Intentional child and adolescent homicides in Milan (Italy): A 30-year interdisciplinary study.

This study aims to discuss the forensic and criminological implications of child homicides in the territory of Milan, Italy. The authors present a retrospective study on all the cases of child and adolescent homicides, that were observed at the Institute of Legal Medicine of Milan (Italy) in the last 30 years (from January 1991 to December 2020). A total of 46 child homicides were collected, focusing on the sociological features, by highlighting peculiar cases, risk factors, potential changing social trends, and comparing our cases with the current literature. The analysis revealed a statistically significant relationship (p < 0.05) for male adolescents and indicated that adolescent homicides were more frequently perpetrated in extrafamilial contexts. In contrast, neonaticides and infanticides were mainly committed at home. Furthermore, the Fisher's Exact test revealed that child murders were mainly committed by immigrants in the Milan district after 2005 (p < 0.05). The two main causes of death were due to sharp and firearm injuries. While the relationship between homicide clusters and homicides committed by sharp objects was not significant, adolescent homicides were mainly committed using firearms (p < 0.05). The present study may help to identify risk factors for homicides against child and adolescent. Consequently, policies that identify, prevent, and minimize this extreme violence should be designed to interrupt the vicious circle of such dreadful murderous events. Child and adolescent homicides deserve additional focus and better education for healthcare professionals and further research should be carried out to develop therapeutic and caring strategies.

The socio-economic status of families experiencing the sudden unexpected death of an infant - Is it possibly related to a higher rate of non-natural deaths among them.

Low socio-economic status is recognized as one of the risk factors for SIDS. In this study we have pointed out the similarities between families that have SIDS cases and families in which infant non-accidental injury has been proven, as well as the differences between them and the general population. This study was conducted in Montenegro, comparing 30 cases of SIDS with 25 cases of known infanticides and with a control group (60 cases) consisting of live newborns and their mothers from the general population, randomly selected from hospital-born newborns without exclusion criteria. We combined and compared the infant characteristics and mother characteristics between the above cases. There were significant similarities between the SIDS group and the infanticide group in terms of the following characteristics: the education level of the mothers (p = 0.086); maternal employment (p = 0.278); and place of residence (p = 0.269); while there were differences between the two groups regarding hospital birth (p = 0.027) and marital status (p = 0.011). The SIDS and infanticide groups, combined, had higher incidences of: out-of-hospital deliveries (p < 0.001); uneducated mothers (p < 0.001); unemployed mothers (p < 0.001); low socio-economic status (p < 0.001); and cases outside of marriage (p < 0.001), compared to the control groups. This study indicated a possible higher incidence of non-natural death among SIDS cases, as reflected by low socio-economic status and linked attributes, which is explained by their similarities with the infanticide groups and differences with the control groups.

Neonaticide rate unchanged in Japan despite a decrease in the birth rate.

BACKGROUND: Neonaticide is the murder of a newborn baby within 24 hours of birth. It has been reported in various countries, but there has been little recent research on the current state of neonaticide in Japan. AIM: To elucidate the epidemiological features of neonaticide in Japan using public long-term, population-based data collected over 14 years and 9 months from July 2003 to March 2018. METHODS: A descriptive analysis of public data from 2003 to the present was conducted related to deaths which had been retrospectively investigated and deemed by the authorities to be caused by child abuse or neglect. RESULTS: Between July 2003 and March 2018, there were 149 cases of 'known' neonaticide in Japan and the incidence was 0.96/100,000 live births. The majority of perpetrators were mothers, accounting for 135 (91%) of cases, and in 70 (48%) cases they were young mothers under the age of 25. None of the infants was delivered in a medical facility. Nine (6%) murders were committed by both parents together and only one (1%) by the father alone. CONCLUSION: The number of births in Japan has been declining gradually but the rate of neonaticide is the same.

Recurrent sudden unexpected death in infancy: a case series of sibling deaths.

