Femicide, the homicide of women, is a leading cause of premature death in the United States for women. Femicide rates are highest among women aged 20–49, according to the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Justice. National statistics indicate that women are killed by intimate or ex–intimate partners more often than by any other category of perpetrator, and the majority of intimate partner (IP) femicides are perpetrated by male intimate partners (husbands, boyfriends, ex-husbands, exboyfriends). A current or former intimate partner is the perpetrator in approximately one in three femicides nationally, but a relatively small proportion of male homicides (5 percent) are perpetrated by a female intimate or ex–intimate partner. As of this writing (2006) there are approximately four women killed by their male intimate partners for each male killed by a female intimate partner.
During 1981–1998, IP homicides decreased by almost 50 percent in the United States. Overall rates of IP homicide among males decreased 67.8 percent, and rates among females decreased 30.1 percent. The rates have since stabilized. The decreases in IP homicides are temporally associated with the implementation of national social programs and legal interventions to reduce IP violence, and analysis by Browne, Williams, and Dutton shows that in states where the laws and resources (such as shelters and crisis hotlines) were the most available, there were the greatest decreases in women killing male intimate partners. However, the relationship was not supported for men killing their female intimate partners. Other researchers have shown that increases in women’s resources, decreases in marriage rates, enforcement of domestic violence policies such as pro-arrest mandates, and reductions in gun accessibility are all associated with the decreases in IP homicides.
The vast majority (67–80 percent) of IP homicides involve physical abuse of the female by the male partner or ex-partner before the murder, no matter which partner is killed. Approximately two-thirds of the cases of IP femicide have a documented history of abuse of the female partner by the male partner prior to the murder. In 75 percent of cases where males were murdered by their female partners, histories of abuse of the females by the males were documented. A recent national case control study found the following perpetrator factors associated with increased IP femicide risk: having failed to graduate from high school, being unemployed and not looking for work, having access to a gun, being highly controlling of the partner, forcing sex, stalking, using alcohol or drugs prior to an assault, threatening to kill the partner, and previously having used weapons against the partner. Victim characteristics associated with increased IP femicide risk included having less education, having a child by someone other than the perpetrator, and being separated from the perpetrator after having lived together. Factors that increase IP femicide risk at the time of the incident included use of a gun by the perpetrator, the occurrence of events triggering jealousy, and the perpetrator perceiving that the victim is leaving him for another partner.
II. Same-Sex Intimate Partner Homicide
III. Maternal Mortality and Intimate Partner Homicide
IV. Ethnically Specific Issues
A. Risk Factors
B. Health Outcomes
It is estimated that 1,000 to 1,500 homicide-suicide deaths occur annually in the United States. Understanding of the epidemiology of homicide followed by suicide, however, is hampered by the lack of a national surveillance system. With no means of capturing homicide-suicide events in homicide databases (such as the Supplemental Homicide Report), researchers have relied on police and medical-examiner record reviews and follow-up interviews (a reasonable task only for small studies) or searched newspaper clippings for case identification. Despite these limitations, a growing body of literature confirms that homicide-suicide has certain patterns. Homicide is more likely to be followed by suicide when there is a close bond between the victim and perpetrator, and the majority (approximately 70 percent) involved male perpetrators killing a female intimate partner. Across studies of IP homicides, approximately 25 percent of femicides in the United States, Australia, and Canada are followed by suicide, compared with less than 5 percent of nonintimate killings.
The large national case control study of femicide described earlier contained one-third homicide-suicide cases. The suicidal perpetrators were more likely to be married and employed and to report less illicit drug use and abuse during pregnancy. These differences suggest that men who kill their partners and then kill themselves may have a larger ‘‘stake in conformity’’ than those who kill their female intimate partners and do not commit suicide. In other words, they may appear to be somewhat less dangerous than others who are seen in domestic violence criminal justice systems. Even so, the femicide-suicide perpetrators and femicide-only perpetrators had a similar background in terms of prior arrest for violent crimes (18 and 23 percent, respectively) and they engendered a similar amount of fear in their partners (thinking her partner capable of killing her, 53 and 49 percent, respectively).
