Infant Homicides Within the Context of Safe Haven Laws — United States, 2008–2017

Homicide is the 13th leading cause of death among infants (i.e., children aged <1 year) in the United States (1). Infant homicides occurring within the first 24 hours of life (i.e., neonaticide) are primarily perpetrated by the mother, who might be of young age, unmarried, have lower educational attainment, and is most likely associated with concealment of an unintended pregnancy and nonhospital birthing (2). After the first day of life, infant homicides might be associated with other factors (e.g., child abuse and neglect or caregiver frustration) (2). A 2002 study of the age variation in homicide risk in U.S. infants during 1989–1998 found that the overall infant homicide rate was 8.3 per 100,000 person-years, and on the first day of life was 222.2 per 100,000 person-years, a homicide rate at least 10 times greater than that for any other time of life (3). Because of this period of heightened risk, by 2008 all 50 states* and Puerto Rico had enacted Safe Haven Laws. These laws allow a parent^† to legally surrender an infant who might otherwise be abandoned or endangered (4). CDC analyzed infant homicides in the United States during 2008–2017 to determine whether rates changed after nationwide implementation of Safe Haven Laws, and to examine the association between infant homicide rates and state-specific Safe Haven age limits. During 2008–2017, the overall infant homicide rate was 7.2 per 100,000 person-years, and on the first day of life was 74.0 per 100,000 person-years, representing a 66.7% decrease from 1989–1998. However, the homicide rate on first day of life was still 5.4 times higher than that for any other time in life. No obvious association was found between infant homicide rates and Safe Haven age limits. States are encouraged to evaluate the effectiveness of their Safe Haven Laws and other prevention strategies to ensure they are achieving the intended benefits of preventing infant homicides. Programs and policies that strengthen economic supports, provide affordable childcare, and enhance and improve skills for young parents might contribute to the prevention of infant homicides.

Since 1999, when Texas became the first state to implement Safe Haven Laws, an estimated 4,100 infants have been safely surrendered nationwide (5). Safe Haven Laws are applied differently in each state, and one notable difference is the age limit of legal relinquishment (4). For example, 11 states and Puerto Rico limit relinquishment to infants who are aged ≤3 days, whereas 19 states allow relinquishment up to age 1 month (4). North Dakota allows relinquishment of infants aged <1 year (4).

Data for this analysis come from the National Vital Statistics System,^§ which includes a linked birth and death certificate for >99% of infants who die in the United States. Birth certificates provided demographic characteristics present at birth (e.g., mother’s age). Death certificates indicated both an underlying cause and manner of death, which the medical examiner or coroner is primarily responsible for certifying. Infant homicide was defined as the death of a child before the first birthday, using the International Classification of Diseases, Tenth Revision (ICD-10) underlying cause of death codes X85–Y09, Y87.1, U01, and U02.^¶ Age at death was calculated as the difference in days between the dates of birth and death recorded on the death certificate; an infant killed on their date of birth had an age at death of 0 days. To examine the association between homicide rates and state-specific Safe Haven age limits for legal relinquishment, infant homicides were categorized using age limits specified in state Safe Haven Laws as of 2016** (4). These age limits were treated as stable and applied throughout the entire study period. Data years 2008–2017 were used to coincide with national enactment and implementation of Safe Haven Laws. Homicide rates were presented as rates per person-years of exposure, which allowed for the calculation of homicide risk by age of infant, because infant homicides occurred at different times during infancy (e.g., day of birth, week one).^††

During 2008–2017, the U.S. population aged <1 year accounted for 39,984,337 person-years of exposure; days of birth accounted for 109,471 person-years (0.27%). The remainder of infancy accounted for 39,874,866 person-years. An estimated 2,851 infants were victims of homicide during 2008–2017 (Table 1). The overall infant homicide rate was 7.2 per 100,000 person-years. The homicide rate of infants killed on the day of birth was 74.0 per 100,000 person-years, which was 5.4 times higher than the rate at any other time of life (Supplementary Table, https://stacks.cdc.gov/view/cdc/93750).

