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Neonaticide in china and the role and vies of the religions on the issue

Infant homicide is a legal term that refers to killing of a child in the first year of life. Infanticide, as defined by the Infanticide Act, is when a mother 'causes death of her child under the age of 12 months by wilful act or omission, but at the time of the act or omission the balance of her mind was disturbed by reason of her not having fully recovered from the effect of her having given birth to the child or by reasons of the effect of lactation consequent on the birth of the child'.

Neonaticide is not specifically defined by the Infanticide Act, but in medical publications usually refers to the killing of a child during the first 24 hours of life. Following a review of world publications from 1751 to 1968 and from experience in three of his own cases, Resnick 2 suggested that the motives behind neonaticide and infant homicide are inherently different: Subsequent studies have supported the proposal that the motivations differ, but suggest that most infant homicides are due to a sudden loss of temper with the child 9 and not altruism.

If the motivation behind neonaticide and infant homicide differs, the risk factors for committing these offences may also differ.

This paper will therefore analyse these offences independently. Evidence of ritual killing of babies with structural or aesthetic abnormalities has been documented amongst the Aztecs, ancient Chinese, the Mardudjara Aborigines of Australia and some African cultures.

Weak or deformed babies were destroyed for eugenic reasons and because they would be a burden on the state. In medieval England neonaticide was neonaticide in china and the role and vies of the religions on the issue. In addition, female infant homicide has been seen by some as the most effective method of population control. What is the evidence that these are relevant today?

Whether there was an ethnic bias amongst the female infant homicides is not clear from the study, but this seems unlikely. Regarding economics, it has been suggested that most neonaticidal mothers are financially poor, 18 but in recent studies 51119 the contribution of economic circumstances has not been examined directly.

Neonaticide has been shown to be more common amongst teenage mothers than older mothers 1119 and in those with low levels of education.

Finally, there are no data to suggest that congenital abnormalities are overrepresented among today's victims of neonaticide. Thus, the historical work has been unhelpful in providing risk factors for modern application.

Of greater potential value are a series of factors that appear strongly associated with neonaticide. As already mentioned, mothers who commit neonaticide are also more likely to be young. In the study by Overpeck, half were less than 19 years. Teenage women are, however, at excess risk of preterm delivery, 21 so this again may not represent a true risk factor. A further risk factor associated with age that is highlighted in many case report studies is the frequent observation that women are single 2 and still living at home with their parents.

In D'Orban's study, 9 all the mothers went on to hide the body of their victim. Others seeking explanations for why these women do not seek an abortion have proposed that neonaticide is a 'terminal abortion' procedure 20 and that the risk is greatest in societies with strict anti-abortion laws.

Lester 33 noted a decrease in neonaticide following a relaxation of abortion laws in the United States. A later study, 34 however, looking at data from 39 nations, did not find an association between the strictness of abortion laws and the incidence of neonaticide. Moreover, in England and Wales the incidence of infant homicide changed little after 1985 5 despite passage of the Abortion Act 1967.

Resnick has stated that the stigma of having an illegitimate child is 'the primary reason for neonaticide in unmarried women today as it has been through the centuries'. This suggestion is backed up by D'Orban's finding that, in 24 cases of neonaticide, all but one of the victims was born out of wedlock.

Against a causal connection is the unchanging incidence of infant homicide at a time when the stigma of having an illegitimate child has greatly lessened; some may say, however, that amongst young teenage women living at home the stigma of an illegitimate child is as great as ever. Although neonaticide has been described at the hands of married women, the most frequent neonaticide in china and the role and vies of the religions on the issue is extramarital paternity.

This is embodied in the Infanticide Act, initially passed in 1922 and reformed in 1938. This Act reduced the offence of infanticide from murder to manslaughter. It fails, however, to distinguish between neonaticide and infanticide. D'Orban 9 found that just 3 out of 11 women who committed neonaticide had a psychiatric abnormality at the time of their act; 2 were said to have a 'personality disorder' and the other was judged 'subnormal'.

Childbirth was almost certainly not causal in either of these conditions. Despite this, all but one woman whose baby survived were dealt with under the Infanticide Act 1938.

In practice, it would therefore appear that the severity of abnormality needed to fulfil the criteria of 'disturbance of the balance of mind' as specified in the Act is much less than that required to warrant a psychiatric diagnosis. Instead, Silverman and Kennedy 35 suggest that the circular argument 'if they killed their kids they must be crazy' has probably led to a bias in the judicial system. Management and prevention Although it has been suggested that there may be 'hundreds and possibly thousands of neonaticides' each year in Britain the official figure is in the region of 10.

If this figure is anywhere near correct, the women at risk are very unlikely to be identified before the event. Furthermore, most of the risk factors for neonaticide conspire against prevention. A shy, timid, passive, adolescent living with her parents who is concealing her pregnancy, or in a state of denial with few biological manifestations of her gravid state and the absence of any psychiatric symptoms, is unlikely to come into contact with the medical profession.

For example, the suggestion that 'increased social support should be provided for young pregnant women, young parents and isolated parents' 36 reveals a lack of understanding of issues such as concealment, denial, and the fact that the perpetrator is usually a single mother who, far from being isolated, is usually living at home with her parents and family.