There have been several explanations offered in the literature for femicide-suicide. One explanation is that the perpetrator becomes remorseful after killing his source of nurturance and commits suicide. This explanation, however, is challenged by the premeditated nature of the majority of femicide-suicides and the immediacy between the two acts. Typologies that have been advanced to explain homicide often fail to take into account the gendered nature of homicide-suicides and the history of intimate violence within relationships. Several authors include mercy killing—when failing health prevents caregiving—as a homicide-suicide trigger among older adults. However, Dawson and Gartner, examining homicide-suicides in Ontario, Canada, in 1998 reported that in twelve of fourteen cases attributed to mercy killing, there was no indication that the victim had been involved in the decision that ended her life. Mental illness, most notably depression, is another contributory factor cited in the literature. However, the proportion of perpetrators reported to have been depressed varies widely across studies, from 15 percent to 86 percent. The majority of these studies did not standardize data concerning perpetrator depression or suicidality, and psychological reports were rarely available.
A more recent explanation for femicide-suicide relates to male proprietariness—‘‘a pathological possessiveness’’ that addresses issues of power and control in intimate relationships. Femicide-suicides often occur following estrangement and are planned acts by the perpetrator, supporting the explanation of male proprietariness. However, this explanation is also incomplete. Combining male proprietariness and perpetrator mental health issues with a history of IP violence may more comprehensively account for high stakes placed on the relationship with the partner. Interestingly, the constant across the literature is the perpetrator’s belief that ‘‘If I can’t have you, nobody will.’’ Yet this statement, along with estrangement and controlling behavior, are also significant risk factors for femicide without suicide. Most authors acknowledge that the explanations for femicide-suicide, where no witnesses survive, is difficult to prove and most likely involves, as Easteal describes, ‘‘a mosaic’’ of causes.
Same-Sex Intimate Partner Homicide
According to the Centers for Disease Control and Prevention, the proportion of IP homicide committed by same-sex partners is greater for gay men than for lesbians. Nationally, among male victims of homicide, 6.2 percent were murdered by a same-sex partner; and among female victims, less than 1 percent (0.5 percent) were murdered by a same-sex partner.
Using the data from the larger multicity study on femicide described above, a case study of the five (1.6 percent) female-perpetrated IP femicides was conducted. Among the five cases, prior physical violence, controlling behaviors, jealousy, alcohol and drugs, and ending the relationship were consistently reported antecedents to the murder. These preliminary findings support that power and control are central to models of IP femicide, whether perpetrated by a man or a woman.
Maternal Mortality and Intimate Partner Homicide
Similar to the methodological challenges of studying homicide-suicides, the national homicide database does not indicate whether a woman was pregnant or had recently delivered when she was killed. Even so, detailed record reviews in some urban areas and a review of the national mortality surveillance system data by the CDC have demonstrated that homicide is the second leading cause of maternal mortality or pregnancy-associated death (death during pregnancy or in the year after pregnancy termination by delivery or other means) in the United States, causing 2 maternal deaths for every 100,000 live births. In at least three major urban areas in the United States (New York City, Chicago, Washington, D.C.) and the entire state of Maryland, homicide was the leading cause of maternal mortality, causing as many as 20 percent of maternal deaths. The increased proportion related to homicide is attributed to decreases in other causes of maternal mortality, such as medical complications of pregnancy and delivery.
Although current limitations in data do not allow the identification of the perpetrator in these maternal mortality homicides, one can assume that the majority were by an intimate partner, as in cases where women were not pregnant. One can also deduce that the majority of those cases that were IP homicides had been preceded by domestic violence against the woman.
In related findings, abuse during pregnancy was associated with a threefold increase in risk of IP completed or -attempted femicide in the multicity femicide study. Violent victimization during pregnancy has also been associated with detrimental health outcomes such as depression, substance use, smoking, anemia, first and second trimester bleeding, poor weight gain, and maternal death. These findings lend support to the need for health care settings that include prenatal care to assess and intervene in domestic violence, as has been urged by medical and nursing organizations.
Ethnically Specific Issues
Numerous studies since the 1990s have substantiated that IP violence is a major public health problem for African American women, as well as all women of color or ethnic/racial minority status. IP violence against African American women has a significant impact on their health as well as their children. Among African American women between the ages of fifteen and forty-four years, femicide is the leading cause of premature death. Recent national data reveal that African American women are murdered by men at a rate three times higher (3.31 per 100,000) than white women (0.99 per 100,000). African American women are also disproportionately affected by pregnancy-associated homicide.
