Silent witnesses: Unveiling the epidemic of femicides in Northwest Tshwane, South Africa – a decade of analysis.

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Yaseen Bismilla This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4784491/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Jan, 2025 Read the published version in BMC Public Health → Version 1 posted 4 You are reading this latest preprint version Abstract Background Femicides, defined as the gender-based killing of women, are a pressing public health issue worldwide, with South Africa experiencing some of the highest rates globally. This study focuses on the North West region of Tshwane, particularly the Garankuwa area, aiming to address gaps in understanding the epidemiology, demographics, circumstances, and pathology associated with femicides. The Garankuwa mortuary serves as the primary site for this investigation, providing a detailed analysis over a ten-year period. Objectives The study had four main objectives: to analyse the demographics and incidence rates of femicides in the Northwest Tshwane area, to examine the circumstances surrounding femicides (including the time, location, and demographic risk factors), to identify the causes and pathological characteristics of femicides; and to observe trends in femicide rates over the ten-year study period. Methods This study was a retrospective cross-sectional descriptive analysis, focusing on all deceased females admitted to the Garankuwa mortuary from 2009 to 2018. The inclusion criteria comprised female cases at autopsy, with a suspected homicidal manner of death. Cases that were later identified as suicides, accidental, or natural deaths following ancillary investigations were excluded. Data was meticulously collected from various sources, including the National Injury Mortality Surveillance System (NIMSS), death registers, post-mortem reports, and police docket information. Results Over the ten-year period, the Garankuwa mortuary admitted an annual average of 1131 bodies, with approximately 23.5% (266) being female. Of these, 17.5% were identified as femicides. The average incidence rate of femicides was 11.2 per 100,000 female population, showing a general decline over the study period, except for notable increases in 2013 and 2016. The study found that the most common months for femicides were September and December, with most incidents occurring at home, followed by residential areas and medical facilities. The geographic analysis identified Temba, Rietgat, and Akasia as the areas with the highest number of femicide cases. Demographically, the majority of femicide victims were black, with the most affected age group being 18–39 years. The leading causes of death were gunshot wounds, sharp force injuries, and blunt force trauma, with significant incidences of strangulation and asphyxial deaths, primarily affecting the neck and head regions. Conclusion The study highlights the severity of femicides in the Northwest Tshwane region, confirming specific characteristics and trends that align with national patterns. The findings emphasize the necessity for targeted prevention programs, stricter firearm control measures, and community-based violence prevention strategies. The demographic data indicate that young black women are particularly vulnerable, necessitating protective and educational initiatives tailored to this group. Gender based violence femicides medico-legal mortuary forensic medicine community-based violence prevention epidemiology demographics pathology Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Violence against women and adult femicides are critical medico-legal issues nationally and worldwide. The South African and international media constantly report on the murder of women. Year 2013 and 2014 in particular were populated by global media headlines involving the killing of two South African women namely Annene Booysen and model Reeva Steenkamp [ 1 ]. South Africa has one of the highest femicide rates in the world. High incidence rates of femicide have been recorded by the South African Police Service (SAPS) in their annual crime reports, with 989 women murdered during the 2021 to 2022 financial year, an alarming 14.1% increase from the previous financial year [ 2 ]. Gender-based violence (GBV) refers to harmful acts directed at an individual or group of individuals based on their gender, and is primarily rooted in gender inequality, the abuse of power and harmful norms [ 3 , 4 ]. GBV is an alarmingly increasing serious South African public health concern and international human rights issue [ 5 ]. Violence against women (VAW) is defined as any act of gender-based violence that and encompasses physical, sexual, psychological, emotional and financial abuse to women. VAW specifically is the most common form of GBV [ 3 ]. It is reported that worldwide, at least one in five women have been physically and/or sexually abused by a man or men at some point of their lifetime [ 5 ]. “Femicide” refers to the intentional killings of women and girls, representing the lethal end point of multiple, overlapping, and interconnected forms of gender-based violence [ 3 ]. Femicide contravenes women's constitutional right to life as outlined in the International and Supreme laws of most countries, including South Africa [ 6 ]. The first National femicide study in South Africa was undertaken in 1999 and reported an incidence rate of 24.7/100,000 for women 14 years and older. This incidence rate is six times higher than the international rate of 4.0/100,000 population as estimated by the World Health Organization at the same time [ 5 ]. Regarding the incidence of femicides, global figures differ from one country to another. The United States in 2011, reported a femicide incidence rate of 4.7 / 100,000 women, with a 22.4% femicide rate [ 7 ]. In Taiwan, Wen-Li Fong et al noted femicide rates to be slightly higher, accounting for 29.1% of all homicides in 2010 [ 8 ]. Despite the magnitude of deaths resulting from VAW nationally and globally, there are still gaps in data that undermine prevention efforts [ 9 ]. There is limited research regarding femicides in the specific location of this study, providing such gaps in data. This study will help identify vulnerable women in the North-western District of Tshwane and assist in developing tools to implement a targeted, context-specific femicide prevention programs to protect women from the hazards of violence that threaten their lives in this area. Moreover, this study emphasizes the need for raising awareness about the scale of female violence in society. Methods This study is a retrospective, cross-sectional descriptive analysis focusing on all deceased females admitted to the Garankuwa mortuary from January 1, 2009, to December 31, 2018, where the apparent manner of death was suspected to be homicidal. The Garankuwa mortuary, situated in the north-west of Pretoria near the township of Ga-Rankuwa, functions as a teaching facility for the Sefako Makgatho Health Sciences University. The mortuary handles an estimated 1200 autopsy cases per year. The north-western part of the City of Tshwane, which includes the areas of Akasia, Rosslyn, Pretoria North, Klipfontein, Ga-Rankuwa, Mabopane, Winterveld, and Soshanguve, as well as a rural zone in the west, has a population of approximately 997,000, making it the most populous region in the City of Tshwane. The study population was defined by inclusion and exclusion criteria. Inclusion criteria encompassed cases involving females or individuals of undetermined sex confirmed to be female at autopsy or through anthropological analyses in cases of severe decomposition. These cases also had a suspected initial manner of death categorized as homicide or unknown. Exclusion criteria included cases found to be suicides, accidents, or natural deaths after ancillary investigations, those awaiting toxicology or histology results without supportive homicide evidence, decomposed or skeletonized cases without supportive history or findings, non-viable abandoned foetuses under 26 weeks, and cases with pending post-mortem report finalizations for any reason. Data was extracted from the department's electronic database using the National Injury Mortality Surveillance System (NIMSS) data collection form, which is attached to every post-mortem case. This form includes information such as gender, race, age, SAPS location, scene of injury, date and time of death, and apparent manner of death, assisting in the initial sorting by inclusion criteria. The researcher then used post-mortem reports, docket identification forms, and the death register to fill in any missing or incomplete information from the NIMSS form. Docket information for each case at the Garankuwa mortuary is securely stored in an access-controlled, locked storeroom. Each docket includes a NIMSS form, post-mortem report, autopsy scribe notes, supporting information regarding the deceased's history and identity, and results from ancillary investigations. After identifying inclusion cases, the researcher began the exclusion process as data collection proceeded. The annual death registers and post-mortem reports were manually reviewed by the researcher to determine the cause of death, affected body regions, and the number of inflicted wounds. Data capture involved extracting information from the database, the death register, and post-mortem reports. The researcher used a data collection sheet to capture this information electronically in Microsoft Excel (Microsoft Office 365) and IBM SPSS statistical software for subsequent analysis. This approach helped in ensuring that the study's findings were robust, reliable, and