PROTOCOL: Risk factors for femicide

Femicide is the killing of women, girls and baby girls because of their gender. Femicide is the violent death of women based on gender, whether it occurs within the family, a domestic partnership, or any other interpersonal relationship; in the community, by any person, or when it is perpetrated or tolerated by the state or its agents, by action or omission (OAS 2008). Femicide constitutes a violation of women's rights and can be understood as, the ultimate form of violence against women, which ends in the killing of a woman or women affected. The term femicide was used since 1976 by the sociologist Diana Russell, with the objective of emphasizing differences in the characteristics of the women and men homicides (Russell, 2011). Femicide became frequently used in academic research, epidemiology, public health, politics, social science, laws, policy making even several conceptual theories that have been expanded through observational epidemiological studies. The concept of femicide could be too confusing and too broad because of the gender component. International researchers have made efforts to investigate about femicide concept (Sanz-Barbero et al., 2016). Aware of the importance of a clear and operational definition of femicide for data analysis and monitoring systems, an extended definition of femicide taking into account the cultural aspects and the possibility of the women act as aggressor and commit femicide. Femicide could be perpetrated by intimate partners, family members, and in rare occasions the perpetrators can be women either lesbian partners or kin (Weil et al., 2018; WHO, 2012). Then, the most recent definition of femicide is: The killing of a woman because some man or men, although occasionally also some women who accept menʼs values, has or have sentenced her to death adducing whatever reasons, motives or causes, but nonetheless actually and ultimately because he or they believe she has defied (the words they often use are “offended” or “insulted”) patriarchal order (in their words “honourable” societies) beyond what her judge (often but not always the same person who kills her) is prepared to tolerate without retaliating in that way (Grzyb et al., 2018; Iranzo, 2015). Femicide is used in general for conceptualized forms of discrimination and violence against women when it is present an unequal power distribution, sometimes with government complicity and as a result of a cultural constructions. Femicide was translated to Spanish as feminicide and it is used in Latin American countries for the characterization of the cases and in laws. In this review, we will use the terms femicide and feminicide as synonyms. Killing of women based on this gender is a global issue. There are cases in all countries in the world, they are tolerated, accepted, justified and could remain unpunished (ACUNS, 2014; Sarmiento et al., 2014). The killing of a woman by her partner is often the culmination of long-term violence and can be prevented (UNODC, 2019). Women are killed with firearms, knives, or brute force, depending on the circumstances of the incident, the type of perpetrator, and other contextual factors, such as the presence of firearms in the home (Geneva Declaration Secretariat, 2015). Estimates accounts for 137 women killed in the world daily by a family member (UNODC, 2019). Even though men are the principal victims of lethal violence, women continue to bear the heaviest burden as a result of gender stereotypes and inequality. Across the world, in rich and poor countries, in developed and developing regions, a total of 50,000 women per year are killed by their current and former partners, fathers, brothers, mothers, sisters, and other family members because of their role and status as women (UNODC, 2019). Several types of gender-related killings of women have been identified: intimate femicide, non-intimate femicide, child femicide, family femicide, femicide because of association/connection, unorganized systematic sexual femicide, organized systematic sexual femicide, femicide because of prostitution or stigmatized occupations, femicide because of trafficking, femicide because of smuggling, transphobic femicide, lesbophobic femicide, racist femicide and femicide because of female genital mutilation (Sarmiento, 2014). Also can be included femicide for accusations of sorcery/witchcraft, dowry deaths and female selective abortions. All of them have a gender component. Gender-related killings are the extreme manifestation of existing forms of violence against women. Such killings are not isolated incidents that arise suddenly and unexpectedly, but represent the ultimate act of violence which is experienced in a continuum of violence (United Nations, 2012). Femicide is the result of multiple, increasing and continuous manifestations of violence, which are rooted in the historical unequal power relations between men and women and in the systemic gender-based discrimination, supported by pseudo-social values, cultural patterns and practices (ACUNS, 2014). Several risk factors have been identified related to a woman being victim of femicide: prior domestic violence, gun access, estrangement, threats to kill and threats with a weapon, nonfatal strangulation, and stepchild in the home if a female victim. Other risks included stalking, forced sex, and abuse during pregnancy (Campbell et al., 2003). Individual factors: young age, heavy drinking, depression, personality disorders, low academic achievement, low income, witnessing, or experiencing violence as a child, being abused