [9] Infanticide or abandonment of a newborn is far more common than the CDR pilot suggests, as many infants are 'dumped' in sewers, refuse dumps and dirt bins, and the pilot only identified remains brought to a mortuary. Despite SA's liberal termination of preganancy legislation and the availability of community-based contraception services, it would appear that we are not meeting the needs of large numbers of women.…”

Developing an understanding of fatal child abuse and neglect: Results from the South African child death review pilot study

“…The rate of infanticide in SA is estimated to be among the highest reported rates globally, at 28.4/100 000 live births, [1] only surpassing a reported rate for Dar es Salaam, Tanzania. [19] Abandonment and injury deaths of infants were found to be common immediately after birth.…”

“…[1] The first national prevalence study on child abuse confirms excessive rates of child maltreatment, with one-third of children reporting experiences of sexual and/or physical abuse during childhood. [20] The insidious nature of violence against children highlights the need to prioritise prevention efforts to break the cycle of child maltreatment, particularly in the home.…”

“…Fatal child abuse is the most severe consequence and forms a proxy measure for the effectiveness of a country's child protection system. [1] The SA child homicide study estimates a child homicide rate of 5.5/100 000 children <18 years of age [2] -more than double the global child homicide rate. [3] Furthermore, the relationship between child homicide and fatal child abuse was noted, with nearly half (44.6%) of child homicides related to child abuse and neglect.…”