reflective of the femicide trends in the Northwest Tshwane region over the specified period. Results Table 1 Number and incidence rates of femicides per population of North West Pretoria. Year of study Total no. of bodies admitted to Garankuwa FPS Total female bodies admitted to Garankuwa FPS Total Estimate Female population of North west Pretoria (Region 1) Total of femicides in North West Pretoria Femicide incidence per 100,000 population in North West Pretoria 2009 1186 259 366,338 59 16.1 2010 2090 263 378,206 56 14.8 2011 1026 255 390,674 53 13.6 2012 1016 259 402,977 35 8.6 2013 1045 272 414,734 54 13.0 2014 1157 274 426,139 36 8.4 2015 1167 268 437,201 40 9.1 2016 1237 283 448,027 49 10.9 2017 1172 266 458,885 41 8.9 2018 1219 264 469,558 42 8.9 Average 1131 266 419,273 46.5 11.23 Regarding Table 1 above, the totals obtained for North Western Pretoria female population were estimated by multiplying Tshwane population by the average percentage of Region 1 (27%) and then by the 0.5 to estimate female population. It shows that there was an estimated annual average population of 419,273 females in the in the North west area of Tshwane serviced by Garankuwa mortuary. This figure represents about 50.5% of the population of the entire North western Tshwane region during the study period [ 10 ]. During the ten-year study period, Table 1 further shows an annual average of 1131 bodies were admitted at the Garankuwa mortuary, of which an overall average of 266 bodies were female. Of all the female bodies admitted to Garankuwa mortuary over this period, an average of 17.5% (46.5 bodies) were noted to be femicides. A relatively stable trend of the number of femicides was noted during this study period, with the highest number in 2009 (59 bodies) and the lowest in 2012 (35 bodies). Table 1 also shows that the average incidence of femicides in the North Western region of Tshwane was 11.23/100,000 female population over the study period. A declining trend was noted with regard to this incident rate over the 10-year study period, except for an outlying increase in 2013 (13.0/100 000) and 2016 (10.9/100 000); with the highest incidence in 2009 (16.1/100 000) and lowest in 2012 (8.6/100 000). Figure 1 above shows that the youngest victim was a newborn (1 case) and the oldest was 88 years of age (with 5 cases having undocumented ages). The median age was 44. The highest age groups of femicides in this study were in the age group 30–39 years old, 36.6% (n = 170), closely followed by group 18–29 (n = 143, 30.8%), the 15-17yo (n = 60, 12.9%) and 40–49 (n = 55, 11.8%). These 4 age groups accounted for 92% of all femicides during the study period. Figure 1 further shows that child femicide age group (0–17-year-old) accounted for 15.9% of all femicides (n = 74), adults (18–64-year-old) accounted for 81.7% of all femicides (n = 378) and the elderly (over 65 years old) accounted for 2.4% of all femicides (n = 13). The highest age group (18–39 years old) accounted for 67.3% of all femicides. With regards to race distribution, the majority of cases in this study were black at 97.2%, followed by white at 2% and other races at 0.8%. The most common month of Femicide occurrences was December (3 of the 10 years) and September (2 of the 10 years), with January (3 of the 10 years) and July (3 of the 10 years) equally being the least common month. The areas where the bodies were mostly recovered, showed to be highest in the home (40.2% of all cases), followed by residential area (19.2% of all cases), then from a medical facility (7% of all cases). Figure 2 above shows that 25 cases did not have a SAPS station, giving the total of 441 cases analyzed. The top three SAPS stations where the most femicides occurred were Temba 24.0% (n = 105), followed by Rietgat 15.0% (n = 66), lastly Akasia 13.6% (n = 60). Therefore, Temba SAPS accounted for the highest femicides during the study period. The “other” category showed a high number of cases, as over 30 SAPS stations were represented in this category. Figure 3 above shows that of the total number of cases, 95% (n = 442) had confirmed causes of death. The other 24 cases were missing or undocumented. It can also be seen that the majority of victims died from gunshot injuries, accounting for 32.1%, (n = 142) of cases, followed by blunt force injuries (24.7%, n = 109) and sharp force trauma (21.7%, n = 96). Strangulation deaths accounted for 11.7% (n = 52) of cases, followed by asphyxia-related deaths accounting for a total of 4.7% (n = 21) of cases. The remaining causes (burns, drowning, other, unknown) accounted for 5.0% (n = 22) of cases. Figure 4 above shows the top five most common methods of death for the above mentioned 442 cases (Fig. 3 ). There is a relatively consistent linear trend of gunshot wound (GSW) related femicides over the 10-year study. Figure 4 also shows a sharp increase in sharp wound killings in 2013, with a relatively constant trend over the study period. Strangulation related killings showed a consistent trend, except for 2010, sharply peaking, and then returning to a stable trend. There was no other remarkable change in trends of blunt force or asphyxial related killings over the study period. Figure 5 below shows that the top 3 highest regions of the body involved was the head with 34% (n = 160), followed by neck 31% (n = 144), and chest at 17% (n = 81). Facial injuries accounted for 1% (n = 9) and anogenital injuries accounted for 0.6% (n = 3) of bodies. The remainder of regions involved with unremarkable, however the “other” category accounted for 6% (n = 30), which included multiple regions / mass regions involved. In Fig. 6 below, the top 4 SAPS locations showing the top 5 methods of death accounted to 247 cases, which represents 56% of all the SAPS stations in this study. Temba SAPS overall showed the highest number of deaths in all the top 5 methods of deaths. Temba SAPS and Rietgat SAPS showed the highest number of GSW deaths, totaling to a combined value of 56% (n = 52) out of the top SAPS locations. After Temba (n = 18), Akasia SAPS showed a similarly high number of blunt force femicides (n = 17). Interestingly, during this period, Temba SAPS showed the same amount of sharp force deaths as GSW (n = 26 in both circumstances). Temba (n = 15) and Akasia (n = 13) also showed the highest rates of strangulation deaths. Figure 7 below shows that the highest region of killing to the head was GSW (n = 73) accounting for 58% of GSW related deaths to the top three regions. This was followed by GSW to the chest region with 30% (n = 37) of GSW related deaths to the top three regions involved. Figure 7 also shows that blunt force injury was notably highest to the head region with 78% (n = 67) of the top three regions involved in blunt force killings. Notably, Fig. 7 below also showed that sharp force injury to the neck was the highest region involved, accounting for 46.3% (n = 45), closely followed by the chest at 40% (n = 39) out of the top three regions involved in sharp force injuries. The neck was the main region of strangulation related deaths in almost all cases, accounting for 92% (n = 59) as compared to the other top three regions involved in strangulation deaths. Figure 8 above shows that of the 442 victims mentioned in Fig. 3 , just over half (55%, n = 243) victims died from single injuries while 40% (n = 177) suffered multiple injuries. The primary medical cause of death was unknown in 5% (n = 22) of cases. Discussion Previous data does not point to specific causes of femicides, but the discussion rather emphasizes the risk factors associated with femicides. Women’s biological factors like age, race and personal history (pregnancy, socio- economic and marital status) all increase the risk of violent fatalities [ 4 ]. In South Africa, specific community issues like women's isolation, poverty and unemployment play a significant role in increasing the risk of VAW [ 11 ]. This study aimed to explore the epidemiology and pathology of femicides in the north-western region of Pretoria over a ten-year period. The findings have provided significant insights into the demographic characteristics, methods of death, and trends over time, aligning with and expanding upon previous research. Age is an important factor in analyzing the risk of femicide victims [ 12 ]. This study revealed a median age of femicide victims at 44 years, with the majority (67.3%) being between 18–39 years old. This aligns with Abrahams et al. (2022), who reported a stable mean age of femicide victims in South Africa at 37.7 years [ 13 ]. This also aligns with the findings of three national mortuary-based retrospective South African studies (2001) from data from 1999–2017, that showed the most pronounced femicide age ranged 30 to 44 years old [ 14 ]. This is also in keeping with a ten-year retrospective Cape Town based, South African study (2016), which showed that adult femicide victims had a median age of 41 years, with those aged between 18–39 years old being most affected; accounting for the majority (71%) of cases [ 1 ]. Interestingly, Wen-Li Fong et al (2016) reports a majority femicide age incidence of 30–49 year-old in Taiwan [ 9 ], slightly older than this studies results. Racial composition showed an overwhelming majority of victims being Black (97.2%), reflecting the demographic distribution of the region and possibly indicating socio-economic vulnerabilities. According to the 2011 South African Census, there were around 75.40% black, 20.08% white, 2.01% colored and 1.84% Indian people living within the borders of Tshwane [ 15 ]. When looking at this incidence with regard to race distribution, a 1999 National femicide South African study showed