The rate among males (8.0), who accounted for 57.4% of infant homicides, was slightly higher than that among females (6.2) (Table 1). Infants of non-Hispanic White (White) mothers accounted for 62.1% of homicides; however, rates among infants of non-Hispanic Black (Black) mothers (14.4), and non-Hispanic American Indian/Alaska Native (AI/AN) mothers (14.9) were more than twice the rate among infants of White mothers (5.9). Infants of Asian/Pacific Islander mothers had the lowest homicide rate (3.1). In addition, although infants of mothers aged 20–29 years accounted for almost two thirds (65.2%) of infant homicides, the rate among infants of mothers aged <20 years (18.7) was more than twice that among infants of mothers aged 20–29 years (9.1) and more than seven times that among infants of mothers aged ≥30 years (2.6).

Overall, 75.0% of infant homicide victims were born to unmarried mothers; the homicide rate among these infants (13.4) was approximately 4.5 times the rate per 100,000 person-years among infants born to married mothers (3.0). Nearly all infant homicide victims were born at a hospital (95.8%); however, among the small percentage who were born at a residence (2.9%) or another location (0.7%), the homicide rates (23.7 and 66.9) were approximately 3.4 and 9.6 times the rate among infants born at a hospital. Moreover, in the 2,371 cases where the mother’s education level was reported (83.2% of all infant homicides), homicide rates were higher among infants of mothers with lower education levels (less than high school, 12.2; high school graduation or equivalent, 10.8) than among infants whose mothers had higher education levels (1.0–7.1).

The percentage of homicides occurring each week of infancy varied (Figure). The first peak occurred in the first week of life, when 3.9% of all homicides occurred. A second peak occurred at week 11. Among the 111 infant homicides that occurred during the first week of life during 2008–2017, 73.0% occurred within the first 24 hours of life, and approximately two thirds of those infants (65.4%) were born at a residence.

Most (92.4%) homicides occurred among infants who were too old for Safe Haven relinquishment at the time of their deaths; however, there was no obvious association between infant homicide rates and Safe Haven age limits (Table 2). For example, the infant homicide rates in states that limit relinquishment to ≤7 days and ≤14 days were 7.0 and 9.4 per 100,000 person-years, respectively. Conversely, the infant homicide rate for states that limit relinquishment to ≤45 days compared with ≤60 days was 10.6 and 7.3, respectively.

Corresponding author: Rebecca F. Wilson, ysp2@cdc.gov.

¹Division of Violence Prevention, National Center for Injury Prevention and Control, CDC; ²Division of Injury Prevention, National Center for Injury Prevention and Control, CDC.

References

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Abbreviations: AI/AN = American Indian/Alaska Native; CI = confidence interval; GED = General Education Development; HS = high school; N/A = not applicable.
* During 2008–2017, approximately 2,919 infants were victims of homicide (https://webappa.cdc.gov/sasweb/ncipc/mortrate.html). Because this study used restricted-use National Vital Statistics System linked birth and infant death data, 68 infant homicides were excluded because the corresponding birth and death certificates could not be linked.
^† Percentages might not sum to 100% because of rounding.
^§ Number of deaths per 100,000 person-years. Rates are not reported for subgroups in which the number of infant homicides is <20 or response is unknown.
^¶ Infant homicides for Puerto Rico were not available for this analysis.
** Includes infants who died on first day of life.
^†† Mother’s race/ethnicity is the best measure of race/ethnicity of the infant; thus, infant race/ethnicity is based on mother’s race/ethnicity as reported on the infant’s birth certificate.

FIGURE. Percentage of infant homicides, by age at death (weeks) — restricted-use National Vital Statistics System, linked birth and infant death data, United States, 2008–2017

Abbreviation: CI = confidence interval.
* During 2008–2017, approximately 2,919 infants were victims of homicide https://webappa.cdc.gov/sasweb/ncipc/mortrate.html. Because this study used restricted-use National Vital Statistics System linked birth and infant death data, 68 infant homicides were excluded because the corresponding birth and death certificates could not be linked. The District of Columbia did not enact a Safe Haven Law until 2009; therefore, the two infant homicides that occurred in 2008, in the District of Columbia, were removed when infant homicide rates were examined within the context of Safe Haven Laws. Counts are not reported when the number of infant homicides is <10.
^† Percentages might not sum to 100% because of rounding.
^§ Infant homicide rates are based on the state in which the infant’s death occurred (i.e., state of occurrence). Rates are not reported when number of infant homicides is <20. Denominator includes number of live births multiplied by the Safe Haven days in each Safe Haven age limit category.
^¶ Infant homicides for Puerto Rico, which has a Safe Haven Law age limit of 3 days, were not available for this analysis.