OBJECTIVES: To determine the rate of sudden unexpected death in infancy (SUDI) for infants born after a previous SUDI in the same family, and to establish the causes of death and the frequency of child protection concerns in families with recurrent SUDI. DESIGN: Observational study using clinical case records. SETTING: The UK's Care of Next Infant (CONI) programme, which provides additional care to families who have experienced SUDI with their subsequent children. PATIENTS: Infants registered on CONI between January 2000 and December 2015. MAIN OUTCOME MEASURES: Cause of death, presence of modifiable risk factors for SUDI and child protection concerns. RESULTS: There were 6608 live-born infants registered in CONI with 29 deaths. 26 families had 2 deaths, and 3 families had 3 deaths. The SUDI rate for infants born after one SUDI is 3.93 (95% CI 2.7 to 5.8) per 1000 live births. Cause of death was unexplained for 19 first and 15 CONI deaths. Accidental asphyxia accounted for 2 first and 6 CONI deaths; medical causes for 3 first and 4 CONI deaths; and homicide for 2 first and 4 CONI deaths. 10 families had child protection concerns. CONCLUSIONS: The SUDI rate for siblings is 10 times higher than the current UK SUDI rate. Homicide presenting as recurrent SUDI is very rare. Many parents continued to smoke and exposed infants to hazardous co-sleeping situations, with these directly leading to or contributing to the death of six siblings. SUDI parents need support to improve parenting skills and reduce risk to subsequent infants.

Personality structure and attachment models of women who kill their children. A systematic review on maternal filicide.

BACKGROUND: A mother's ability to attune with her child is crucial in structuring one's attachment style and personality. Both dimensions shape mother-child interactions, and they are therefore likely to impact on the risk of filicide. Numerous risk factors for filicide have been identified, but personality and attachment look relatively understudied. OBJECTIVE: We focused on filicide mothers' personality and states of mind regarding attachment to shed new light on this phenomenon, for the purpose of an improved and earlier identification of at-risk maternities. METHODS: A systematic review of five electronic databases was performed. All studies on filicide, infanticide or neonaticide were included in the search, regardless of the study design or the socio-demographic characteristics of the offenders. RESULTS: Twelve original articles were found to be eligible for the systematic review. The data were categorized in personality and attachment related, and then by study design. Only two studies performed comparisons with control groups, and only three reported data about psychodiagnostic/neuropsychiatric tests or questionnaires. Personality diagnoses were strongly heterogeneous (mostly pertaining to cluster B and C), and not supported by statistically significant evidence. Attachment was examined by only one study, which showed that the most frequent states of mind regarding attachment were unresolved/unclassifiable (U/CC). CONCLUSIONS: Despite their pivotal importance in determining relational patterns in an individual, both personality and attachment are almost unacknowledged across the literature about maternal filicide. It is thus advisable to further focus on them, carrying out structured and validated assessments, to better define the causes of this dramatic event.

How Does Economic Inequality Affect Infanticide Rates? An Analysis of 15 Years of Death Records and Representative Economic Data.

BACKGROUND: Is there a relationship between economic inequality and infanticide rates? Few studies have examined the socioeconomic factors that trigger infanticide. This study aims to statistically analyze the effect of these factors on infanticide rates. METHODS: This study used infant death records in South Korea from 2003 to 2017 to assess the impact of unemployment rates and various statistical indicators (e.g., GDP and income inequality index) on the rate of infanticide. A generalized additive model and a quasi-Poisson regression were used for statistical analyses. RESULTS: A time-trend analysis shows that the infanticide rate tended to grow despite a decreasing trend in the quarterly infant mortality rate. A 1% increase in the unemployment rate is associated with a significant rise in the relative risk of infanticide after a lag of two quarters. Relative risks increased significantly three and four quarters after a 0.1 rise in the p80/p20 ratio (income inequality index). CONCLUSIONS: Policymakers should pay attention to socioeconomic factors while formulating healthcare regulations to protect potential infanticide victims, including vulnerable infants and their parents.