during childhood, absent, or rejecting father. Relationship factors: marital conflict, marital instability, male dominance in the family, economic stress, poor family functioning, isolation of the woman from her family. Community factors: weak community sanctions against domestic violence, poverty, unemployed, low social capital, delinquent peer association. Societal factors: traditional/rigid gender norms/roles, social norms supportive of violence, sense of ownership over women. The analysis of violence phenomena must recognize the influence of cultural factors constructed around the roles and behavior of men and women and the diminished power of women explained by lack of access to resources. The pursuit of a single explanatory factor is inadequate. Approximations as intersectionality (Sosa, 2017) and the ecological frameworks/model have been applied to conceptualized violence against women integrating individual, situational/relationship, exosystem/community, and macrosystem/societal factors (Heise, 1998; Krug et al., 2002) or theoretical approaches (Corradi et al., 2016). There are several risk factors for femicide as mentioned above, the major one intimate partner homicide is prior domestic violence (Campbell et al., 2007). Evidence indicates that the majority of gender motivated killings of women are perpetrated by intimate partners or close family members (UNODC, 2011). Women are 9 times as likely to be killed by an intimate partner (husband, boyfriend, same-sex partner, or ex) than by a stranger (Campbell et al., 2007). Globally, as many as 38% of all murders of women are committed by intimate partners (WHO 2013). Home is the most likely place for a woman to become a victim of homicide (UNODC, 2011). Women are often emotionally involved and economically dependent on those who victimize them contributing to the perpetuation and acceptance of violence (Ellsberg et al., 2000; Krug et al., 2002). In general, various types of abuse coexist, for example, sexual, physical, economical, moral, patrimonial, and psychological abuse. Manifestations of violence increase with time and become more severe causing the death of the woman. Not all the femicides occur in this context, but most of them do. The median time that women spend in a violent relationship is around 5–10 years depending on the womanʼs age. Justifications to continue in a violent relationship include fear of retribution, lack of alternative means of economic support, concern for children, emotional dependence, a lack of support from family or friends, an abiding hope that the abusive man will change, and the stigmatization associated with being unmarried (Ellsberg et al., 2000; Krug et al., 2002). A womanʼs response to abuse is often limited by the options available to her, having into account the lack of positive response of society. Traditional societies defend menʼs rights of physically punishing their wives based on cultural and religious justifications (Ellsberg et al., 2000; Krug et al., 2002). Violence against women have several and deep overall consequences. Abusive partner relationships have deep impact on womenʼs health (physical, sexual, reproductive, physiological, behavioral, and fatal health consequences (United Nations, 2015)). Fatal health consequences could be: AIDS-related mortality, maternal mortality, femicide and forced suicide (Krug et al., 2002). The resulting damage also extends its impacts on the health of children. In fact, children may suffer a range of behavioral and emotional disturbances, included psychological, social, physical, and academic consequences e.g., post-traumatic stress, attachment difficulties, weight and appetite changes, and drops in school grades (Alisic et al., 2015). The experience of violence episodes during childhood can be associated with perpetrating or experiencing violence later in life (Renner 2006). Femicide is a research priority because of fatal consequences and protection of the women human rights. Femicide is still remarkably prevalent in many cultures and societies. What constitutes a “femicide or feminicide” is not entirely clear, and how the concept has been defined within observational research is not universally standardized. This systematic review will explore how femicide has been conceptualized and evaluated in currently available case-control and cohort studies. Furthermore, we will systematically identify factors associated with the risk of femicide. A better understanding of its risk factors can help the development of interventions as well as novel preventive strategies to mitigate this problem. Our main objective is to systematically identify factors associated with the risk of femicide. Besides, we will investigate how femicide has been defined by researchers. How has femicide been defined in the epidemiological case-control and cohort studies? Which are the main risk factors for femicide? We will include both prospective and retrospective cohort studies as well as case-control studies, irrespective of sample size, year of publication or publication status (i.e., both published and nonpublished studies will be acceptable). Studies must be written in English, Spanish, or Portuguese. Case-control or cohort studies that investigated risk factors for feminicide Study that has a group of women with the homicide outcome and another one for comparison (population controls, women victims of mild/severe violence, women killed controls, women with attempted homicide, other) Studies that have a group of perpetrators of female homicide and a comparison group (population controls, men