American Indian and Alaska Native women also had slightly higher rates of femicide than white women (1.09 per 100,000), while Asian and Pacific Islander women were the least likely (0.89 per 100,000) to be killed by a male. Among the five states that report ethnic/racial background (Arizona, California, Nebraska, Oregon, and Texas), Hispanic women have the second highest rate compared with white women. The reported rates per 100,000 for these five states are: white, 1.40; Hispanic, 1.54; African American, 3.88. In New York City, immigrant women were found to be more at risk for IP femicide than those born in the United States. Near-fatal (attempted) femicide of African American and other ethnic minority women also contributes to long-term disabling injuries and conditions. In the majority of these fatal and near femicides, the men who kill or abuse these women are intimate partners (husbands, boyfriends, ex-husbands, or ex-boyfriends).
Several multiyear studies of femicide trends have also reported ethnically specific data. Among African American women, the largest majority (84 percent) are killed between the ages of eighteen and sixty-four, with the mean age being thirty-two. African American women, similar to other women in the United States, are more likely to be murdered by men they know, such as a spouse (59 percent) or an intimate acquaintance, not a stranger. In cases where the male perpetrator is known, 94 percent of the homicides of African American women were intraracial.
Hispanic women have the second highest rate of femicide victimization. The trends among Hispanic women are very similar to those among African American women, except for their age. The mean age of Hispanic victims of femicide is twenty-eight, younger than both white and African American women, with the overwhelming majority being killed between the ages of eighteen and sixty-four (86 percent). Similar to African American women, they are most likely to be killed by a spouse (69 percent) or intimate acquaintance, the majority of whom are Hispanics, although the intraracial percentage is slightly less (84 percent) than for African American women.
In general, studies have shown that poverty, low educational level, partner unemployment, and young age are associated with increased risk of IP homicide. Among the few intragroup studies examining these risk factors and IP homicide rates among African American women, low socioeconomic status, lack of employment of the partner, and the establishment of limited social networks within a community are significant risk factors for IP violence. Similarly, Hispanic women often find that the context of their lives is frequently characterized by poverty, lower levels of education, discrimination, and an environment with higher use of alcohol and drugs, often by their male intimate partners. Often both African American and Hispanic women live in communities where there is a high level of violence and limited resources in general, and even fewer resources to protect women and children from IP violence and ultimately homicide. In the multicity IP femicide study, unemployment was a stronger risk factor than ethnicity or race, suggesting that it is the context of lack of resources that drives the increased risk associated with minority status rather than any culturally or racially specific characteristics.
Many studies have established that IP violence is associated with poor health outcomes for women, including poor pregnancy outcomes. Although there are fewer studies describing health outcomes for women of color, the majority of the existing articles describe abused ethnic/racial minority women as having more physical consequences, poorer mental health, and lower quality of health compared with nonabused women. Not only do these women report poorer health, but among middle-class African American women, those who have a history of physical and psychological abuse are less likely to use preventive health care practices such as breast self-exams, gynecological exams, and physical exams. In a study of African American privately insured female enrollees in health maintenance organizations, abused women had more health problems (central nervous system, gynecological, sexually transmitted infections, gastrointestinal), more problems per health visit, and more emergency department visits compared with nonabused women.
The evidence is mixed regarding whether African American or Hispanic women are more at risk for violent victimization during pregnancy. There have been four major national studies, all showing disproportionately more African American women being abused during pregnancy. Several studies have shown Hispanic women at lower risk during pregnancy, but at least one study that differentiated among Hispanic ethnic groups found that Puerto Rican women were more likely to be abused during pregnancy, while Mexican American, Central American, and Cuban American pregnant women were less likely to be victimized than African American and Anglo-American pregnant women.
