RJ is a member of the Editorial Board of
Conceived and designed the experiments: NA SM RJ LJM. Analyzed the data: NA SM RJ CL. Wrote the first draft of the manuscript: NA. Contributed to the writing of the manuscript: NA SM RJ LJM CL.
Naeemah Abrahams and colleagues compare the incidence of female homicide in women aged over 14 years in South Africa in 1999 and 2009 and analyze the fatal violent attacks perpetrated by intimate partners.
Death is the most extreme consequence of intimate partner violence. Female homicide studies with data on the perpetrator–victim relationship can provide insights. We compare the results of two South African national studies of female homicide with similar sampling done 10 y apart.
We conducted a retrospective national survey using a weighted cluster design of a proportionate random sample of 38 mortuaries to identify homicides committed in 2009. We abstracted victim data from mortuary and autopsy reports, and perpetrator data from police interviews. We compared homicides of women 14 y and older in 2009 with previously published data collected with the same methodology for homicides committed in 1999.
The study found that the rate of female homicide per 100,000 female population in 2009 was 12.9 (95% confidence interval [CI]: 9.3, 16.5), compared to 24.7 (95% CI: 17.7, 31.6) in 1999. The incidence rate ratio of 0.54 (95% CI: 0.20, 0.84) reflects a significantly lower rate in 2009. The rate of intimate partner femicide was 5.6/100,000 in 2009 versus 8.8/100,000 in 1999, with an incidence rate ratio of 0.63 (95% CI: 0.24, 1.02), indicating no difference between rates. Logistic regression analysis of homicide characteristics showed that the odds ratio of suspected rape among non-intimate femicides in 2009 compared to 1999 was 2.61 (95% CI: 1.23, 4.08) and among intimate partner femicides it was 0.84 (95% CI: 0.50, 1.42). The OR of homicide by gunshot was 0.54 (95% CI: 0.30, 0.99) in 2009 versus 1999. There was a significant drop in convictions of perpetrators of non-intimate femicide in 2009 versus 1999 (OR = 0.32 [95% CI: 0.19, 0.53]). Limitations of the study include the relatively small sample size and having only two time points.
Female homicide in South Africa was lower in 2009 than 1999, but intimate partner femicide and suspected rape homicide rates were not statistically different. The cause of the difference is unknown. The findings suggest that South Africa needs greater efforts nationally to implement evidence-based violence prevention.
Violence against women (often referred to as gender-based violence) is common, serious, and takes many forms, including physical, sexual, and emotional abuse, and has profound implications for every aspect of women's lives. One of the most common forms of violence is perpetrated by a husband or male partner (often referred to as intimate partner violence), and as it usually happens in private, is often ignored or goes unreported. According to the World Health Organization, population surveys indicate that 10%–69% of women have been abused by an intimate partner. This form of violence is so prevalent because in many countries and cultures, violence against a female partner is often not perceived as a crime but rather as a private family matter.
The extreme consequence of violence against women is death, and given the seriousness of the widespread problem of violence against women, there have been many international and national efforts to raise awareness of the issue and to implement policies to reduce such violence. In order for these policies to be most effective, countries implementing strategies to prevent intimate partner violence should also have the capacity to monitor the results of such strategies, but unfortunately, these data are not routinely available. Tracking changes in fatal intimate partner violence (that is, when a woman is killed by an intimate partner, also referred to as intimate femicide) is one possible option of monitoring the impact of policies and programs. So in this study from South Africa, the researchers collected data on and compared the prevalence of intimate femicide at two time points ten years apart (1999 and 2009, between which time points new legislation on gender-based violence was introduced) to examine whether there were any differences.
The researchers analyzed information on female homicide victims, aged 14 years and older, whom they identified from mortuary registers and databases in 2009. The researchers collected cause of death data from the autopsy reports and checked other information via police interview. The researchers then compared these results with a similar study they had conducted for homicides in 1999 but treated each study independently, with a separate statistical analysis, and calculated rates according to the population estimates at each time point.