Trends of infanticides in northern Tunisia: A 40 years study (1977-2016).

BACKGROUND: The Tunisian Penal Code defines infanticide as the murder committed by the mother on her child at birth or immediately after. There is a dearth of studies and official statistics on infanticide in the Arab region and North Africa. OBJECTIVE: to analyze the infanticide trends in northern Tunisia between 1977 and 2016. PARTICIPANTS AND SETTING: we included all cases of infanticides autopsied at the Legal Medicine Department of Charles Nicolle Hospital in Tunis, over a period of 40 years (1977-2016). METHODS: A descriptive retrospective study. RESULTS: We collected a total of 513 cases of infanticide over the study period. The general prevalence of infanticide was 0.42 per 100,000 live births per year. Infanticide often occurred during the week, in winter (31.5%) and in spring (30.9%). The newborn was often found on public roads (40.9%) and in urban areas (81.4%). The newborn was often full-term (73.6%), mature, without any congenital malformation, found completely naked (75.2%) and with an empty stomach (93.7%). The umbilical cord was often cut (71.5%), not ligated (82%) with an irregular edge (64%). There was often no putrefaction (54.4%). The hydrostatic test (81.8%) and histological examination (81.1%) showed that infants had breathed. Neglect was the most common cause of death (49.9%). CONCLUSION: Northern Tunisia has a low prevalence of infanticide compared to most of the previous European and American studies. A better understanding of infanticide would allow us to adapt measures of prevention.

["Evolution of paternal filicide-suicide in the province of Quebec"]. / Évolution dans le temps du filicide-suicide masculin au Québec.

OBJECTIVES: The purpose of this study was to specify the number of male filicide-suicide committed in the province of Quebec between 1997 and 2012, and to evaluate whether there has been an increase in the number of male filicide-suicide according to the period studied and the type of motivation to commit the crime. METHOD: The data cover all officially registered male filicides committed in the province of Quebec from 1997 to 2012, against youths under 18 years old. A total of 50 cases were divided by five years spans starting in 1997 and analyzed using the Grille d'analyse multidimensionnelle de l'homicide intrafamilial. RESULTS: The results show that among the 50 male filicides committed between 1997 and 2012, 13 of these were followed by the aggressor's suicide. Also, the likelihood of suicide committed as a result of filicide is higher among individuals who committed filicide between 2007 and 2012 and who were motivated by marital separation, compared to filicides committed between 1997 and 2001 motivated by another reason. In particular, the majority of perpetrators of filicide committed between 2007 and 2012, motivated by marital separation, committed suicide as a result of the act of committing, compared to individuals who were motivated by another reason for the same period. CONCLUSIONS: On one hand, the present study demonstrates the importance of considering self-destruction and, more specifically, the suicide of these individuals. On the other hand, our study emphasizes the importance of considering the type of motivation to commit filicide, including spousal separation, which is an element of understanding specific to male filicide-suicide.

Gender differences in legal outcomes of filicide in Austria and Finland.

Female offenders of filicide have been found to receive more lenient legal handling than male offenders. We aimed to discover these possible gender differences in the legal outcome of filicide cases. This was a binational register-based study covering all filicide offenders in Austria and Finland 1995-2005. We examined the legal outcomes of the crimes of all living offenders (64 mothers and 26 fathers). Mothers received a conviction of murder and life imprisonment less often than fathers. Within psychotic and personality-disordered offenders, infanticides, and offenders convicted for life, gender differences were less evident. Even though there seems to be some gender differences within the legal outcomes of filicide, ruling seemed more consistent than expected within distinct subgroups of offenders. Gender-based assumptions should not hinder equal and just handling of filicide cases.

Repeated neonaticide: differences and similarities to single neonaticide events.

This study aims to identify differences between single and repeat perpetrators of filicide by using register-based data. The study used register-based, comprehensive, nationwide data from both Austria and Finland. The current study covers 23 perpetrators, 20 single and 3 repeat perpetrators, with a total of 28 victims. All victims had a maximum age of 24 h and all perpetrators were women. Every third victim of neonaticide was a victim of a repeat case. The repeat perpetrators were older; had a higher number of children over their lifespan, some of whom lived with them; were more likely to live within established family structures; had higher levels of education and employment; had a higher proportion of personality disorders; and were more likely to identify stress factors during pregnancy. One unexpected finding was low levels of awareness about pregnancy within the perpetrator's circle remain a risk factor, especially for repeat perpetrators. Arguably, the quality of interpersonal relationships these women have may be affected by their own mental health issues and life experience and vice versa.

Infanticide and American criminal justice (1980-2018).

Maternal infanticide, or the murder of a child in the first year of life by its mother, is a subject both compelling and repulsive. The victim is innocent, but the perpetrator may be a victim too. In the USA, mentally ill women who commit infanticide may receive long prison sentences or even the death penalty. England, Canada, Australia, and more than 20 European countries have "infanticide laws," which provide more humane treatment and psychiatric care for mentally ill mothers who kill. One of the reasons for the sentences in the USA lies in our archaic insanity defense. In addition, the psychiatric community does not recognize perinatal illness as a formal diagnosis. Furthermore, general forensic psychiatrists who testify in the courtroom have little knowledge of perinatal illness. I suggest that it is time to invite psychiatrists and psychologists as clinicians and scientists to partner with our legal representatives in the courtroom in order to determine laws based on psychiatric facts and not conjecture. The voices of perinatal mental health advocates must continue to be heard in all courtrooms of the USA.

Maternal Infanticide and Filicide in a Psychiatric Custodial Institution in Hong Kong.

OBJECTIVE: The aim of this study was to review the history, legislation, and psychiatric perspective of filicide, to compare the characteristics of mothers who committed neonaticide versus infanticide, and to discuss the infanticide law in Hong Kong. METHODS: Data of mothers remanded to the Siu Lam Psychiatric Centre from 2008 to 2016 for filicide were reviewed, as were data of filicide from the Child Fatality Review Reports published by the Social Welfare Department. RESULTS: From 2008 to 2016, eight mothers were remanded to Siu Lam Psychiatric Centre for filicide. Four were convicted of infanticide; the other four were convicted of manslaughter. Those convicted of infanticide were single and aged <18 years. They had concealed their pregnancies and received no antenatal care. They delivered at home and then either smothered or abandoned the newborn. They reported no suicidal attempts after the index offence and had no record of mental illness. They were given supervision orders instead of prison sentences. In contrast, those convicted of manslaughter were in their 30s and married. They were documented to have killed the victims by charcoal burning, strangulation, mutilation, or defenestration. They all attempted suicide immediately after the killing and had histories of mental illness: paranoid schizophrenia (n = 2), severe depressive disorder with psychotic symptoms (n = 1), and recurrent depressive disorder (n = 1). They were sentenced to Hospital Orders for unspecified periods. CONCLUSIONS: In Hong Kong, the incidence of maternal filicide is low. However, the infanticide provision grants leniency to mothers, including those who show no evidence of mental illness.

[Neonaticides in France: analysis of 357 cases identified in the press (1993-2012)]. / Les néonaticides en France : analyse de 357 cas identifiés dans la presse (1993-2012).

