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.
Highlights
The number of children killed in a country is a proxy indicator of the effectiveness of the child protection system [1,2]; homicides of children under 5 y old, in particular, reflect a failure in maternal and child health service provision
The report concluded, that the under-5-y age group has the second largest number of homicides among children 0–19 y old, after the 15–19 y age group [4]. This pattern was shown in the South African National Child Homicide Study, with 39.6% of all child homicide deaths among the under-5-y group (41.0% among 15–17 y olds) [5]
This study provides us with an opportunity to further analyze the gender differences in the under-5-y age group, and in this paper we separate neonaticide and infanticide and use live births as the denominator to calculate the mortality rates within infancy
Summary
The number of children killed in a country is a proxy indicator of the effectiveness of the child protection system [1,2]; homicides of children under 5 y old, in particular, reflect a failure in maternal and child health service provision. The report concluded, that the under-5-y age group has the second largest number of homicides among children 0–19 y old, after the 15–19 y age group [4] This pattern was shown in the South African National Child Homicide Study, with 39.6% of all child homicide deaths among the under-5-y group (41.0% among 15–17 y olds) [5]. 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. In 2015, 5.9 million children (43 out of every 1,000 children born alive) died before their fifth birthday Half of these deaths occurred among neonates (babies 28 days old or younger); three-quarters of them occurred among infants (children less than one year old). Unwanted pregnancies are the most common cause of infanticide and neonaticide, but some infants are killed because they are disabled or of the wrong gender—in some cultures male children are considered more socially valuable than female children
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