Using these methods, the researchers found that in 2009, there were 930 female homicides compared to 1,052 in 1999, giving an overall female homicide rate per 100,000 women of 12.9 in 2009 compared to 24.7 in 1999. There was a statistically significant decrease in the rate of non-intimate femicide, with a rate of 8.6 per 100,000 women in 1999 compared to 4.2 in 2009. Although there was some evidence of a decrease in the rate of intimate partner femicide—8.8 per 100,000 women in 1999 compared to 5.6 in 2009—this decrease was not statistically significant. The researchers also found that there was a significant decrease in the rate of fatal shootings (female gun homicides), 7.5 per 100,000 women in 1999 compared to 2.5 in 2009, and that this finding was similar for homicides perpetrated by partners and non-partners (intimate and non-intimate gun homicides). Finally, the researchers found that the overall rate of fatal rapes (female rape homicides) was 3.4 per 100,000 women in 1999 compared to 2.5 in 2009, but again, this difference was not statistically significant. Unfortunately, the researchers found that the odds (chance) of conviction of perpetrators of intimate femicide was unchanged between the two time points (1.11), and the odds of conviction of perpetrators of non-intimate femicides had significantly decreased (0.32).
These findings suggest that, overall, female homicide in South Africa was substantially lower in 2009 than in 1999, but the 2009 figure is still five times the global rate of this crime. The rate of non-intimate femicide declined significantly over the two time points, but there was no statistically significant reduction in intimate femicide. There was a substantial difference in the rate of homicide from gunshot between the two years, most likely explained by gun control legislation. This study has several limitations, including the small number of mortuaries included and the differences in the studies conducted in 1999 and 2009. Nevertheless, this study indicates that a renewed commitment from the South African government is urgently needed to develop policy-driven prevention interventions to reduce female homicide, especially when perpetrated by an intimate partner.
Please access these websites via the online version of this summary at
Violence against Women Online Resources provide lists of
The World Health Organization website lists some
The US Centers for Disease Control and Prevention provides more information about
Sexual Violence Research Initiative provides links to
The murder of an intimate partner is one of the most extreme consequences of gender-based violence. Although intimate partner violence (IPV) can be perpetrated by both males and females, women are disproportionately killed by their intimate partners
In 1998 South Africa adopted the Domestic Violence Act (Act 116 of 1998), promulgated in 1999
Countries implementing strategies to prevent IPV nationally need to have a capacity to monitor these strategies, but monitoring is often not possible using routine information. Analysing trends in fatal IPV (intimate partner femicide) is one means of monitoring overall programming impact, but these data are usually not available routinely. In South Africa we conducted research into intimate partner femicide at two time points 10 y apart to establish whether there were differences. This paper compares the findings for the two time periods on the prevalence and patterns of female homicide and intimate femicide of women aged 14 y and over. A simple brief account of the findings of this study was presented in a report for policy makers in South Africa in 2012
The Ethics Committee of the South African Medical Research Council approved the study, and the national and provincial Departments of Health, the Forensic Pathology Service, and the South African Police Service provided further approval and access to data. The police gave written informed consent before interviews.
We conducted a retrospective, national mortuary-based study of female and child homicide cases that presented at medical legal laboratories between 1 January 2009 and 31 December 2009. This study design was similar to the 1999 national female homicide study
We present an analysis of female homicide victims, aged 14 y and older, identified from mortuary registers and databases. We abstracted data onto a form from autopsy reports, with follow-up interviews with police investigators using a questionnaire to verify the cause of death, identify relationships between the victim and the perpetrator, and to collect other crime investigation data. The data for the 1999 study were collected in 2002–2003, whereas in the 2009 study police interviews were concluded in 2011. The shorter delay in the second study did not appear to adversely affect the availability of data, since there were fewer cases with incomplete data in 2009 than in 1999 (17 cases not traced in the police system in 2009 compared to 147 in 1999).
We collected cause of death data from the autopsy reports and verified the socio-demographic data during the police interview. Autopsy reports provided information about pregnancy and whether rape was suspected. Police verified suspicious rape cases. For both studies, the police provided information on the perpetrator, case outcome, history of IPV, and the relationship of the victim with the perpetrator. We considered intimate partners to include current or former husbands and boyfriends (dating and co-habiting), same-sex sexual partners, and rejected suitors. The identification of rape homicides was also identical in the two studies (see
For the comparison, we considered the 1999 and 2009 surveys as two independent surveys because of the time separation and the independent samples. We applied sampling weights by year and weighted for the total number of mortuaries within the strata. We used the mid-year population estimates from Statistics South Africa for 1999 and 2009 for the calculation of rates. The 1999 rates were based on the population from the 1996 census
All procedures took into account the multi-stage structure of the dataset, with weighting, stratification by mortuary size, and the using mortuaries as clusters. We estimated the homicide rates for all female homicides in 1999 and 2009 and within femicide subgroups (intimate, non-intimate), and 95% confidence limits were calculated using standard methods for estimating confidence intervals from complex multi-stage sample surveys (Taylor linearization). Incidence rate ratios (IRRs) for 2009 compared to 1999 homicide rates were estimated, as well as confidence intervals to facilitate the comparison between years. We did multiple logistic and linear regression analyses to test whether year of survey or type of homicide status was associated with socio-demographic or crime-related variables (proportion of intimate femicide, age of victim, suspected rape, pregnant at time of death, conviction of perpetrator, and mechanism of death [gun injury, stab injury, or blunt injury]). The regression models included interaction effects between the survey year and the type of homicide to evaluate the homogeneity of the year effect across the intimate and non-intimate subgroups.
All the sampled mortuaries in each year contributed data. Our sample identified 930 female homicides in 2009 compared to 1,052 in 1999. The overall female homicide rate per 100,000 women was 12.9 (95% confidence interval [95% CI]: 9.3, 16.5) in 2009 compared to 24.7 (95% CI: 17.7, 31.6) in 1999, and the estimated IRR was 0.52 (95% CI: 0.20, 0.84), reflecting a significantly lower rate in 2009 (
Homicide Characteristic | 1999 (Unweighted = 1,052; Weighted = 3,793) | 2009 (Unweighted = 930; Weighted = 2,363) | IRR of Population Rate Estimates 2009/1999 (95% CI) | ||||
Female Population | Rate per 100,000 Population (95% CI) | Female Population | Rate per 100,000 Population (95% CI) | ||||
|
15,360,904 | 3,793 (2,693, 4,894) | 24.7 (17.7, 31.6) | 18,273,358 | 2,363 (1,703, 3,024) | 12.9 (9.3, 16.5) | 0.52 (0.20, 0.84) |
|
15,360,904 | 1,335 (959, 1,710) | 8.6 (6.2, 11.1) | 18,273,358 | 768 (534, 1,003) | 4.2 (3.0, 5.5) | 0.48 (0.18, 0.78) |
|
15,360,904 | 1,349 (972, 1,727) | 8.8 (6.2, 11.2) | 18,273,358 | 1,024 (725, 1,322) | 5.6 (4.0, 7.2) | 0.63 (0.24, 1.02) |
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14–29 y | 6,892,855 | 649 (441, 857) | 10.3 (6.3, 12.4) | 7,885,758 | 474 (328, 631) | 6.0 (4.2, 8.0) | 0.63 (0.25, 1.02) |
30–44 y | 4,363,286 | 524 (336, 712) | 12.8 (7.7, 16.3) | 5,047,200 | 430 (285, 574) | 8.5 (5.6, 11.4) | 0.70 (0.23, 1.18) |
45–59 y | 2,261,298 | 71 (26, 117) | 3.5 (1.1, 5.1) | 3,193,500 | 103 (59, 147) | 3.2 (1.8, 4.6) | 1.02 (0, 2.08) |
60+ y | 1,843,465 | 26 (8, 44) | 1.5 (0.4, 2.3) | 2,146,900 | 14 (1, 26) | 0.7 (.05, 1.2) | 0.46 (0, 1.03) |
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African | 11,683,651 | 1,023 (710, 1,336) | 8.8 (6.0, 11.4) | 14,137,939 | 801 (563, 1,039) | 5.7 (4.0, 7.3) | 0.64 (0.24, 1.05) |
Coloured | 1,375,413 | 252 (40, 464) | 18.3 (2.9, 33.7) | 1,711,912 | 173 (30, 316) | 10.1 (1.8, 18.5) | 0.55 (0, 1.25) |
Indian | 424,331 | 21 (0, 44) | 4.9 (0, 10.3) | 510,296 | 18 (0, 35) | 3.5 (0, 6.9) | 0.71 (0, 1.85) |
White | 1,974,767 | 53 (20, 86) | 2.8 (1.0, 4.3) | 1,912,465 | 28 (0, 35) | 1.5 (0, 1.8) | 0.54 (0, 1.15) |
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All female homicide | 15,360,904 | 1,147 (557, 1,735) | 7.5 (3.6, 11.3) | 18,273,358 | 462 (281, 642) | 2.5 (1.6, 3.5) | 0.33 (0.08, 0.59) |
IF | 15,360,904 | 405 (189, 619) | 2.7 (1.2, 4.0) | 18,273,358 | 179 (99, 258) | 1.0 (0.5, 1.4) | 0.37 (0.07, 0.66) |
NIF | 15,360,904 | 435 (198, 669) | 2.8 (1.3, 4.4) | 18,273,358 | 132 (70, 193) | 0.7 (0.4, 1.1) | 0.25 (0.04, 0.46) |
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All female homicide | 15,360,904 | 526 (246, 806) | 3.4 (1.6, 5.2) | 18,273,358 | 455 (306, 605) | 2.5 (1.7, 3.3) | 0.72 (0.19, 1.25) |
IF | 15,360,904 | 151 (63, 239) | 1.0 (0.4, 1.6) | 18,273,358 | 108 (64, 151) | 0.6 (0.4, 0.8) | 0.60 (0.13, 1.07) |
NIF | 15,360,904 | 171 (63, 277) | 1.1 (0.4, 1.8) | 18,273,358 | 210 (130, 291) | 1.2 (0.7, 1.6) | 1.03 (0.17, 1.88) |
IF, intimate femicide; NIF, non-intimate femicide.
A significantly lower rate of female gun homicides per 100,000 women was found in 2009, with the 1999 rate of 7.5 (95% CI: 3.6, 11.3) much higher than the 2009 rate of 2.5 (95% CI: 1.6, 3.5). The IRR was 0.33 (95% CI: 0.08, 0.59). There was a similar finding for both intimate and non-intimate gun homicides.
The overall female rape homicide rate per 100,000 women for 1999 was 3.4 (95% CI: 1.6, 5.2) compared to 2.5 (95% CI: 1.7, 3.3) for 2009 (
A comparison of the characteristics by type of homicide between 2009 and 1999 is shown in
Characteristic | Intimate Femicide | Non-Intimate Femicide | Effect Measure of Study Year and Type of Homicide | |||
1999 Percent (95% CI) | 2009 Percent (95% CI) | 1999 Percent (95% CI) | 2009 Percent (95% CI) | Year OR (95% CI) | Type of Homicide OR (95% CI) | |
|
29 (24, 35) | 31 (24.3, 37.8) | 37 (27, 51) | 41 (27.3, 56.3) | 1999: 1.00 | Non-intimate femicide: 1.00 |
2009: 1.83 (−0.29, 3.9) |
Intimate femicide: −10.82 (−12.91, −8.73) |
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11.4 (7.2, 15.6) | 11.0 (7.9, 14.1) | 13.2 (7.1, 19.3) | 28.5 (21.8, 35.3) |
|
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1999: 1.00 | Non-intimate femicide: 1.00 | |||||
2009: 0.84 (0.50, 1.42) | Intimate femicide: 0.96 (0.57, 1.61) | |||||
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1999: 1.00 | Non-intimate femicide: 1.00 | |||||
2009: 2.61 (1.43, 4.77) | Intimate femicide: 0.31 (0.20, 0.46) | |||||
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2.4 (0.3, 4.5) | 3.6 (1.9, 5.3) | 1.0 (0.1, 2.3) | 3.1 (0.6, 5.6) | 1999: 1.00 | Non-intimate femicide: 1.00 |
2009: 2.17 (0.92, 5.12) | Intimate femicide: 1.30 (0.62, 2.73) | |||||
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35.1 (25.4, 44.7) | 37.4 (29.2, 45.7) | 32.7 (24.5, 41.0) | 23.1 (16.9, 29.2) |
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1999: 1.00 | Non-intimate femicide: 1.00 | |||||
2009: 1.11 (0.76, 1.61) | Intimate femicide: 1.10 (0.63, 1.94) | |||||
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1999: 1.00 | Non-intimate femicide: 1.00 | |||||
2009: 0.32 (0.19, 0.53) | Intimate femicide: 3.79 (2.60, 5.52) | |||||
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33.2 (24.2, 42.3) | 29.5 (23.6, 35.5) | 21.2 (14.1, 28.3) | 22.4 (16.2, 28.6) | 1999: 1.00 | Non-intimate femicide: 1.00 |
2009: 0.88 (0.58, 1.35) | Intimate femicide: 1.75 (1.29, 2.37) | |||||
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30.6 (19.9, 41.2) | 17.4 (11.2, 23.6) | 33.6 (23.1, 44.2) | 17.1 (10.6, 23.7) | 1999: 1.00 | Non-intimate femicide: 1.00 |
2009: 0.54 (0.30, 0.99) | Intimate femicide: 0.86 (0.53, 1.39) | |||||
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33.2 (25.8, 40.6) | 31.4 (25.0, 37.8) | 34.3 (23.4, 45.2) | 35.5 (28.9, 42.1) | 1999: 1.00 | Non-intimate femicide: 1.00 |
2009: 0.77 (0.50, 1.20) | Intimate femicide: 1.09 (0.82, 1.46) | |||||
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50.2 (44.3, 55.7) | 57.1 (51.9, 62.3) | ||||
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16.6 (10.8, 22.4) | 18.2 (13.6, 22.7) | ||||
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31.6 (22.1, 41.0) | 33.0 (26.3, 39.8) |
Coefficients.
Characteristics with significant interaction between type of homicide and year.
IQR, interquartile range.
The overall rate of female homicide in South Africa was substantially lower in 2009 than in 1999, and the reasons for this are unknown. The reduction in the overall rate of female homicide found in the study is consistent with the decrease in overall homicides shown in annual police statistics. These show a decrease of 44% between 2003/2004 and 2010/2011 (the police reporting year is 1 April to 31 March)
The lower female homicide rate in 2009 is encouraging, but levels remain high in comparison to other countries. The female homicide rate in 2009 was five times the global rate
We considered whether the rise in the proportion of suspected rape homicides among non-intimate femicide cases could be due to artefact. We consider this unlikely. There is no reason to believe genital examinations have changed since 1999. Rape kits may be used more in autopsies, but this cannot easily explain why we had different findings in autopsies of non-intimate and intimate femicide victims. The nature of the victim–perpetrator relationship is usually not known by the medical examiner at the time of the autopsy. One might have expected that a greater use of rape kits in 2009 would have resulted in more discovery of DNA and a higher rate of perpetrator convictions. This finding was not seen. These findings do not suggest that the increase in the proportion of suspected rape homicides among non-intimate femicide cases is an artefact of improvements in post-mortem examinations.
There was a very substantial difference in the rate of homicide from gunshot between the two years. The decrease is most likely explained by gun control legislation (Firearms Control Act), a policy-driven intervention implemented since 2000 but only fully effective from 2004, with provisions for safer firearm use and ownership amongst its key features
In the last decade there have been multiple efforts to improve policing in South Africa
The research had a number of limitations. The sample size for estimating the population incidence rates in 1999 and 2009 was adequate, but the study lacks power (to detect type 2 error) for the comparison of rates between study years, especially for subgroups. The number of mortuaries that formed the sampling frame was different between the two years, with a smaller sampling frame in 2009. However, we increased our sampling fraction for the middle-sized and smaller mortuary strata, and therefore do not expect our estimates to be affected by the difference in mortuary numbers between the two years. Our findings most likely underestimate the female homicide rate. Our intimate and non-intimate femicide rates were calculated for cases where perpetrators had been identified, and the availability of these data was dependent on information from the police investigation. The proportion of cases missing perpetrator data was not different between the two study years (18.5% in 1999 and 22.9% in 2009,
This study was conducted in order to investigate whether there were changes in the prevalence and patterns of female homicide in South Africa in 2009 compared to 1999, and we had a particular interest in looking for changes that could have indicated some success of the new gender-based violence legislation and perhaps accompanying prevention programming at a national level. There was evidence of change that we suggest is probably a consequence of gun control legislation, and we did find a difference in female homicide rates overall, but there was a lack of evidence that could be viewed as indicating a positive impact of gender-based violence policies and programming. Whilst we could not rule out type 2 errors, we failed to detect a difference in the non-intimate rape homicide rate, despite a significant reduction in rape homicides overall, and we did not detect a difference in the rate of intimate femicide, despite one being found in the rate of non-intimate femicide. Although the exact factors driving the decrease in female homicide overall are unknown, it does appear that a renewed commitment from government to developing policy-driven prevention interventions is needed to have an impact on the gender-related proportion of female homicide, as well as on the availability of reliable data to monitor trends. The World Health Organization has identified a number of effective evidence-based prevention interventions for gender-based violence
95% confidence interval
intimate partner violence
incidence rate ratio
odds ratio