that the femicide rate of a colored woman was double (18.3 / 100 000) than that of an African woman (8.9 / 100 000), and six times that of a white woman [ 1 ]. Molefe et al further reported that African and Colored femicide victims accounted for almost equal proportions of 46.9% and 45.7% of their Cape Town based study, respectively. The minority of victims in her study were white and Asian, in keeping with the demographical distribution of race in that study sample [ 1 ]. It is important to note, according to Campbell et al (2003), that race is not independently linked to an increased risk of femicide rate, but that it is rather linked to socio-economic status [ 15 ]. This study showed an average incidence rate of 11.23/100 000 in North West Tshwane area, which is on par with the last reported South African national femicide rate of 11.2/100 000 in 2017 [ 5 ]. This average femicide rate of 11.23/100 000 is significantly higher than the United States in 2011, reporting a femicide incidence rate of 4.7 / 100,000 women [ 7 ]. This study also observed a general decline in femicide incidence rates over the ten-year period, from 16.1/100,000 in 2009 to 8.9/100,000 in 2018. This is in line with the findings of three national mortuary-based retrospective South African which reported a decrease trend in the femicide rate from 1999 (24.7/100 000) to 2017 (11.2 /100 000) [ 5 , 13 ]. Molefe el al showed similar trend results, with an average femicide incidence rate of 12.4/100,000 in her Cape Town based ten-year study (between 2000 and 2009), showed no significant annual differences [ 1 ]. Interestingly, this study showed an outlying increase in 2013 and 2016 was noted, which may warrant further investigation to understand the underlying causes. Internationally, between 2010 and 2021, Europe witnessed an average reduction in femicide rates (by 19%), with the Americas recording an average increase over the same period (by 6%) [ 3 ]. Research in Africa between 2010 and 2019, unfortunately showed South Africa to consistently be the leading country of femicide rates on the continent [ 16 ]. When focusing on circumstances surrounding femicides, Molefe et al showed that the highest number of cases occurred in July (9.9%), followed by November and December (similar percentages of 9.5%) in Cape Town. It furthermore showed that femicide numbers were similar across the months of February, April and June (percentages ranging between 7.6% and 7.7%) with the lowest being in January (5.6%) [ 1 ]. In investigating other demographic risk factors in South Africa, it is important to note that each municipal area is allocated the local South African Police Service (SAPS) station according to the Theoretical Human Resource Requirement (THRR). The SAPS stations are therefore an accurate predictor of the geographic locations, and for some areas can furthermore be an indirect predictor of the victims' socio-economic profile [ 17 ]. A Cape Town based study showed that vast majority of femicide victims (30.8%) died in medical centers from 2006 to 2016. Furthermore, other common locations noted in the same Cape Town study showed victim's homes (10.6%), victim's formal housing (9.3%), urban public roads (8.3%) and 4.9% of victims were found in open land [ 1 ]. This study showed that the highest time of death was from 00h00 to 03h59 (63.2%), followed by 20h00 to 00h59 (15,7%). This similarly corresponds a Cape Town based study, showing that over one third of femicide cases occurred in the late night hours to early morning hours, with the most prevalent killing period being between 20h00 and 00h00 [ 1 ]. No other data on timing of femicides, both locally and internationally, was found at the time of this study. Understanding the epidemiological and demographic variables in femicide victims is important, but what data is available regarding the pathology of these femicide victims? This study found gunshot wounds (GSWs) to be the most common method of femicide, followed by blunt force trauma and sharp force injuries. This was consistent with the South African Firearms Control Briefing (2022), which reported an increase in firearm-related femicides from 17.3% in 2009 to 21.8% in 2017 [ 5 , 13 ]. Similarly, in 2008, a 13-year retrospective South African study showed that the majority cause of death of femicide cases was also gunshot wounds (80%), followed by sharp objects (14%), and lastly blunt objects (11%) [ 18 ]. Alarmingly, firearms are also regarded the most common weapons used in femicides in USA [ 7 ]. Furthermore this study observed a relatively consistent linear trend in GSW’s over the study period, differing from Molefe et al. (2016), who reported a declining rate of gun-related femicide numbers between 2000 and 2009, by a total of 66.7% [ 1 ]. This study showed sharp force as the third highest manner of death, with a relatively stable trend over the 10 year period, with a sharp spike in 2013. Similarly, the South African follow up femicide study reported a steady trend in stab related femicide deaths between 1999 (32.7%) and 2009 (33.4%) [ 13 ]. Molefe el al (between 2000 and 2009) showed a similar linear trend of stab injuries as causes of femicide death, during her ten-year Western Cape study [ 1 ]. Previous femicide studies have also reported strangulation to the neck as a very common form of interpersonal VAW, as it is a very personal region of the body [ 19 ]. Wen-Li Fong et al found that strangulation /smothering, followed by sharp force injuries, to be the most frequent causes of death in a Taiwanese based study [ 8 ]. Violent asphyxias were notably found in 27.3% of femicides in a 2012 Egyptian study, mostly by throttling and strangulation alone or a combination of both [ 20 ]. This study showed that only 11.7% of femicides were strangulation related, being the fourth highest method of death. A Western cape, South African study of femicides showed that a vast majority (35.7%) of victims died from asphyxial deaths, including strangulation [ 1 ]. Previous femicide studies also indicated that the location of the head and neck, being the most common injury site [ 19 ]. This study showed that the head, neck, and chest were the primary regions involved in fatal injuries, with GSWs predominantly affecting the head and chest. This pattern is supported by previous studies, such as the Taiwanese study by Wen-Li Fong et al., which also highlighted the neck and face as common sites of injury in femicides [ 8 ]. No other body location with manner of death data was found at he time of the study. Conclusion This study demonstrates the high incidence and specific characteristics of femicides in the North West area of Tshwane. The data results corroborate the introduction's emphasis on the prevalence of firearm and sharp instrument use in these homicides and highlight significant geographic disparities in femicide rates. The consistent injury patterns identified important forensic insights and underscore the need for targeted public health and law enforcement interventions. By addressing these specific areas, it is possible to make strides in reducing the incidence of femicide and improving the safety and well-being of women in this region. This study proves useful, as government initiatives like the National Strategic Plan on Gender Based Violence and Femicide launched in 2020 by the Department of Women, Youth and Persons with Disabilities, are using a more evidence-based GBV prevention approach [ 21 ]. Future research should continue to monitor these trends and evaluate the effectiveness of implemented interventions. Additionally, exploring the socio-economic and cultural factors contributing to femicide could offer deeper insights into prevention strategies. The findings of this study underscore the urgent need for comprehensive approaches to tackle the persistent and deadly issue of femicide in South Africa. Declarations Consent for publication Permission from the CEO of Forensic Pathology Services and Head of department of Garankuwa FPS has been approved. No consent is required from the relatives as the autopsy is caried out in terms of the Inquests Act (no.58 of 1959) and is directed towards public good. Availability of data and materials Confidentiality of data information was maintained, as all post-mortem reports and files were kept in an access-controlled room during data selection and collection. The data collected and captured is stored on an access-controlled password protected device. Access to information about individual participants is restricted to the researcher only. Declaration of interests: I have nothing to declare. ETHICS APPROVAL: Ethics clearance certificate granted by Sefako Makgatho University Research Ethics Committee (SMUREC) and and the Preclinical Sciences (School of medicine) Research Ethics Committee (SREC), with protocol number SMUREC/M/372/2023: PG. COMPETEING INTERESTS: None. FUNDING: None. AUTHORS CONTRIBUTIONS: Dr Y Bismilla, the reasearcher, performed the structuring of the protocol and carried out all aspects of the research process, under the guidance and supervision of Dr KK Hlaise, and co-supervisor Dr C van Wyk. ACKNOWLEDGMENTS The author thanks Dr K. K. Hlaise and Dr C van Wyk for their constant support and advice during this study, as well as all his colleagues (fellow doctors and forensic officers) who participated in data collection. The author also thanks Mr J Loots and the reviewers for their invaluable contributions. References Molefe I. 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Department of Statistics, Ministry of Health and Welfare, ROC. Taiwan. 