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South Africa has one of the world’s highest reported homicide rates involving babies. A first national study by the Medical Research Council of SA and the University of Cape Town released this week has declared the annual killing of hundreds of newborns and infants to be a 'serious social and public health problem’.

'Mothers were identified as the perpetrators in all of the neonaticides and were the most common perpetrators overall,' the researchers write in the international peer-reviewed journal PLOS Medicine. The SA National Child Homicide Study declares that there is 'a critical need for intervention to assist vulnerable mothers’.

Researchers led by Naeemah Abrahams of the gender and health research unit at the Medical Research Council in Cape Town estimate the South African rates for neonaticide (killing a child within the first 28 days of life) to be 19.6 per 100,000 live births, and for infanticide (killing a child under one year) to be 27.7 per 100,000 live births. These rates are surpassed only by an estimate for the Tanzanian city Dar es Salaam of 27.7 per 100,000 live births ‘and are much higher than those reported in developed settings’

Homicide of children is a global proble but it is often not considered a priority against competing public health challenges. A 2014 UNICEF report concluded that the under-five-year age group is the second largest homicide group after 15-19 year olds. This, first,  SA National Child Homicide Study found 40% of all child homicides among the under-five-year group.

Drawing on funding from the Open Society Foundation and the Medical Research Council, Abrahams and *colleagues studied medical and legal data from a random sample of 38 medico-legal laboratories in urban and rural settings across South Africa for 2009. Child and perpetrator data were collected from police interviews.

They estimate that 454 children under the age of five years old were killed that year. Most deaths (53%) were among newborns aged zero to six days and 74% were infants under one year old. The great majority (85%) of newborns died after being abandoned.

Overall, there was no gender bias among child homicides, but 56% of homicides of boys took place in an urban setting compared to 44% of homicides of girls. The researchers believe this may reflect lesser propensity to kill boys in traditional areas in which son preference is strong.

Evidence of sexual assault was found in both sexes – but only in older children (one to four years) – 'with a higher proportion of sexual violence found for girl homicides than for boy homicides,’ the study says.

Mothers were identified or suspected as perpetrators in nearly two-thirds of homicides (71%) and in all of the neonaticides. “Few children were killed by strangers (2.5%), and one in five of the children were killed in the context of a family murder.” The child’s home and public spaces were the most common places where bodies were found.

The perpetrator was convicted in only 17% of homicides in children under five years. There were high levels of joblessness among perpetrators. Their age was known in less than half of cases, with the mean age being 28 years – or 25 years if the perpetrator was a mother and 23.5 years if the mother abandoned her newborn.

There is not information on motives for abandoning newborns, and so it is not known whether babies are left to die – or in the hope that they will be found alive. ‘The abandoned neonates were commonly discovered in garbage and refuse dumps and public spaces.’

Nearly two-thirds of neonaticides that involved abandonment (74%) occurred in Gauteng (43%) and KwaZulu-Natal (31%) where 40% of live births occur.

'Our study shows that the first six days of life are the time point of highest risk for being killed in South Africa among children under five years, with the risk declining thereafter,’ write Abrahams and colleagues.

'This suggests that there is a particularly high rate of unwanted pregnancy going to term, which is remarkable in a country that has one of the most liberal abortion laws in the world and reasonably good contraception services.'

'It points primarily to a failure of maternal and reproductive health services. Research among women who were denied abortions in Cape Town showed that despite the law, there are numerous barriers that women encounter when seeking a legal abortion in the public sector.' These include advanced gestational age and lack of trained staff for second trimester abortion.

The study points out that ‘the killing of children is the extreme part of a continuum of violence against children in South Africa, adding that it is a serious social and public health problem and suggests failures of state services.

'Intervening is critical at all levels, including reproductive services as well as child protection services,' Abrahams and colleagues conclude. But while prevention should be the priority, the evidence base on prevention is limited.

'One of the ways to identify risks and patterns and develop early intervention systems is to employ a child death review system similar to those used for prevention of maternal mortality and perinatal deaths. Such reviews could assist in identifying failures in the child protection system and assist in identifying cause of death in suspected abuse cases,' the authors write.

On a positive note, a pilot child death review project has been initiated in response to the study. “The process of developing review teams of all those involved in the investigation of child homicides has seen services come together for the first time.”

Issued by MedicalBrief