Background and objectives: Despite easy access to contraception and child abandonment in France, neonaticides continue to occur and, although rare, are widely publicized. The objective of this study was to characterize neonaticides and their perpetrators over a twenty-year period in France based on cases reported in the press. Methods: 2,319 press articles describing the discovery of a newborn corpse in the regional and national press were extracted from electronic databases or other digital supports. A total of 357 neonaticides were described, corresponding to a mean annual rate of 2.34 per 100,000 births. Results: The mother was identified in 74% of cases. The corpse was usually discovered in the house or garden (35%, mostly in the rubbish bin and 6% in the freezer), but also in the wilds (31%). In almost one-quarter of cases, the mother had suffered a haemorrhage. Most neonates were killed by asphyxiation (35%), direct blows or being thrown out of a window (11%), or drowning (11%). Only 22% of neonates died without the mother's intervention, due to lack of care or neglect. Marked regional disparities were observed, even after calculation of regional rates. The mothers responsible (230 women due to 19 multiple neonaticides) had a mean age of 27.8 years and half of them had at least one other living child. Conclusions: Media coverage of neonaticides and access to electronic databases provide an opportunity to describe a rare phenomenon, for which it is difficult to collect sufficient sample sizes to allow analysis of the perpetrators and court rulings.

The worldwide incidence of neonaticide: a systematic review.

Neonaticide is the killing of a neonate on the day of its birth by his/her own mother. Neonaticidal women were reported to be predominantly young, unmarried, and primiparous. The motive for murdering the newborn relates to the shame, the fear of rejection, and abandonment by significant others, and the social stigmas associated with an illegitimate birth. The goal of the present study was to conduct a systematic review of the scientific literature and identify population-based studies reporting the incidence of neonaticide in different countries. A total of 485 abstracts were screened. After applying the inclusion/exclusion criteria, 10 studies were selected. Additional searches identified two more articles. Most of these studies were from Europe, where incidence varied from 0.07 (Finland, 1980-2000 period) to 8.5 neonaticides per 100000 births (Austria, 1975-2001 period). More recent studies have indicated that a growing proportion of neonaticidal women are married, multiparous, and suffers from mental disorders. Preventive measures, such as anonymous free delivery, were shown to reduce the incidence of neonaticide, although this effect may be short-lived. Despite social and institutional changes, neonaticide persists even in the most socially advanced, liberal, and prosperous societies in the world.

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

South Africa (SA) has not met the child mortality target for the Millennium Development Goals, despite having invested substantially in programmes and policies to achieve these targets. The scale-up of the prevention of mother-to-child transmission programmes reduced HIV transmission from mother to child, but this has not been sustained owing to limitations in community-based child health services. Child mortality has declined, but has now plateaued. Children continue to die from preventable and treatable causes of death. Current data sources are incomplete, and do not provide information on deaths occurring out of health facilities. The child death review (CDR) pilot explores the pattern of child deaths and informs prevention strategies to improve child survival in SA. In this editorial we draw on the conclusions of the CDR pilot, where multiagency teams were established to investigate non-natural and unexpected deaths referred to two mortuary sites in order to strengthen child health and protection response systems and to prevent child deaths.

A lost family-planning regime in eighteenth-century Ceylon.

Based on Dutch colonial registers (thombos), this paper reconstructs fertility for two districts in Ceylon, 1756-68. It overcomes challenges in data quality by establishing the outer bounds of plausible estimates in a series of scenarios. Among these, total fertility rates (TFRs) averaged 5.5 in one district, but only 2.7 in the other. These figures exclude the victims of infanticide, a custom noted in European travelogues between about 1660 and 1820. Sex ratios among children differed depending on the number of older siblings, and overall, 27 per cent of girls are missing in one district and 57 per cent in the other. There was little significant variation either in the TFR or the sex ratio by socio-economic status, suggesting that poverty was not a key factor in motivating infanticides. Instead, we argue that at least parts of Ceylon had a forward-looking culture of family planning in the eighteenth century, which was lost in subsequent decades.

Anonymous birth law saves babies--optimization, sustainability and public awareness.