2017. http://www.mohw.gov.tw Abrahams N et al. Decrease in femicide in South Africa: three national studies across 18 years. Research Brief. Pretoria: South African Medical Research Council. [Cited March 8 2022]. https://www.samrc.ac.za/sites/default/files/attachments/2022-09/DecreaseFemicideSouthAfricaResearchBrief.pdf Jewkes R, Penn-Kekana L, Levin J, Ratsaka M, Schrieber M. Prevalence of emotional, physical and sexual abuse of women in three South African provinces. S Afr Med J. 2001;91(5):421–8. PMID: 11455808. Campbell JC, Webster D, Koziol-McLain J, Block C, Campbell D, Curry MA, Gary F, Glass N, McFarlane J, Sachs C, Sharps P, Ulrich Y, Wilt SA, Manganello J, Xu X, Schollenberger J, Frye V, Laughon K. Risk factors for femicide in abusive relationships: results from a multisite case control study. Am J Public Health. 2003;93(7):1089–97. 10.2105/ajph.93.7.1089 . PMID: 12835191; PMCID: PMC1447915. Femicide, its causes and recent trends: What do we know? Consuelo, CORRADI, Full Professor of Sociology, University LUMSA, Italy. Brussels © European Union, Online.). https://www.europarl.europa.eu/RegData/etudes/BRIE/2021/653655/EXPO_BRI(2021)653655_EN.pdf Author unknown. Commission of Inquiry into Allegations of Police Inefficiency and a Breakdown in Relations between SAPs and the Community in Khayelitsha. Report. Cape Town, 5A: August 2014. [cited 2014, Dec,24]. Mathews S, Abrahams N, Jewkes R, Martin LJ, Lombard C, Vetten L. Intimate femicide-suicide in South Africa: a cross-sectional study. Bull World Health Org. 2008;86:552–8. Au KI, Beh SL. Injury patterns of sharp instrument homicides in Hong Kong, Forensic Sci. Int. 2011. 201–4. Kotb NA, Ibrahim SF. Violent deaths of pregnant women in Egyptian governorates of Cairo and Giza. J Forensic Leg Med. 2018;60:25–9. 10.1016/j.jflm.2018.09.003 . Epub 2018 Sep 7. PMID: 30223232. Shai N, Ramsoomar L, Abrahams N. Femicide Prevention Strategy Development Process: The South African Experience. Peace Rev. 2022;34(2):227–45. https://doi.org/10.1080/10402659.2022.2049001 . Additional Declarations No competing interests reported. Supplementary Files YBISMMEDABSTRACTBMCPublichealth.docx Cite Share Download PDF Status: Published Journal Publication published 29 Jan, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 25 Jul, 2024 Editor assigned by journal 24 Jul, 2024 Submission checks completed at journal 24 Jul, 2024 First submitted to journal 22 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4784491","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":331687793,"identity":"94738213-eb16-4435-a730-6ebccfe94f63","order_by":0,"name":"Yaseen Bismilla","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYPCCAzwMDIyNBx4w2DCAGcRqaTiQwJDGAGYQowVCJjAcRuLiAAbHjz988HHHHRn5aYeBttSct1vbDmQw1NhE49RyJsfYcOaZZzwGtxOBWo7dTt52BshgOJaW24BLy4EcNmnetsM8BtIgLWy3k80OABmMDYdxazn//Pnvv0At8rNBWv6dSzY7/5CAlhsJZsyMQC0MIIclth2wM7tBwBbJG2+MJXvboH5J7EtOMLvxEOQp3H7hO5/+8MPPtjv28rPTHz748M3O3uw8iFFjg1OLwgE0gUSwygQcykFAHt0sezyKR8EoGAWjYIQCADTPcxFKPkPwAAAAAElFTkSuQmCC","orcid":"","institution":"Sefako Makgatho Health Sciences University","correspondingAuthor":true,"prefix":"","firstName":"Yaseen","middleName":"","lastName":"Bismilla","suffix":""}],"badges":[],"createdAt":"2024-07-22 22:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4784491/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4784491/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-024-21059-7","type":"published","date":"2025-01-29T15:58:15+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":63312318,"identity":"dc55e2a2-d270-4046-a324-fb6fcb5c3618","added_by":"auto","created_at":"2024-08-26 20:38:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40377,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of femicides by age.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4784491/v1/11e15a882cf95bda03aae253.png"},{"id":63312317,"identity":"5ac438f0-2f07-4bca-adf0-5b45ad9cd43b","added_by":"auto","created_at":"2024-08-26 20:38:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":41968,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of femicides by SAPS location.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4784491/v1/430fbfb4e35779a842d0cdbc.png"},{"id":63312870,"identity":"ada442ee-9c97-4c55-b287-5f1611763b80","added_by":"auto","created_at":"2024-08-26 20:46:25","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":73849,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of femicides by methods of death.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4784491/v1/3c412b0cf8661b24a2a764cc.png"},{"id":63312321,"identity":"74dbdfb3-5669-44e4-8ec7-fe97104bcd77","added_by":"auto","created_at":"2024-08-26 20:38:26","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":130853,"visible":true,"origin":"","legend":"\u003cp\u003eTrends of the top five most common methods of death.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4784491/v1/3f630b3a00d1e45f2446e24c.png"},{"id":63313338,"identity":"82620035-1976-4220-a9dc-c78179acd6f1","added_by":"auto","created_at":"2024-08-26 20:54:26","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":60463,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of femicides by region of injury.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-4784491/v1/613ba01b3bef781810f11b79.png"},{"id":63312871,"identity":"19d15e8a-7882-4b10-8007-4c46a04857f1","added_by":"auto","created_at":"2024-08-26 20:46:26","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":37686,"visible":true,"origin":"","legend":"\u003cp\u003eTop five methods of death by SAPS location.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-4784491/v1/b8fd98b4e59700bf2f74edc3.png"},{"id":63312325,"identity":"0355532f-a821-4c9d-a0dd-af1954438bcb","added_by":"auto","created_at":"2024-08-26 20:38:26","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":36745,"visible":true,"origin":"","legend":"\u003cp\u003eTop three methods of death by region of injury.\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-4784491/v1/45c28310fad29d2e85cec957.png"},{"id":63312323,"identity":"adf0c1df-3cf2-41de-915f-af1a2f127021","added_by":"auto","created_at":"2024-08-26 20:38:26","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":349926,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of femicides by amount of primary causes of death.\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-4784491/v1/00ce04308207b5d4af19930f.png"},{"id":75351594,"identity":"3f48a3dc-a579-46ea-9021-362e823aca97","added_by":"auto","created_at":"2025-02-03 16:12:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1379923,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4784491/v1/b9a0fe99-dcae-4831-8940-687d46945747.pdf"},{"id":63312319,"identity":"b653226c-9605-40c5-8b70-c1bda7051609","added_by":"auto","created_at":"2024-08-26 20:38:25","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":17561,"visible":true,"origin":"","legend":"","description":"","filename":"YBISMMEDABSTRACTBMCPublichealth.docx","url":"https://assets-eu.researchsquare.com/files/rs-4784491/v1/eccd0dbbc143047aee705c1d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Silent witnesses: Unveiling the epidemic of femicides in Northwest Tshwane, South Africa – a decade of analysis.","fulltext":[{"header":"Introduction","content":"\u003cp\u003eViolence against women and adult femicides are critical medico-legal issues nationally and worldwide. The South African and international media constantly report on the murder of women. Year 2013 and 2014 in particular were populated by global media headlines involving the killing of two South African women namely Annene Booysen and model Reeva Steenkamp [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSouth Africa has one of the highest femicide rates in the world. High incidence rates of femicide have been recorded by the South African Police Service (SAPS) in their annual crime reports, with 989 women murdered during the 2021 to 2022 financial year, an alarming 14.1% increase from the previous financial year [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGender-based violence (GBV) refers to harmful acts directed at an individual or group of individuals based on their gender, and is primarily rooted in gender inequality, the abuse of power and harmful norms [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. GBV is an alarmingly increasing serious South African public health concern and international human rights issue [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eViolence against women (VAW) is defined as any act of gender-based violence that and encompasses physical, sexual, psychological, emotional and financial abuse to women. VAW specifically is the most common form of GBV [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is reported that worldwide, at least one in five women have been physically and/or sexually abused by a man or men at some point of their lifetime [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u0026ldquo;Femicide\u0026rdquo; refers to the intentional killings of women and girls, representing the lethal end point of multiple, overlapping, and interconnected forms of gender-based violence [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFemicide contravenes women's constitutional right to life as outlined in the International and Supreme laws of most countries, including South Africa [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The first National femicide study in South Africa was undertaken in 1999 and reported an incidence rate of 24.7/100,000 for women 14 years and older. This incidence rate is six times higher than the international rate of 4.0/100,000 population as estimated by the World Health Organization at the same time [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding the incidence of femicides, global figures differ from one country to another. The United States in 2011, reported a femicide incidence rate of 4.7 / 100,000 women, with a 22.4% femicide rate [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In Taiwan, Wen-Li Fong et al noted femicide rates to be slightly higher, accounting for 29.1% of all homicides in 2010 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the magnitude of deaths resulting from VAW nationally and globally, there are still gaps in data that undermine prevention efforts [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. There is limited research regarding femicides in the specific location of this study, providing such gaps in data. This study will help identify vulnerable women in the North-western District of Tshwane and assist in developing tools to implement a targeted, context-specific femicide prevention programs to protect women from the hazards of violence that threaten their lives in this area. Moreover, this study emphasizes the need for raising awareness about the scale of female violence in society.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study is a retrospective, cross-sectional descriptive analysis focusing on all deceased females admitted to the Garankuwa mortuary from January 1, 2009, to December 31, 2018, where the apparent manner of death was suspected to be homicidal. The Garankuwa mortuary, situated in the north-west of Pretoria near the township of Ga-Rankuwa, functions as a teaching facility for the Sefako Makgatho Health Sciences University.\u003c/p\u003e \u003cp\u003eThe mortuary handles an estimated 1200 autopsy cases per year. The north-western part of the City of Tshwane, which includes the areas of Akasia, Rosslyn, Pretoria North, Klipfontein, Ga-Rankuwa, Mabopane, Winterveld, and Soshanguve, as well as a rural zone in the west, has a population of approximately 997,000, making it the most populous region in the City of Tshwane.\u003c/p\u003e \u003cp\u003eThe study population was defined by inclusion and exclusion criteria. Inclusion criteria encompassed cases involving females or individuals of undetermined sex confirmed to be female at autopsy or through anthropological analyses in cases of severe decomposition. These cases also had a suspected initial manner of death categorized as homicide or unknown. Exclusion criteria included cases found to be suicides, accidents, or natural deaths after ancillary investigations, those awaiting toxicology or histology results without supportive homicide evidence, decomposed or skeletonized cases without supportive history or findings, non-viable abandoned foetuses under 26 weeks, and cases with pending post-mortem report finalizations for any reason.\u003c/p\u003e \u003cp\u003eData was extracted from the department's electronic database using the National Injury Mortality Surveillance System (NIMSS) data collection form, which is attached to every post-mortem case. This form includes information such as gender, race, age, SAPS location, scene of injury, date and time of death, and apparent manner of death, assisting in the initial sorting by inclusion criteria. The researcher then used post-mortem reports, docket identification forms, and the death register to fill in any missing or incomplete information from the NIMSS form.\u003c/p\u003e \u003cp\u003eDocket information for each case at the Garankuwa mortuary is securely stored in an access-controlled, locked storeroom. Each docket includes a NIMSS form, post-mortem report, autopsy scribe notes, supporting information regarding the deceased's history and identity, and results from ancillary investigations. After identifying inclusion cases, the researcher began the exclusion process as data collection proceeded. The annual death registers and post-mortem reports were manually reviewed by the researcher to determine the cause of death, affected body regions, and the number of inflicted wounds.\u003c/p\u003e \u003cp\u003eData capture involved extracting information from the database, the death register, and post-mortem reports. The researcher used a data collection sheet to capture this information electronically in Microsoft Excel (Microsoft Office 365) and IBM SPSS statistical software for subsequent analysis. This approach helped in ensuring that the study's findings were robust, reliable, and reflective of the femicide trends in the Northwest Tshwane region over the specified period.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumber and incidence rates of femicides per population of North West Pretoria.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear of study\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal no. of bodies admitted to Garankuwa FPS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal female bodies admitted to Garankuwa FPS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal Estimate Female population of North west Pretoria (Region 1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal of femicides in North West Pretoria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFemicide incidence per 100,000 population in North West Pretoria\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e366,338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e378,206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e390,674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e402,977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e414,734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e426,139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e437,201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e448,027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e458,885\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e469,558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAverage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1131\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e266\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e419,273\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e46.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e11.23\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e above, the totals obtained for North Western Pretoria female population were estimated by multiplying Tshwane population by the average percentage of Region 1 (27%) and then by the 0.5 to estimate female population. It shows that there was an estimated annual average population of 419,273 females in the in the North west area of Tshwane serviced by Garankuwa mortuary. This figure represents about 50.5% of the population of the entire North western Tshwane region during the study period [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDuring the ten-year study period, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e further shows an annual average of 1131 bodies were admitted at the Garankuwa mortuary, of which an overall average of 266 bodies were female. Of all the female bodies admitted to Garankuwa mortuary over this period, an average of 17.5% (46.5 bodies) were noted to be femicides. A relatively stable trend of the number of femicides was noted during this study period, with the highest number in 2009 (59 bodies) and the lowest in 2012 (35 bodies).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e also shows that the average incidence of femicides in the North Western region of Tshwane was 11.23/100,000 female population over the study period. A declining trend was noted with regard to this incident rate over the 10-year study period, except for an outlying increase in 2013 (13.0/100 000) and 2016 (10.9/100 000); with the highest incidence in 2009 (16.1/100 000) and lowest in 2012 (8.6/100 000).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e above shows that the youngest victim was a newborn (1 case) and the oldest was 88 years of age (with 5 cases having undocumented ages). The median age was 44. The highest age groups of femicides in this study were in the age group 30\u0026ndash;39 years old, 36.6% (n\u0026thinsp;=\u0026thinsp;170), closely followed by group 18\u0026ndash;29 (n\u0026thinsp;=\u0026thinsp;143, 30.8%), the 15-17yo (n\u0026thinsp;=\u0026thinsp;60, 12.9%) and 40\u0026ndash;49 (n\u0026thinsp;=\u0026thinsp;55, 11.8%). These 4 age groups accounted for 92% of all femicides during the study period. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e further shows that child femicide age group (0\u0026ndash;17-year-old) accounted for 15.9% of all femicides (n\u0026thinsp;=\u0026thinsp;74), adults (18\u0026ndash;64-year-old) accounted for 81.7% of all femicides (n\u0026thinsp;=\u0026thinsp;378) and the elderly (over 65 years old) accounted for 2.4% of all femicides (n\u0026thinsp;=\u0026thinsp;13). The highest age group (18\u0026ndash;39 years old) accounted for 67.3% of all femicides.\u003c/p\u003e \u003cp\u003eWith regards to race distribution, the majority of cases in this study were black at 97.2%, followed by white at 2% and other races at 0.8%. The most common month of Femicide occurrences was December (3 of the 10 years) and September (2 of the 10 years), with January (3 of the 10 years) and July (3 of the 10 years) equally being the least common month. The areas where the bodies were mostly recovered, showed to be highest in the home (40.2% of all cases), followed by residential area (19.2% of all cases), then from a medical facility (7% of all cases).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e above shows that 25 cases did not have a SAPS station, giving the total of 441 cases analyzed. The top three SAPS stations where the most femicides occurred were Temba 24.0% (n\u0026thinsp;=\u0026thinsp;105), followed by Rietgat 15.0% (n\u0026thinsp;=\u0026thinsp;66), lastly Akasia 13.6% (n\u0026thinsp;=\u0026thinsp;60). Therefore, Temba SAPS accounted for the highest femicides during the study period. The \u0026ldquo;other\u0026rdquo; category showed a high number of cases, as over 30 SAPS stations were represented in this category.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e above shows that of the total number of cases, 95% (n\u0026thinsp;=\u0026thinsp;442) had confirmed causes of death. The other 24 cases were missing or undocumented. It can also be seen that the majority of victims died from gunshot injuries, accounting for 32.1%, (n\u0026thinsp;=\u0026thinsp;142) of cases, followed by blunt force injuries (24.7%, n\u0026thinsp;=\u0026thinsp;109) and sharp force trauma (21.7%, n\u0026thinsp;=\u0026thinsp;96). Strangulation deaths accounted for 11.7% (n\u0026thinsp;=\u0026thinsp;52) of cases, followed by asphyxia-related deaths accounting for a total of 4.7% (n\u0026thinsp;=\u0026thinsp;21) of cases. The remaining causes (burns, drowning, other, unknown) accounted for 5.0% (n\u0026thinsp;=\u0026thinsp;22) of cases.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e above shows the top five most common methods of death for the above mentioned 442 cases (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). There is a relatively consistent linear trend of gunshot wound (GSW) related femicides over the 10-year study. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e also shows a sharp increase in sharp wound killings in 2013, with a relatively constant trend over the study period. Strangulation related killings showed a consistent trend, except for 2010, sharply peaking, and then returning to a stable trend. There was no other remarkable change in trends of blunt force or asphyxial related killings over the study period.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e below shows that the top 3 highest regions of the body involved was the head with 34% (n\u0026thinsp;=\u0026thinsp;160), followed by neck 31% (n\u0026thinsp;=\u0026thinsp;144), and chest at 17% (n\u0026thinsp;=\u0026thinsp;81). Facial injuries accounted for 1% (n\u0026thinsp;=\u0026thinsp;9) and anogenital injuries accounted for 0.6% (n\u0026thinsp;=\u0026thinsp;3) of bodies. The remainder of regions involved with unremarkable, however the \u0026ldquo;other\u0026rdquo; category accounted for 6% (n\u0026thinsp;=\u0026thinsp;30), which included multiple regions / mass regions involved.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e below, the top 4 SAPS locations showing the top 5 methods of death accounted to 247 cases, which represents 56% of all the SAPS stations in this study. Temba SAPS overall showed the highest number of deaths in all the top 5 methods of deaths. Temba SAPS and Rietgat SAPS showed the highest number of GSW deaths, totaling to a combined value of 56% (n\u0026thinsp;=\u0026thinsp;52) out of the top SAPS locations. After Temba (n\u0026thinsp;=\u0026thinsp;18), Akasia SAPS showed a similarly high number of blunt force femicides (n\u0026thinsp;=\u0026thinsp;17). Interestingly, during this period, Temba SAPS showed the same amount of sharp force deaths as GSW (n\u0026thinsp;=\u0026thinsp;26 in both circumstances). Temba (n\u0026thinsp;=\u0026thinsp;15) and Akasia (n\u0026thinsp;=\u0026thinsp;13) also showed the highest rates of strangulation deaths.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e below shows that the highest region of killing to the head was GSW (n\u0026thinsp;=\u0026thinsp;73) accounting for 58% of GSW related deaths to the top three regions. This was followed by GSW to the chest region with 30% (n\u0026thinsp;=\u0026thinsp;37) of GSW related deaths to the top three regions involved. Figure\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e also shows that blunt force injury was notably highest to the head region with 78% (n\u0026thinsp;=\u0026thinsp;67) of the top three regions involved in blunt force killings.\u003c/p\u003e \u003cp\u003eNotably, Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e below also showed that sharp force injury to the neck was the highest region involved, accounting for 46.3% (n\u0026thinsp;=\u0026thinsp;45), closely followed by the chest at 40% (n\u0026thinsp;=\u0026thinsp;39) out of the top three regions involved in sharp force injuries. The neck was the main region of strangulation related deaths in almost all cases, accounting for 92% (n\u0026thinsp;=\u0026thinsp;59) as compared to the other top three regions involved in strangulation deaths.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e above shows that of the 442 victims mentioned in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, just over half (55%, n\u0026thinsp;=\u0026thinsp;243) victims died from single injuries while 40% (n\u0026thinsp;=\u0026thinsp;177) suffered multiple injuries. The primary medical cause of death was unknown in 5% (n\u0026thinsp;=\u0026thinsp;22) of cases.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrevious data does not point to specific causes of femicides, but the discussion rather emphasizes the risk factors associated with femicides. Women\u0026rsquo;s biological factors like age, race and personal history (pregnancy, socio- economic and marital status) all increase the risk of violent fatalities [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In South Africa, specific community issues like women's isolation, poverty and unemployment play a significant role in increasing the risk of VAW [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aimed to explore the epidemiology and pathology of femicides in the north-western region of Pretoria over a ten-year period. The findings have provided significant insights into the demographic characteristics, methods of death, and trends over time, aligning with and expanding upon previous research.\u003c/p\u003e \u003cp\u003eAge is an important factor in analyzing the risk of femicide victims [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This study revealed a median age of femicide victims at 44 years, with the majority (67.3%) being between 18\u0026ndash;39 years old. This aligns with Abrahams et al. (2022), who reported a stable mean age of femicide victims in South Africa at 37.7 years [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This also aligns with the findings of three national mortuary-based retrospective South African studies (2001) from data from 1999\u0026ndash;2017, that showed the most pronounced femicide age ranged 30 to 44 years old [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This is also in keeping with a ten-year retrospective Cape Town based, South African study (2016), which showed that adult femicide victims had a median age of 41 years, with those aged between 18\u0026ndash;39 years old being most affected; accounting for the majority (71%) of cases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Interestingly, Wen-Li Fong et al (2016) reports a majority femicide age incidence of 30\u0026ndash;49 year-old in Taiwan [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], slightly older than this studies results.\u003c/p\u003e \u003cp\u003eRacial composition showed an overwhelming majority of victims being Black (97.2%), reflecting the demographic distribution of the region and possibly indicating socio-economic vulnerabilities. According to the 2011 South African Census, there were around 75.40% black, 20.08% white, 2.01% colored and 1.84% Indian people living within the borders of Tshwane [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen looking at this incidence with regard to race distribution, a 1999 National femicide South African study showed that the femicide rate of a colored woman was double (18.3 / 100 000) than that of an African woman (8.9 / 100 000), and six times that of a white woman [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Molefe et al further reported that African and Colored femicide victims accounted for almost equal proportions of 46.9% and 45.7% of their Cape Town based study, respectively. The minority of victims in her study were white and Asian, in keeping with the demographical distribution of race in that study sample [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is important to note, according to Campbell et al (2003), that race is not independently linked to an increased risk of femicide rate, but that it is rather linked to socio-economic status [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study showed an average incidence rate of 11.23/100 000 in North West Tshwane area, which is on par with the last reported South African national femicide rate of 11.2/100 000 in 2017 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This average femicide rate of 11.23/100 000 is significantly higher than the United States in 2011, reporting a femicide incidence rate of 4.7 / 100,000 women [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study also observed a general decline in femicide incidence rates over the ten-year period, from 16.1/100,000 in 2009 to 8.9/100,000 in 2018. This is in line with the findings of three national mortuary-based retrospective South African which reported a decrease trend in the femicide rate from 1999 (24.7/100 000) to 2017 (11.2 /100 000) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Molefe el al showed similar trend results, with an average femicide incidence rate of 12.4/100,000 in her Cape Town based ten-year study (between 2000 and 2009), showed no significant annual differences [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Interestingly, this study showed an outlying increase in 2013 and 2016 was noted, which may warrant further investigation to understand the underlying causes.\u003c/p\u003e \u003cp\u003eInternationally, between 2010 and 2021, Europe witnessed an average reduction in femicide rates (by 19%), with the Americas recording an average increase over the same period (by 6%) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Research in Africa between 2010 and 2019, unfortunately showed South Africa to consistently be the leading country of femicide rates on the continent [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen focusing on circumstances surrounding femicides, Molefe et al showed that the highest number of cases occurred in July (9.9%), followed by November and December (similar percentages of 9.5%) in Cape Town. It furthermore showed that femicide numbers were similar across the months of February, April and June (percentages ranging between 7.6% and 7.7%) with the lowest being in January (5.6%) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn investigating other demographic risk factors in South Africa, it is important to note that each municipal area is allocated the local South African Police Service (SAPS) station according to the Theoretical Human Resource Requirement (THRR). The SAPS stations are therefore an accurate predictor of the geographic locations, and for some areas can furthermore be an indirect predictor of the victims' socio-economic profile [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A Cape Town based study showed that vast majority of femicide victims (30.8%) died in medical centers from 2006 to 2016. Furthermore, other common locations noted in the same Cape Town study showed victim's homes (10.6%), victim's formal housing (9.3%), urban public roads (8.3%) and 4.9% of victims were found in open land [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study showed that the highest time of death was from 00h00 to 03h59 (63.2%), followed by 20h00 to 00h59 (15,7%). This similarly corresponds a Cape Town based study, showing that over one third of femicide cases occurred in the late night hours to early morning hours, with the most prevalent killing period being between 20h00 and 00h00 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. No other data on timing of femicides, both locally and internationally, was found at the time of this study.\u003c/p\u003e \u003cp\u003eUnderstanding the epidemiological and demographic variables in femicide victims is important, but what data is available regarding the pathology of these femicide victims? This study found gunshot wounds (GSWs) to be the most common method of femicide, followed by blunt force trauma and sharp force injuries. This was consistent with the South African Firearms Control Briefing (2022), which reported an increase in firearm-related femicides from 17.3% in 2009 to 21.8% in 2017 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Similarly, in 2008, a 13-year retrospective South African study showed that the majority cause of death of femicide cases was also gunshot wounds (80%), followed by sharp objects (14%), and lastly blunt objects (11%) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Alarmingly, firearms are also regarded the most common weapons used in femicides in USA [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Furthermore this study observed a relatively consistent linear trend in GSW\u0026rsquo;s over the study period, differing from Molefe et al. (2016), who reported a declining rate of gun-related femicide numbers between 2000 and 2009, by a total of 66.7% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study showed sharp force as the third highest manner of death, with a relatively stable trend over the 10 year period, with a sharp spike in 2013. Similarly, the South African follow up femicide study reported a steady trend in stab related femicide deaths between 1999 (32.7%) and 2009 (33.4%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Molefe el al (between 2000 and 2009) showed a similar linear trend of stab injuries as causes of femicide death, during her ten-year Western Cape study [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious femicide studies have also reported strangulation to the neck as a very common form of interpersonal VAW, as it is a very personal region of the body [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Wen-Li Fong et al found that strangulation /smothering, followed by sharp force injuries, to be the most frequent causes of death in a Taiwanese based study [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Violent asphyxias were notably found in 27.3% of femicides in a 2012 Egyptian study, mostly by throttling and strangulation alone or a combination of both [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This study showed that only 11.7% of femicides were strangulation related, being the fourth highest method of death. A Western cape, South African study of femicides showed that a vast majority (35.7%) of victims died from asphyxial deaths, including strangulation [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious femicide studies also indicated that the location of the head and neck, being the most common injury site [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This study showed that the head, neck, and chest were the primary regions involved in fatal injuries, with GSWs predominantly affecting the head and chest. This pattern is supported by previous studies, such as the Taiwanese study by Wen-Li Fong et al., which also highlighted the neck and face as common sites of injury in femicides [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. No other body location with manner of death data was found at he time of the study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates the high incidence and specific characteristics of femicides in the North West area of Tshwane. The data results corroborate the introduction's emphasis on the prevalence of firearm and sharp instrument use in these homicides and highlight significant geographic disparities in femicide rates. The consistent injury patterns identified important forensic insights and underscore the need for targeted public health and law enforcement interventions. By addressing these specific areas, it is possible to make strides in reducing the incidence of femicide and improving the safety and well-being of women in this region. This study proves useful, as government initiatives like the National Strategic Plan on Gender Based Violence and Femicide launched in 2020 by the Department of Women, Youth and Persons with Disabilities, are using a more evidence-based GBV prevention approach [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFuture research should continue to monitor these trends and evaluate the effectiveness of implemented interventions. Additionally, exploring the socio-economic and cultural factors contributing to femicide could offer deeper insights into prevention strategies. The findings of this study underscore the urgent need for comprehensive approaches to tackle the persistent and deadly issue of femicide in South Africa.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePermission from the CEO of Forensic Pathology Services and Head of department of Garankuwa FPS has been approved. No consent is required from the relatives as the autopsy is caried out in terms of the Inquests Act (no.58 of 1959) and is directed towards public good.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConfidentiality of data information was maintained, as all post-mortem reports and files were kept in an access-controlled room during data selection and collection. The data collected and captured is stored on an access-controlled password protected device. Access to information about individual participants is restricted to the researcher only.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI have nothing to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICS APPROVAL:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics clearance certificate granted by Sefako Makgatho University Research Ethics Committee (SMUREC) and\u0026nbsp;and the Preclinical Sciences (School of medicine) Research Ethics Committee (SREC),\u0026nbsp;with protocol number SMUREC/M/372/2023: PG.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOMPETEING INTERESTS:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHORS CONTRIBUTIONS:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr Y Bismilla, the reasearcher, performed the structuring of the protocol and carried out all aspects of the research process, under the guidance and supervision of Dr KK Hlaise, and co-supervisor Dr C van Wyk.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eACKNOWLEDGMENTS\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author thanks Dr K. K. Hlaise and Dr C van Wyk for their constant support and advice during this study, as well as all his colleagues (fellow doctors and forensic officers) who participated in data collection. The author also thanks Mr J Loots and the reviewers for their invaluable contributions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMolefe I. Violence against women: epidemiology and pathology of femicides and suspected sexual homicides in Cape Town: a 10-year follow-up study. 2016. University of Cape Town. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.academia.edu/78699208\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eSouth African Police Service. SAPS Annual Crime report, South Africa SAPS. 2022/2023. [Cited 2022, December]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.saps.gov.za/services/downloads/Crime-Statistics-2021_2022-latest.xlsx\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eGender-related killings of women and girls (femicide/feminicide). Global estimates of gender-related killings of women and girls in the private sphere in 2021 Improving data to improve responses. United Nations Office on Drugs and Crime (UNODC). 