African American women’s responses to IP violence may be influenced by their chronic experiences of racism and the social contexts in which they live (i.e., poverty, limited or no access to community resources). Such life experiences often result in different opportunities for and restrictions on their resistance to violence. Often, previous racist or other negative experiences may prevent African American women from seeking help from institutional and/or community resources, which have traditionally safeguarded and protected white women from partner violence. However, while patterns of help-seeking may be different across ethnic/racial groups, most women do seek help after violent incidents. The help may be from formal sources (medical, counseling, law enforcement) or informal sources (talking to family and friends). For abused Hispanic/Latina women in the Chicago Women’s Health Risk Study, only one-fifth (20 percent) sought any kind of help, even after experiencing a severe or life-threatening violent event from their intimate partner. The multicity femicide study was of a diverse sample of 311 women (African Americans, 44.8 percent; whites, 27.7 percent; Hispanic/Latina, 21.9 percent). The largest group (42 percent of those sampled) had been to a health care provider in the year before their death, while 30 percent had sought help from law enforcement; however, very few women (4 percent) had sought help from a battered woman’s shelter or crisis hotline. These study findings suggest that failing to assess for IP violence at every health encounter is a missed opportunity for the prevention of IP homicide.
Intimate violence continues to be a major public health issue for all women, and even though its occurrence has decreased, it ends with an IP homicide all too frequently. Many studies have identified characteristics of IP homicide that distinguish it from other forms of homicide. Despite findings that enhance the understanding of IP homicide, there is still a lack of systematic research studies on several issues, perhaps especially on ethnically specific issues related to IP homicide. There have been very few studies resulting in very few findings related to IP homicide as it affects Hispanic, Native American, and Asian American women. Among studies that consider ethnic/racial minority groups, most comparisons are made with white (Anglo-American) women; more studies are needed to examine variations in associated factors within ethnic/racial minority groups, including comparisons across the socioeconomic spectrum. The research to date suggests that disproportionate risk related to ethnic/racial minority status may be more of a reflection of poverty, discrimination, and unemployment and its negative consequences, which result in a lack of access to resources that could prevent IP homicide. Additionally, an increased number of studies are needed that clearly define and identify ethnic/racial minority groups rather than grouping all black women (i.e., African American, African, Caribbean), all Hispanic women (i.e., Puerto Rican, Mexican, Cuban), or all Asian women (i.e., Korean, Chinese, Japanese) together as if they were homogeneous groups.
Demonstration projects are needed that test and evaluate evidence-based interventions aimed at reducing IP violence and ultimately its homicide. Such interventions must reflect what is known about gender issues and cultural influences as well as IP violence and incorporate mental health (depression, post-traumatic stress disorder), substance use/abuse, and parenting issues simultaneously.
Advocates, health care providers, law enforcement officers, lawyers, and community activists must also continue to support coordinated community responses to reduce risks for IP homicide. When women are identified as victims of abuse in a health care, legal, law enforcement, or community setting, there is a need to assess the risk factors for lethal violence in the abusive relationship. Specifically, it is important to assess perpetrators’ access to guns and warn women of the risk this presents. This is especially important in the case of women who have been threatened with a gun or another weapon and in conditions of estrangement. Under federal law, individuals who have been convicted of domestic violence or who are subject to a restraining order are barred from owning firearms. Judges issuing orders of protection in cases of IP violence should consider the heightened risk of lethal violence associated with abusers’ access to firearms.
Often, battered women like the idea of a professional notifying the police for them; with the exception of California, however, states do not mandate health care or other professionals to report to the criminal justice system unless there is evidence of a felony assault or an injury from an assault. In states other than California, a professional can offer to call the police, but the woman has the final say, as she can best assess any increased danger that might result from the police being notified. An excellent resource for referral, shelter, and information is the National Domestic Violence Hotline (1-800-799- SAFE).
If a woman confides that she is planning to leave the abuser, it is critical to warn her not to tell him she is leaving face to face. It is also clear that extremely controlling abusers are particularly dangerous under conditions of estrangement. Asking a question such as ‘‘Does your partner try to control all of your daily activities?’’ can quickly help a professional assess this extreme need for control. Professionals can also expeditiously assess whether the perpetrator is unemployed, whether children are present in the home, and whether the perpetrator has threatened to kill the victim. Under these conditions of extreme danger, it is incumbent on professionals to be extremely assertive with abused women about their risk of homicide and their need for shelter. Evidence suggests that where there are shelters, legal advocates, health care professionals, and police trained to intervene collaboratively in cases of IP violence and where communities are consistently made aware of the issues related to IP violence and IP homicide, women and children are more likely to survive the violence in their lives.
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