The aims of this study are to assess the impact of Austria's anonymous birth law from the time relevant statistical records are available and to evaluate the use of hatches versus anonymous hospital delivery. This study is a complete census of police-reported neonaticides (1975-2012) as well as anonymous births including baby hatches in Austria during 2002-2012. The time trends of neonaticide rates, anonymous births and baby hatches were analysed by means of Poisson and logistic regression model. Predicted and observed rates were derived and compared using a Bayesian Poisson regression model. Predicted numbers of neonaticides for the period of the active awareness campaign, 2002-2004, were more than three times larger than the observed number (p = 0.0067). Of the 365 women who benefitted from this legislation, only 11.5% chose to put their babies in a baby hatch. Since the law was introduced, a significant decreasing tendency of numbers of anonymous births (p = 047) was observed, while there was significant increase of neonaticide rates (p = 0.0001). The implementation of the anonymous delivery law is associated with a decrease in the number of police-reported neonaticides. The subsequent significantly decreasing numbers of anonymous births with an accompanying increase of neonaticides represents additional evidence for the effectiveness of the measure.

The medico-legal investigation of abandoned fetuses and newborns--a review of cases admitted to the Pretoria Medico-Legal Laboratory, South Africa.

There is a dearth of literature on the extent of fetal or newborn abandonment or "dumping" and the medico-legal investigation procedures these cases require. This is despite the fact that these occurrences are a worldwide phenomenon and by definition involve criminal law concerns such as illegal abortion, concealment of birth, murder, or neonaticide, depending on the country concerned. This article contributes to current literature in both respects and provides a retrospective case audit for the period 2004-2008 pertaining to all abandoned newborns and fetuses admitted to the Pretoria Medico-Legal Laboratory (PMLL) in South Africa. Demographic details, scope, and nature of the medico-legal investigation as well as formulation of cause of death were recorded. A total of 289 cases were identified for inclusion in this study, 57% of which were considered to have been non-viable fetuses, while 45 of the viable fetuses were deemed to have been stillborn. These instances involve the crimes of concealment of birth and at times illegal abortion, yet prosecution of these cases are relatively unheard of. Signs of live birth were identified in 38 of the cases in the study. Of these infants, 9 were deemed to have died from injuries they have sustained, and in a further 9 cases, no anatomical cause of death could be identified. Homicidal cases should be brought in cases where death ensued as a result of abandonment; however, it is not known how many cases were prosecuted. A comparatively large number of cases were found to have been admitted to the Pretoria Medico-Legal Laboratory. This is alarming because South African abortion laws are liberal and services are free at point of access in the public health care sector. A substantial percentage of cases of abandoned infants were found to have shown signs of life after birth implying a homicidal manner of death or death by abandonment, but it seems these cases are merely shelved.

Prevalence and phenomenology of neonaticide in Switzerland 1980-2010: a retrospective study.

For a child, the likelihood of being murdered is highest during the first year of life, and many such cases are neonaticides. Although several recent studies have examined neonaticide in different countries and cultures, there has been no in-depth analysis of Swiss cases, even though this country has special neonaticide legislation and four "baby hatches" have been opened to prevent such killings. The primary objective of this retrospective study was to analyze the prevalence and phenomenon of neonaticide in Switzerland. Using data from judicial files, 11 cases were identified in 15 German-speaking cantons between 1980 and 2010. The sample included two uncommon cases of nonmaternal neonaticide. The discussion addresses possible prevention strategies.

Conjuring the ghosts of missing children: a Monte Carlo simulation of reproductive restraint in Tokugawa Japan.

This article quantifies the frequency of infanticide and abortion in one region of Japan by comparing observed fertility in a sample of 4.9 million person-years (1660-1872) with a Monte Carlo simulation of how many conceptions and births that population should have experienced. The simulation uses empirical values for the determinants of fertility from Eastern Japan itself as well as the best available studies of comparable populations. This procedure reveals that in several decades of the eighteenth century, at least 40% of pregnancies must have ended in either an induced abortion or an infanticide. In addition, the simulation results imply a rapid decline in the incidence of infanticide and abortion during the nineteenth century, when in a reverse fertility transition, this premodern family-planning regime gave way to a new age of large families.