2022. Available from: Femicide_brief_Nov2022.pdf.\u003c/li\u003e\n\u003cli\u003eGibbons J. Vienns. United Nations Office on Drugs and Crimes. Global Study on Homicide 2013: Trends, Contexts, Data. 2013. [cited 2014, February 24].\u003c/li\u003e\n\u003cli\u003eWorld Health Organisation. Violence against Women, Definition and scope of the problem. July 1997. [cited 2014, March, 10]. . pdf.\u003c/li\u003e\n\u003cli\u003eCurrie I, De Waal J. The bill of rights handbook. Juta and Company Ltd; 2005.\u003c/li\u003e\n\u003cli\u003eFederal Bureau of Investigation, Uniform Crime Reports, Department of Justice, Washington, DC. 2011. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/ 2011/crime-in-the-u.s.-2011/violent-crime/murder\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eWen-Li F et al. Adult femicide victims in forensic autopsy in Taiwan: A 10-year retrospective study. 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.forsciint\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eEllsberg M, Jansen HAFM, Heise L, Watts CH, Garcia-Moreno C. Intimate partner violence and women's physical and mental health in the WHO multi-country study on women's health and domestic violence: an observational study. Lancet.371(9619): 1165\u0026ndash;72.\u003c/li\u003e\n\u003cli\u003eProfile. City of Tshwane. Department of Cooperative Governance and Traditional Affairs. 2 November 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cogta.gov.za/cgta_2016/wp-content/uploads/2023/11/2nd-Take_Final_DistrictProfile_TSHWANE2306-1-002.pdf\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eJewkes R. Intimate partner violence: causes and prevention. Lancet. 2002;359(9315):1423\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eDepartment of Statistics, Ministry of Health and Welfare, ROC. Taiwan. 2017. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.mohw.gov.tw\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eAbrahams N et al. Decrease \u003cem\u003ein\u003c/em\u003e femicide \u003cem\u003ein\u003c/em\u003e South Africa: three national studies across 18 years. Research Brief. Pretoria: South African Medical Research Council. [Cited March 8 2022]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.samrc.ac.za/sites/default/files/attachments/2022-09/DecreaseFemicideSouthAfricaResearchBrief.pdf\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eJewkes R, Penn-Kekana L, Levin J, Ratsaka M, Schrieber M. Prevalence of emotional, physical and sexual abuse of women in three South African provinces. S Afr Med J. 2001;91(5):421\u0026ndash;8. PMID: 11455808.\u003c/li\u003e\n\u003cli\u003eCampbell JC, Webster D, Koziol-McLain J, Block C, Campbell D, Curry MA, Gary F, Glass N, McFarlane J, Sachs C, Sharps P, Ulrich Y, Wilt SA, Manganello J, Xu X, Schollenberger J, Frye V, Laughon K. Risk factors for femicide in abusive relationships: results from a multisite case control study. Am J Public Health. 2003;93(7):1089\u0026ndash;97. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2105/ajph.93.7.1089\u003c/span\u003e\u003c/span\u003e. PMID: 12835191; PMCID: PMC1447915.\u003c/li\u003e\n\u003cli\u003eFemicide, its causes and recent trends: What do we know? Consuelo, CORRADI, Full Professor of Sociology, University LUMSA, Italy. Brussels \u0026copy; European Union, Online.). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.europarl.europa.eu/RegData/etudes/BRIE/2021/653655/EXPO_BRI(2021)653655_EN.pdf\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eAuthor unknown. Commission of Inquiry into Allegations of Police Inefficiency and a Breakdown in Relations between SAPs and the Community in Khayelitsha. Report. Cape Town, 5A: August 2014. [cited 2014, Dec,24].\u003c/li\u003e\n\u003cli\u003eMathews S, Abrahams N, Jewkes R, Martin LJ, Lombard C, Vetten L. Intimate femicide-suicide in South Africa: a cross-sectional study. Bull World Health Org. 2008;86:552\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eAu KI, Beh SL. Injury patterns of sharp instrument homicides in Hong Kong, Forensic Sci. Int. 2011. 201\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eKotb NA, Ibrahim SF. Violent deaths of pregnant women in Egyptian governorates of Cairo and Giza. J Forensic Leg Med. 2018;60:25\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jflm.2018.09.003\u003c/span\u003e\u003c/span\u003e. Epub 2018 Sep 7. PMID: 30223232.\u003c/li\u003e\n\u003cli\u003eShai N, Ramsoomar L, Abrahams N. Femicide Prevention Strategy Development Process: The South African Experience. Peace Rev. 2022;34(2):227\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/10402659.2022.2049001\u003c/span\u003e\u003c/span\u003e.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gender based violence, femicides, medico-legal mortuary, forensic medicine, community-based violence prevention, epidemiology, demographics, pathology","lastPublishedDoi":"10.21203/rs.3.rs-4784491/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4784491/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFemicides, defined as the gender-based killing of women, are a pressing public health issue worldwide, with South Africa experiencing some of the highest rates globally. This study focuses on the North West region of Tshwane, particularly the Garankuwa area, aiming to address gaps in understanding the epidemiology, demographics, circumstances, and pathology associated with femicides. The Garankuwa mortuary serves as the primary site for this investigation, providing a detailed analysis over a ten-year period.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThe study had four main objectives: to analyse the demographics and incidence rates of femicides in the Northwest Tshwane area, to examine the circumstances surrounding femicides (including the time, location, and demographic risk factors), to identify the causes and pathological characteristics of femicides; and to observe trends in femicide rates over the ten-year study period.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study was a retrospective cross-sectional descriptive analysis, focusing on all deceased females admitted to the Garankuwa mortuary from 2009 to 2018. The inclusion criteria comprised female cases at autopsy, with a suspected homicidal manner of death. Cases that were later identified as suicides, accidental, or natural deaths following ancillary investigations were excluded. Data was meticulously collected from various sources, including the National Injury Mortality Surveillance System (NIMSS), death registers, post-mortem reports, and police docket information.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOver the ten-year period, the Garankuwa mortuary admitted an annual average of 1131 bodies, with approximately 23.5% (266) being female. Of these, 17.5% were identified as femicides. The average incidence rate of femicides was 11.2 per 100,000 female population, showing a general decline over the study period, except for notable increases in 2013 and 2016. The study found that the most common months for femicides were September and December, with most incidents occurring at home, followed by residential areas and medical facilities. The geographic analysis identified Temba, Rietgat, and Akasia as the areas with the highest number of femicide cases. Demographically, the majority of femicide victims were black, with the most affected age group being 18\u0026ndash;39 years. The leading causes of death were gunshot wounds, sharp force injuries, and blunt force trauma, with significant incidences of strangulation and asphyxial deaths, primarily affecting the neck and head regions.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study highlights the severity of femicides in the Northwest Tshwane region, confirming specific characteristics and trends that align with national patterns. The findings emphasize the necessity for targeted prevention programs, stricter firearm control measures, and community-based violence prevention strategies. The demographic data indicate that young black women are particularly vulnerable, necessitating protective and educational initiatives tailored to this group.\u003c/p\u003e","manuscriptTitle":"Silent witnesses: Unveiling the epidemic of femicides in Northwest Tshwane, South Africa – a decade of analysis.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-26 20:38:21","doi":"10.21203/rs.3.rs-4784491/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-25T11:42:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-24T12:44:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-24T12:43:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-07-22T22:13:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ed5d652-1849-44f8-8e44-ddca9f347e44","owner":[],"postedDate":"August 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-03T16:07:32+00:00","versionOfRecord":{"articleIdentity":"rs-4784491","link":"https://doi.org/10.1186/s12889-024-21059-7","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-01-29 15:58:15","publishedOnDateReadable":"January 29th, 2025"},"versionCreatedAt":"2024-08-26 20:38:21","video":"","vorDoi":"10.1186/s12889-024-21059-7","vorDoiUrl":"https://doi.org/10.1186/s12889-024-21059-7","workflowStages":[]},"version":"v1","identity":"rs-4784491","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4784491","identity":"rs-4784491","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}