Goldstein 37 proposes that the place where physicians can best intervene is through the provision of effective family planning methods for these women.

Studies to date have not analysed the methods of contraception used by mothers who have committed neonaticide. It is probable, however, that these methods have been suboptimal and that an improvement in both education and the provision of family planning amongst young women would be of great benefit.

Resnick 2 has suggested liberalization of abortion laws as the best way to reduce neonaticide but most studies do not support this strategy, as already discussed. Green and Manohar 24 point out the importance of diagnosing pregnancy in an unmarried woman and the need to explore the impact of pregnancy on her psychosocial status; healthcare workers should be especially alert to danger to the child in cases where the mother absents herself from antenatal care.

Neonaticide in china and the role and vies of the religions on the issue

In cases where denial of the pregnancy extends into the third trimester Slayton and Soloff 38 recommend inpatient management, 'if necessary with assistance of involuntary commitment proceedings'. The gender bias applies to deaths in the first three months with no difference after four months of age. This finding is confirmed by studies in Scotland 6 and the United States 39 and yet is opposite to what would be predicted from the historical work.

Marks 3 suggests that the gender bias may be due to an increased physical vulnerability of male babies, pointing out a parallel in the higher number of deaths amongst male infants from any cause. Alternatively, parents may think that male babies are more robust and are consequently more aggressive to them. Other suggestions include the possibility that male infants interact with the environment in a different way, perhaps by being more active, assertive or vocal and are hence more likely to elicit a murderous response.

There have not been any direct studies on the association of poverty with infant homicide. Marks and Kumar 6 suggest, however, that economic factors are unlikely to be important since the rate of infant homicide in England and Wales has changed little since 1957 despite continuing economic improvements. There is likewise no evidence of there being an association between babies born with congenital abnormalities and infant homicide. Unlike neonaticide, mothers who commit infant homicide are usually married or living with their partner.

INFANT HOMICIDE

The data on race and infant homicide are inconsistent. Although some studies suggest that the incidence of child homicide and infant homicide is greater amongst the black population, others have found a higher rate amongst whites. Psychiatric morbidity is believed to be more relevant to infant homicide than to neonaticide. D'Orban, 9 however, judged that only 24 of the 89 women in his study had been mentally ill, of whom 14 had a psychotic illness.

In a reanalysis of these data Marks and Kumar 6 found that women who killed children less than six months old were not usually classified as mentally ill but as 'battering mothers'; however, mental illness did seem to account for most infant homicides over six months.

Amongst those women in whom mental illness was implicated as the cause of their actions, infant homicide was often found to be an extension of a suicidal act on the grounds that there would be no one left to care for the child. Occasionally the primary motive was altruistic, based on a delusional belief that a terrible fate awaited the infant.

Although psychiatric morbidity is a risk factor, most women who are mentally ill do not harm their children and many women who commit infant homicide are not mentally ill.

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Another area of psychiatric morbidity not directly related to the physiological changes associated with pregnancy is substance misuse. A recent article states that infant homicide is committed more frequently by mothers than by fathers. Although the Infanticide Act does not recognize mental illness amongst fathers who commit infant homicide, postnatal mental illness seems to occur in men as well as women.

Management and prevention The risk factors for infant homicide offer more potential for prevention than do those for neonaticide, and the antenatal clinic and postnatal follow-up provide opportunities for identifying high-risk cases.

The first line in identification is through an awareness of the risk factors for postnatal depression and psychosis, as well as risk factors and clinical signs of substance abuse. Overpeck and colleagues 19 have tentatively suggested cross-training healthcare professionals to enable them to deal with domestic violence; neonaticide in china and the role and vies of the religions on the issue, as they point out, there are no data on the relation between infant abuse and infant homicide.

In addition, as already discussed, men who committed infant homicide had not usually been abusive before the offence. Munchausen's syndrome by proxy. Abuse was detected in 33 of 39 cases, with recordings of intentional suffocation in 30. Although none of these parents had evidence of psychotic illness many had an underlying personality disorder.

It is unclear how often such behaviour leads on to infant homicide or a misdiagnosis of sudden infant death syndrome but Southall et al.

Unfortunately those most likely to commit neonaticide tend to evade the healthcare system. Important risk factors that should be picked up in the antenatal history are substance abuse and mental illness. With infant homicide, women at risk may be more amenable to detection, but the perpetrator is equally likely to be the father.

The rarity of both events, coupled with the infrequent contact of perpetrators with health professionals, will continue to hamper identification of the children at greatest risk. In many cases, however, infant homicide and neonaticide probably represent the extreme end of the abuse spectrum. Detection of infants most at risk may consequently result in a more widespread reduction of fatalities. Infanticide Act 1938; Ch 36 2. Murder of the newborn: Am J Psychiatry 1970;126: Characteristics and causes of infanticide in Britain.

Int Rev Psychiatry 1996;8: Recurrence of unexpected infant death. Marks MN, Kumar R. Infanticide in England and Wales. Med Sci Law 1993;33: Med Sci Law 1993;36: Neonaticide, infanticide, and filicide: Bull Am Ac Psychiatry Law 1995;23: HM Stationery Office, 1976 9. Women who kill their children. Br J Psychiatry 1979;134: