Intimate Partner Femicide: The 12 City Femicide Study With Femicide-

Suicide

Jacquelyn Campbell PhD RN FAANAnna D. Wolf Endowed Chair & Professor

Johns Hopkins University School of Nursing Multi City Intimate Partner Femicide Study

Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156

HOMICIDE IN BATTERING RELATIONSHIPSHOMICIDE IN BATTERING RELATIONSHIPS40 - 50% OF US WOMEN KILLED BY HUSBAND, BF OR EX (vs. 5-8% of men) (9 times rate killed by a stranger)7th leading cause of premature death for US women; #2 cause of death-African & Native American women 15-34 yoImmigrant women at increased risk in NYC (Wilt ’04)US – At least 2/3 of women killed – battered prior – if male killed – prior wife abuse in 75% of cases (Campbell, ‘92; Morocco et al, ‘98)More at risk when leaving or left (Wilson & Daly, ‘93; Campbell et. al. ’01; Websdale ‘99) – 1st 3 mos & 1st year - but eventually more safeWomen far more likely victims of homicide-suicide (29% vs.1% male-US–29.3 vs. 2.3%-Canada) 40% - Ontario (DVDRC ‘06)44-47% of women killed seen in health care system before killed (Sharps, Campbell ’02; Wadman & Muelleman ‘99)

40 - 50% OF US WOMEN KILLED BY HUSBAND, BF OR EX (vs. 5-8% of men) (9 times rate killed by a stranger)7th leading cause of premature death for US women; #2 cause of death-African & Native American women 15-34 yoImmigrant women at increased risk in NYC (Wilt ’04)US – At least 2/3 of women killed – battered prior – if male killed – prior wife abuse in 75% of cases (Campbell, ‘92; Morocco et al, ‘98)More at risk when leaving or left (Wilson & Daly, ‘93; Campbell et. al. ’01; Websdale ‘99) – 1st 3 mos & 1st year - but eventually more safeWomen far more likely victims of homicide-suicide (29% vs.1% male-US–29.3 vs. 2.3%-Canada) 40% - Ontario (DVDRC ‘06)44-47% of women killed seen in health care system before killed (Sharps, Campbell ’02; Wadman & Muelleman ‘99)

INTIMATE PARTNER FEMICIDE BY PERPETRATOR IN TEN CITIES (N= 311)

(same sex intimate femicides – Glass et al., 2004)

INTIMATE PARTNER FEMICIDE BY PERPETRATOR IN TEN CITIES (N= 311)

(same sex intimate femicides – Glass et al., 2004)

40.5%29.6%

8.0%

19.3%

2.6%

SPOUSEBOYFRIEND

EX-SPOUSE

EX-BF

OTHER

U.S. INTIMATE PARTNER HOMICIDE RATE U.S. INTIMATE PARTNER HOMICIDE RATE DECLINE 1976-06 DECLINE 1976-06 FBI (SHR, 1976-02; BJS ’05, ‘07)FBI (SHR, 1976-02; BJS ’05, ‘07)

U.S. INTIMATE PARTNER HOMICIDE RATE U.S. INTIMATE PARTNER HOMICIDE RATE DECLINE 1976-06 DECLINE 1976-06 FBI (SHR, 1976-02; BJS ’05, ‘07)FBI (SHR, 1976-02; BJS ’05, ‘07)

0

200

400

600

800

1000

1200

1400

1600

1800

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

2000

2002

2004

FEMALE

MALE

2004, 05 - no ex’s

Decline in Intimate Partner Homicide and FemicideDecline in Intimate Partner Homicide and Femicide

Decline in male victimization in states where improved DV laws and services - resource availability (Browne & Williams ’89; ’98, Dugan, Nagin, & Rosenfeld ‘99)

Exposure reduction - increased female earnings, lower marriage rate, higher divorce rate (Dugan, Nagin & Rosenfeld ’99; Smith & Brewer ’90)

Gun availability decline (Wilt ‘97; Block ‘95; Kellerman ‘93, ‘97- gun increases risk X3) – special issue of Evaluation Review ’06 – Sorenson, Special Editor

Decline in male victimization in states where improved DV laws and services - resource availability (Browne & Williams ’89; ’98, Dugan, Nagin, & Rosenfeld ‘99)

Exposure reduction - increased female earnings, lower marriage rate, higher divorce rate (Dugan, Nagin & Rosenfeld ’99; Smith & Brewer ’90)

Gun availability decline (Wilt ‘97; Block ‘95; Kellerman ‘93, ‘97- gun increases risk X3) – special issue of Evaluation Review ’06 – Sorenson, Special Editor

Decrease by Race - Intimate Homicide Rate By Race Age 20-44 FBI, (SHR), 1976-96

Decrease by Race - Intimate Homicide Rate By Race Age 20-44 FBI, (SHR), 1976-96

0

5

10

15

20

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

Anglo Male

Anglo FemaleA.A. Male

A.A. Female

U.S. INTIMATE PARTNER HOMICIDE RATES U.S. INTIMATE PARTNER HOMICIDE RATES & DOMESTIC VIOLENCE SERVICES 1976-9 & DOMESTIC VIOLENCE SERVICES 1976-9 (Resources per 50 million - Dugan, Nagin & Rosenfeld ‘03)(Resources per 50 million - Dugan, Nagin & Rosenfeld ‘03)

U.S. INTIMATE PARTNER HOMICIDE RATES U.S. INTIMATE PARTNER HOMICIDE RATES & DOMESTIC VIOLENCE SERVICES 1976-9 & DOMESTIC VIOLENCE SERVICES 1976-9 (Resources per 50 million - Dugan, Nagin & Rosenfeld ‘03)(Resources per 50 million - Dugan, Nagin & Rosenfeld ‘03)

0

500

1000

1500

2000

2500

3000

3500

4000

19

76

19

77

19

78

19

79

19

80

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

98

20

00

IP Homicides

Hotlines

Legal Advocacy

INTIMATE PARTNER HOMICIDE: KILLED BY GUNS US ‘76-’02 (SHR) (>2/3 of intimates)

INTIMATE PARTNER HOMICIDE: KILLED BY GUNS US ‘76-’02 (SHR) (>2/3 of intimates)

0

500

1000

1500

2000

2500

0

500

1000

1500

2000

2500

With Guns

Without Guns

Early work on FemicideDayton, OH study on IP homicide – 28 women & 26 men killed by intimate partners – prior DV in 66% of female cases; 75% of male (Campbell ‘81 & ’92)

Several women seen in local ED’s before killedOthers – police called but nothing donePower and control issues clear in reports

Further work developing and refining and testing Danger Assessment (Campbell ‘86; ’89; ‘92 - & ‘08)

Femicide Risk Study(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)

Purpose: Identify and establish risk factors for IP femicide – (over and above domestic violence)

Significance: Determine strategies to prevent IP femicide – especially amongst battered women – Approximately half of victims (54% of actual femicides; 45% of attempteds) did not accurately perceive their risk – that perpetrator was capable of killing her &/or would kill her

RISK FACTORS FOR INTIMATE PARTNER RISK FACTORS FOR INTIMATE PARTNER FEMICIDE: RESEARCH TEAMFEMICIDE: RESEARCH TEAM(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)

RISK FACTORS FOR INTIMATE PARTNER RISK FACTORS FOR INTIMATE PARTNER FEMICIDE: RESEARCH TEAMFEMICIDE: RESEARCH TEAM(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)

R. Block, PhD (ICJA)D. Campbell, PhD, RN (FSU)J. McFarlane, DrPH, RN (TWU)C. Sachs MD, MPH (UCLA)P. Sharps, PhD, RN (GWU)Y. Ulrich, PhD, RN (UW)S. Wilt, PhD (NYC DOH)F. Gary, PhD, RN (UFl)

R. Block, PhD (ICJA)D. Campbell, PhD, RN (FSU)J. McFarlane, DrPH, RN (TWU)C. Sachs MD, MPH (UCLA)P. Sharps, PhD, RN (GWU)Y. Ulrich, PhD, RN (UW)S. Wilt, PhD (NYC DOH)F. Gary, PhD, RN (UFl)

M.A. Curry PhD, RN (OHSU)N. Glass, PhD, RN (OHSU)J. Koziol-McLain, PhD, RN (JHU)J.Schollenberger MPH (JHU)A. Kellerman, MD, MPH (Emory)X. Xu, MSN (JHU)Kathryn Chouaf, MSN (JHU)

M.A. Curry PhD, RN (OHSU)N. Glass, PhD, RN (OHSU)J. Koziol-McLain, PhD, RN (JHU)J.Schollenberger MPH (JHU)A. Kellerman, MD, MPH (Emory)X. Xu, MSN (JHU)Kathryn Chouaf, MSN (JHU)

RISK FACTORS FOR INTIMATE PARTNER FEMICIDE: RISK FACTORS FOR INTIMATE PARTNER FEMICIDE:

CITIES AND CO-INVESTIGATORSCITIES AND CO-INVESTIGATORS (Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)

RISK FACTORS FOR INTIMATE PARTNER FEMICIDE: RISK FACTORS FOR INTIMATE PARTNER FEMICIDE:

CITIES AND CO-INVESTIGATORSCITIES AND CO-INVESTIGATORS (Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)(Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156)

BaltimoreChicagoHoustonKansas City, KA&MOLos AngelosNew YorkPortland, ORSeattle, WA Tampa/St. PeteWichita, KA

BaltimoreChicagoHoustonKansas City, KA&MOLos AngelosNew YorkPortland, ORSeattle, WA Tampa/St. PeteWichita, KA

P. Sharps (GWU)B. Block (ICJA)J. McFarlane (TWU)Y. Ulrich (UW)C. Sachs (UCLA)S. Wilt (NYDOH)M. A. Curry (OHSU)Y. Ulrich (UW)D. Campbell (FSU)Y. Ulrich (UW)

P. Sharps (GWU)B. Block (ICJA)J. McFarlane (TWU)Y. Ulrich (UW)C. Sachs (UCLA)S. Wilt (NYDOH)M. A. Curry (OHSU)Y. Ulrich (UW)D. Campbell (FSU)Y. Ulrich (UW)

Case Control DesignData Source

CASES - women who are killed by their intimate partners

Police Homicide FilesProxy informants

CONTROLS - women who are physically abused by their intimate partners

(second set of nonabused controls – for later analysis)

Women themselves

Addition of Attempted Femicides

Data Source

CASES - women who are killed by their intimate partners

Police Homicide filesProxy informants

CONTROLS - women who are physically abused by their intimate partners

Women themselves

CASES - women who are ALMOST killed by their intimate partners

Women themselves – to address issue of validity of proxy information

Definition: Attempted FemicideGSW or SW to the head, neck or torso.Strangulation or near drowning with loss of consciousness.Severe injuries inflicted that easily could have led to death.GSW or SW to other body part with unambiguous intent to kill.If none of above, unambiguous intent to kill.

PRIOR PHYSICAL ABUSE & STALKING EXPERIENCED ONR YEAR PRIOR TO FEMICIDE (N=311) & ATTEMPTED FEMICIDE (N=182)

PRIOR PHYSICAL ABUSE & STALKING EXPERIENCED ONR YEAR PRIOR TO FEMICIDE (N=311) & ATTEMPTED FEMICIDE (N=182)

Prior physical abuseIncreased in frequencyIncreased in severityStalked

No prior physical abuse Stalked

Prior physical abuseIncreased in frequencyIncreased in severityStalked

No prior physical abuse Stalked

Femicide Femicide

70%70%

66%66%

62%62%

87%87%

30% 30%

58%58%

Femicide Femicide

70%70%

66%66%

62%62%

87%87%

30% 30%

58%58%

AttemptedAttempted

72%72%

54%54%

60%60%

95%95%

28%28%

72%72%

AttemptedAttempted

72%72%

54%54%

60%60%

95%95%

28%28%

72%72%

INTIMATE PARTNER ABUSED CONTROLS (N = 356)

Random sample selected from same cities as femicide and attempted femicide cases Telephone survey conducted 11/98 - 9/99 using random digit dialingWomen in household 18-50 years old & most recently celebrated a birthday Women abused (including sexual assault & threats) by an intimate partner w/in 2 years prior – modified CTSSafety protocols followed

Sample – (only those cases with prior physical abuse or threats)

Number FEMICIDE CASES 220

ATTEMPTED FEMICIDE CASES 143

ABUSED CONTROLS 356

Sociodemographic comparisons

0

10

20

30

40

50

60

70

80

90

Af/Am Anglo Hispanic <HS Ed Job

Fem/Att. Perp

Abuse Perp

Fem/Att. Victim

Abuse Victim

Mean AgeFem/Att Perp = 36Abuse Perp = 31Fem/Att Victim = 34Abuse Victim = 29

DANGER ASSESSMENT ITEMS COMPARING ACTUAL & ATTEMPTED FEMICIDE SURVIVORS (N=493) & ABUSED (WITHIN PAST 24 MONTHS) CONTROLS (N=427) (*p < .05)

DANGER ASSESSMENT ITEMS COMPARING ACTUAL & ATTEMPTED FEMICIDE SURVIVORS (N=493) & ABUSED (WITHIN PAST 24 MONTHS) CONTROLS (N=427) (*p < .05)

Physical violence increased in frequency*Physical violence increased in severity *Partner tried to choke victim *A gun is present in the house *Partner forced victim to have sex *Partner used street drugs *Partner threatened to kill victim *Victim believes partner is capable of killing her * Perpetrator AD Military History (ns.)Stalking score*

Physical violence increased in frequency*Physical violence increased in severity *Partner tried to choke victim *A gun is present in the house *Partner forced victim to have sex *Partner used street drugs *Partner threatened to kill victim *Victim believes partner is capable of killing her * Perpetrator AD Military History (ns.)Stalking score*

Att/Actual

56%

62%

50%

64%

39%

55%

57%

54%

16%

4.6

Att/Actual

56%

62%

50%

64%

39%

55%

57%

54%

16%

4.6

Control

24%

18%

10%

16%

12%

23%

14%

24%

22%

2.4

Control

24%

18%

10%

16%

12%

23%

14%

24%

22%

2.4

VICTIM & PERPETRATOR OWNERSHIP OF WEAPON IN VICTIM & PERPETRATOR OWNERSHIP OF WEAPON IN FEMICIDE (N = 311), ATTEMPTED FEMICIDE (N = 182), FEMICIDE (N = 311), ATTEMPTED FEMICIDE (N = 182), ABUSED CONTROL (N=427) & NON-ABUSED CONTROL ABUSED CONTROL (N=427) & NON-ABUSED CONTROL (N=418) CASES(N=418) CASES

VICTIM & PERPETRATOR OWNERSHIP OF WEAPON IN VICTIM & PERPETRATOR OWNERSHIP OF WEAPON IN FEMICIDE (N = 311), ATTEMPTED FEMICIDE (N = 182), FEMICIDE (N = 311), ATTEMPTED FEMICIDE (N = 182), ABUSED CONTROL (N=427) & NON-ABUSED CONTROL ABUSED CONTROL (N=427) & NON-ABUSED CONTROL (N=418) CASES(N=418) CASES

15.7 14.6 16.915.6

74.1

52.9

26.8

12.7

0

10

20

30

40

50

60

70

80

Victim Perpetrator

FemicideAttemptedAbused controlNonabused control

2=125.6, P< .0001

DANGER ASSESSMENT ITEMS COMPARING ACTUAL & ATTEMPTED FEMICIDE SURVIVORS (N=493) & ABUSED (WITHIN PAST 24 MONTHS) CONTROLS (N=427) (*p < .05)

DANGER ASSESSMENT ITEMS COMPARING ACTUAL & ATTEMPTED FEMICIDE SURVIVORS (N=493) & ABUSED (WITHIN PAST 24 MONTHS) CONTROLS (N=427) (*p < .05)

Partner is drunk every day *Partner controls all victim’s activities *Partner beat victim while pregnant *Partner is violently jealous of victim (says things like “If I can’t have you,no one can”)*Victim threatened/tried to commit suicide Partner threatened/tried to commit suicide *Partner is violent toward victim’s children*Partner is violent outside house*Partner arrested for DV* (not criminality)Partner hurt a pet on purpose

Partner is drunk every day *Partner controls all victim’s activities *Partner beat victim while pregnant *Partner is violently jealous of victim (says things like “If I can’t have you,no one can”)*Victim threatened/tried to commit suicide Partner threatened/tried to commit suicide *Partner is violent toward victim’s children*Partner is violent outside house*Partner arrested for DV* (not criminality)Partner hurt a pet on purpose

Att/Actual

42%

60%

36%

79%

7%

39%

9%

49%

27%

10.1%

Att/Actual

42%

60%

36%

79%

7%

39%

9%

49%

27%

10.1%

Control

12%

32%

7.7%

32%

9%

19%

3%

38%

15%

8.5%

Control

12%

32%

7.7%

32%

9%

19%

3%

38%

15%

8.5%

Nonsignificant Variables of noteHurting a pet on purpose -10% of attempteds/actual victims vs. 8.5% of controls

BUT – some clear cases of using cruelty to a pet as a threat to killWAS a risk for women to be abused (compared with nonabused controls) (AOR = 7.59 – Walton-Moss et al ’05)AND more (but still not sign.) risk in attempted femicide sample – perhaps proxies not as knowledgeable about pets – warrants further investigation

Perpetrator military history – 16% actual/attempteds vs. 22% of controls

Risk ModelsFemicides with abuse history only (violence & threats) compared to abused controls (*N=181 femicides; 319 abused controls – total = 500 (18-50 yo only) Missing variables

variables had to be excluded from femicide model due to missing responses – if don’t know – no – therefore underestimate risk

Logistic Regression Plan – comparing cases & controlsModel variable in blocks – background characteristics – individual & couple, general violence related variables, violent relationship characteristics – then incident level Interaction terms entered – theoretically derived

Significant (p<.05) Variables (Entered into Blocks) before Incident (overall fit = 85% correct classification)

Perpetrator unemployed OR = 4.4Perpetrator gun access OR = 5.4Perpetrator Stepchild OR = 2.4Couple Never Lived Together OR = .34Highly controlling perpetrator OR = 2.1Estranged X Low control (interaction) OR = 3.6Estranged X Control (interaction) OR = 5.5Threatened to kill her OR = 3.2Threatened w/weapon prior OR = 3.8Forced sex OR = 1.9Prior Arrest for DV OR = .34

Femicide – Suicide Cases (32% of femicide cases in study – 29% US)Significant explanatory power for same femicide – suicide risk factors.

Partner access to gunThreats with a weapon, chokingStep child in the homeEstrangement

Unique to femicide – suicide:Partner suicide threats – history of poor mental healthMarriedSomewhat higher education levels (unemployment still a risk factor), more likely to be white, Hispanic or Asian (vs. African America) but not significant in multivariate

Multicity Femicide Study – Results related to pregnancy 25.8% of women killed reported abuse during pregnancy (vs. 8.4% of abused controls) – AOR = 3.813 women (4.2%) killed while pregnant – 11 of 13 abused in relationship before killedStepchild in home AOR = 2.48 Results specific to pregnancy published: (McFarlane, Campbell et. al. ’02 OB/GYN, 100: 27-36; also Campbell, Webster et. al. AJPH ’03)

From Public Health Perspective – Maternal Mortality

Maternal mortality – Death from all causes during pregnancy & year after delivery or pregnancy terminationHomicide - leading cause of maternal mortality in US cities where measured (NYC, Chicago, DC) (Dannenberg, ’95; Krulewitch ‘01) Leading cause of maternal mortality in entire state of MD (Horon & Cheng, 2001) – 20% of deathsHas been neglected in maternal death reviews – (perpetrator data missing) & therefore programming in US but fatality reviews increasingSt. George – Washington Post – 12/04 1237 documented DV maternal mortalities since ’90 - 88 per yr (vs. 1200+ DV femicides overall – 7%)

Maternal Mortality WorldwideHomicide shown to be an important cause in other countries also – e.g. Mozambique, Bangaledesh (Fauveau & Koenig,’88)

Maternal deaths in developing countries – ongoing and serious problem –e.g. in India – 13% of deaths of women – 4-5.5 per 1000 live births (WHO) but % related to IP homicide not documented400 villages Maharastra State (Pune, Aurangabad & Ahmednagar districts) India – hand review of records

16% of all deaths during pregnancy due to IPV; 70% of maternal deaths in region unrecorded & 41% of recorded deaths misclassified (Ganatra et. al. ’98)

Lessons learnedImportance of proxy informants – otherwise NEVER get true incidence of prior DVImportance of hand search of police records – miss many cases otherwiseImportance of homicide-suicides – need for further studyImportance of maternal mortality – data base disconnectImportance of attempted femicides victims as sources of data

Never forget who it’s for -

“please don’t let her death be for nothing – please get her story told”

(one of the Moms)