Preventing Intimate Partner Homicide: Need for Combining Criminal Justice, Medical & Contextual Data Preventing Intimate Partner Homicide: Need for Combining Criminal Justice, Medical & Contextual Data Jacquelyn Campbell PhD, RN, FAAN Anna D. Wolf Chair & Professor Johns Hopkins University School of Nursing National Program Director, RWJF Nurse Faculty Scholars Program Jacquelyn Campbell PhD, RN, FAAN Anna D. Wolf Chair & Professor Johns Hopkins University School of Nursing National Program Director, RWJF Nurse Faculty Scholars Program

Femicide Femicide as the killing of females by males because they are female (Russell ’76, ‘92) Includes other forms of GBV killings With the notion that not naming as obscures misogynistic nature of crime Does motive (hard to ascribe) need to be misogynistic or is context sufficient? More pragmatic to describe femicide as murder of women – to underscore that different dynamics than murders of males

National Femicide Study in South Africa – Abrahams & Shanaaz 2012 Retrospective national survey w/weighted cluster design of a proportionate random sample of 38 mortuaries 1999 & 2009 – Abstracted victim (14 y & older) data from mortuary & autopsy reports, & perpetrator data from police interviews Female homicide /100,000 compared to 24.7 in ‘99. IP femicide 5.6/100,000 in 2009 vs. 8.8/100,00 ‘99 – Less femicide by gunshots ’09 vs. 99 – general attempts to decrease gun availability in country (same in Australia)

UK Frank Mullane Dr. Talukder Overall Homicide – 2010 report UK: Scotland 2.17 #2 in Europe UK: N. Ireland 1.59 UK: England and Wales 1.43 Shootings continue to decrease 459 men killed – 7% by partner/ex (n = 32) 192 women killed, 53% killed by partner (n=102) (vs. 12% stranger - X5) Increased risk among immigrant populations (Canada, NYC also)

Assailant Characteristics DV Homicide Spain 1–7/08 & ‘09 5

Data from Brian Vallee, The War on Women (2007) Canadians Killed Americans Killed

Per capita Femicide Comparisons Spain – femicides/year -.4/100,000 AU –.8/100,000 femicides – ‘08 1.2/100,000 overall IP Homicide ’08; NZ 0.70/100,000 (male & female – family) USA – 1700 DV femicides per year Femicides by men overall (50-60%) DV 1.35/100,000 ‘01; 1.37 ’ ‘ ‘ ’08 – vpc 2.5/100,000 overall (includes < 1 yo) South Africa 8.8/100,000 in ’99; 5.6/100,000 in ‘08 Asian 0.88 per 100,000 7

INTERNATIONAL HOMICIDE RATES ( Rates per 100,000) (World Report on Violence & Health ’03)

World Murder Rates per 100,000 (WHO) 9

Data bases like the WHO & UN Rarely disaggregate by gender Does not disaggregate within gender for ethnic/racial groups Makes conclusions about risk factors erroneous for women murdered b/c more men than women killed Ignores other DV related deaths – homicide- suicides, children killed, others killed

WHO Data Disaggregated by Gender (Stöckl, Devries, Rotstein, Abrahams, Campbell, Watts, Garcia- Moreno, in press, The Lancet) 66 countries reporting (of approx 190)- overall 13.5 homicides committed by an intimate partner X6 higher for female homicides than male 38. 6% of female homicides vs. 6.3% of male Median percentages highest in high-income countries and in South East Asia. Adjustments to account for unknown victim-offender relationships generally increased prevalence 47.4% for women & 6.5 for men Only countries where = #’s of males killed by partners = to women – Panama & Brazil

Proportion of intimate partner homicides among all female homicides Proportion of intimate partner homicides among all male homicides No Data Available 0-4.9% % % %

Global Summary 1:7 homicides globally & < 1/3 of female homicides perpetrated by IP highest IP proportions: SE Asia (58.8%) High Income Countries (41.2%), Americas (40.5%) & African region (40.1%) lower in W Pacific region (19.1%) lower & middle income Europe (20.0%) & E Mediterranean (14.4%) Homicides w/male victims - % of IPH highest High Income Countries (6·3%), African region (4·1%) & lower middle income European Region (3·6%). But huge swaths of world with missing data

US State Department Initiative “It is time for all of us to assume our responsibility to go beyond condemming this behavior, to take concrete steps to end it, to make it sociably unacceptable” Secretary of State Hillary Clinton Framework of tying to Millenium Development Goals – economic development for women education for girls, decreasing maternal mortality, infant mortality Intra Agency Government Task Force established – Research agenda – as yet does not include IP femicide

Frontiers to yet address Holding governments accountable , UN Commission on the Status of Women Iran, Egypt, Pakistan, Sudan & US delegates objected to telling governments to "condemn violence against women & refrain from invoking any custom, tradition or religious consideration to avoid their obligations with respect to its elimination as set out in the Declaration of the Elimination of Violence against Women.”UN Commission on the Status of Women 103 (of 193) UN member states -no laws against DV Lebanon 2011 – 1 st law against honor killings; DV defeat Afganistan 2013 – law defeated in parliament

Other Forms of IP Related Death and Possible Global Surveillance DV Related Suicide of Women – after DV vs. homicide – suicides – male phenomenon – tracked so far in US (30% of IP femicides), Canada, Australia, NZ, Europe – high income countries Gun availability contributes

Comparison of Proportion of Homicide (Femicide) – Suicides US – 29% of IP Femicides Canada – 29.3% of IP Femicides 32% in New Zealand of IP Femicides 22% Australia 12% Spain 17

Femicide & Maternal Mortality  Maternal Mortality (Chang & Horon, 2010) homicide is leading cause of maternal mortality in MD – (primarily partners) & other cities #2 USA  In most countries proportion of maternal mortality due to IP femicide unknown  Small study in India indicates significant proportion of maternal mortality from partners  One of millenium development goals – but won’t be met – antenatal & delivery care improving but not GBV?  Excellent chance for surveillance

Femicide Rates per 100,00 USA ‘01-’08 19

U.S. INTIMATE PARTNER HOMICIDE RATE DECLINE FBI (SHR, ; BJS ’05, ‘09) FEMALE MALE 1993 – first including ex-BF/ex-GF – Catalano, Snyder & Rand BJS ’09 – adds approx 600 IP femicides per year; 250 IP males killed With Ex-GF With Ex-BF

National Death Reporting System – 16 states CDC data base available for public use with permission Combines ME & SHR data Fields for DV – limited to arrests (vs. PO’s) but there Fields for military service Connects incident – so can determine homicides followed by suicide of perpetrator, children killed when woman killed President signed executive order to expand to all 50 states 1/2013 – but… state health departments – resource issue In President’s budget but not in congressional budget Gun data issues

US Homicide data overall – Males represented 77% of homicide victims & nearly 90% of offenders. Victimization rate for males (11.6 per 100,000) X 3 rate for females (3.4 per 100,000) Offending rate for males (15.1/100,000) 9 X rate for females (1.7/100,000)

US Decline in IP Homicide for Men & Women By 2010, rate for females had decreased from 16.1 victimizations per 1,000 females age 12 or older in 1994 by 63%, to 5.9 per 1,000. Male victims of intimate partner homicide 3.0/1,000 in 1994, rate had decreased by 64%, to 1.1 per 1,000 in 2010.

Homicides in US – BJS through 2008 Nearly 1 out of 5 murder victims (16.3%) were killed by intimate >2 out of 5 (45%) female murder victims killed by intimate. % of males killed by an intimate fell from 10.4% in 1980 to 4.9% in 2008, a 53% drop % of females killed by an intimate increased 5% across the same period % of females killed by an intimate declined from 43% in 1980 to 38% in After 1995 % gradually increased, to 45% in 2008.

 Decline in US Mainly Related to: Increased DV Laws and Resources- & Gun Removal from known Abusers Similar Declines in UK & Australia More Decline will need more identification of high risk cases and service provision And appropriate risk management AND prevention of Domestic Violence

Danger Assessment – Developed in 1986 to help women accurately assess risk of murder from abusive partner Further validated with NIJ RAVE study – combination of info for abused women and arrest records for perpetrator 2 years later Data to validate and determine levels of danger – weighted scoring from 12 city ‘02 IP Femicide Study (Campbell et al ‘02; Campbell et al ‘09) Case – Control – police homicide records & population based survey of abused women in same cities Plus trauma data bases to identify near lethal cases –

Lethality Assessment Project – Shortened form of Danger Assessment for first responders to use at scene of a DV call Collaborative between DV advocacy organizations & CJ Those screened in at “high risk” (based on DA research) told they are and told most protective action is DV shelter given – officer calls shelter hotline (from RAVE study results – also most protective from highly dangerous abuser is arrest – less dangerous abuser PO also protective) Ongoing surveillance in MD – reports from police – who screens in at high risk, who talks to advocate, who goes to DV shelter – evidence based & ongoing surveillance

Community Collaborative Model Women/Victims in Shelters Or Health Care System Lethality Assessment & Safety Assessment dangerassessment.org Partners of Men in System Offenders in CJ, BIP, MH SA Tx &/or VA/DoD Criminal Justice- Judicial System – MA High Risk Team (JGCC) Risk Assessment (Re-assault) System Safety Audit – CCR, Fatality Reviews & Court Watch/Monitoring ( MNDV Lethality Assessment Program (LAP)

To Decrease, We must keep track – to measure & understand Increasing fatality reviews – publishing results in comparable ways – DV related deaths, near lethals Including information from family – to determine real prevalence of prior DV (arrest records only approximately 30%) also service to community Also work for better surveillance in communities – through maternal mortality reviews AND through contributing data to data bases – combining CJ & ME Watch proportions of males & females in data bases DISAGGREGATE by gender!!

To move the needle – Combination of “Sanctions & Sanctuary” Legal and community level sanctions against DV Increase awareness through surveys, increase knowledge of health outcomes, increase knowledge & surveillance of fatalities & near lethals – change community attitudes Enforce laws and pass new ones Empower police with evidence based strategies Increase collaborations in communities around shared goals Measure results – collaborative - e.g. OK LAP test (NIJ) Sanctuary for abused women – DV orgs & health

Saturday 8 March 2014