perpetrating another type of crime, other) Studies that report relative risk (RR) or odds ratio (OR) with the corresponding 95% confidence intervals (CIs) or that offer data to perform the calculation. Studies without comparation group or case series. We will include studies that studied women victims of homicide. No restriction on age will be imposed. Female homicide/femicide with firearm Female homicide/femicide with bladed weapon Female homicide/femicide with blunt object Female homicide/femicide by strangulation/asphyxiation Female homicide/femicide burn Female homicide/femicide by intoxication Other violent forms of female homicide/femicide Any accidental deaths will not be considered for this systematic review. It is important to notice that femicide is a relatively recent denomination of female homicide. We will include cases of female homicide. In cases of transsexual population, we will consider gender identity (e.g., if the biological sex of the person is male but gender identity is female, the person will be considered a woman). If it is not possible to establish the gender identity, we will include the particular case as gender identity undefined. We will extract 2 × 2 tables, RR or odds ratio-related estimates—depending on the data availability in each study. When data are available as a point estimate (95% CI) derived from two or more multiple regression models, we will extract the estimates from the most complete model (full model). Definitions of femicide used in the primary case-control and cohort studies. Associated factors to be a victim of femicide estimated by RRs or ORs or available data. Associated factors for a person to commit a femicide estimated by RRs or ORs or available data. Age Race/ethnicity Immigrant status Educational level Employment Socioeconomic status Previous violence relationship Victim or witness of domestic violence during childhood (<14 years) Victim of rape or sexual violence in childhood (<14 years) Daughter of a mother battered by her partner History of depression History of mental illness Manic or psychotic symptoms Personality disorder Suicide attempt Firearm access Alcohol/drugs use Age difference of woman and partner Relationship between woman and partner Relationship duration Cohabitation Type of violence perpetrated by partner Type of violence perpetrated by women Increased frequency of physical violence over the past year Attempted femicide Previous of aggression of woman with a firearm or white arm Nonfatal attempt to strangle/hang woman by partner Rape or forced sex by partner History of murder of a relative Desire/attempt or separation by woman The woman had a new relationship Woman denounced violence to authorities Attempts to drop charges or going back on the decision to leave or report the aggressor to the police Woman with protective measure The woman had children Woman had nonbiological children with the abuser Woman had biological children with the abuser Physical aggression during pregnancy (from beginning to 12 months postpartum) Aggression to children by the partner Aggression of children with a firearm or white arm Violent behavior against people without inbreeding specification Violent behavior against people with inbreeding Violent behavior against people with no inbreeding/unknown ties Commit previous crimes Arrest history History of violent behaviors with previous partner Previous detention or history for domestic violence Jealous or controller behavior Cruel behaviors directed at the victim and lack of remorse Justification of violent behavior due to aggressorʼs own state (alcohol, drugs, stress) or victimʼs provocation Son of a mother raped by her partner Additional risk factors not mentioned above be explicitly mentioned in the final version of the systematic review. We will search for all published and unpublished studies in the most common medical databases. We will include Google Scholar searcher to retrieve additional studies and relevant references from related systematic reviews. Medline (Ovid platform) Appendix 1 Ovid MEDLINE(R) 1946 to 2020 MEDLINE(R) Epub Ahead of Print 2020 MEDLINE(R) Daily Update 2020 Embase (Ovid platform) Appendix 2 Scopus Appendix 3 Biblioteca Virtual da Saúde (BVS) Appendix 4 Web of Science Appendix 5 Principal Coleção do Web of Science KCI-Data base of Korean journals Russian Science Citation Index SciELO Citation Index Derwent Innovations Index Proquest Appendix 6 Applied Social Sciences Index & Abstracts (ASSIA)‎ (1987–nowadays) Education Resources Information Center (ERIC‎) (1966–nowadays) ProQuest Central‎ (1970–nowadays) Sociological Abstracts‎ (1952–nowadays) ProQuest Dissertations & Theses Global‎ ‎ (multidisciplinary–dissertations) Cochrane Database of Systematic Reviews (web platform) Appendix 7 PsycINFO Appendix 8 APA PsycInfoAPA PsycInfo APA PsycArticlesAPA PsycArticles APA PsycBooksAPA PsycBooks SocINDEX Appendix 9 SocINDEX with Full Text CAPES FSTA Full Text Collection CINAHL with Full Text Publications from the World Health Organization, and the bibliographic references of included articles, as well as annals of scientific events on homicide in women, femicide and feminicide and the Opengrey literature as of We will include the Google Scholar searcher Appendix We will all and through the search to and all we will the data to the systematic review for the of of the systematic review. will the and for identified primary studies. will be through if by a We will the for the report et al., We will use the for and systematic review final Cochrane 2014). 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