Infant Homicides and Safe Haven Laws in the U.S., 2008–2017

Summary

• An infant's highest risk of homicide is on the day of birth. By 2008, all 50 states and Puerto Rico had Safe Haven Laws, which let a parent legally surrender an infant who might otherwise be abandoned or endangered.
• The homicide rate on the day of birth fell from 222.2 per 100,000 person-years in 1989–1998 to 74.0 in 2008–2017 — a 66.7% decline — but it remains at least 5.4 times higher than at any other time of life.
• Supporting families — economic support, affordable childcare, skills for young parents — might help prevent infant homicides.

Background

Homicide is the 13th leading cause of death among U.S. infants. Killings in the first 24 hours are mostly by the mother — often young, unmarried, with less education, and tied to a concealed, unintended pregnancy and a birth outside a hospital. Later in infancy, other factors come into play, such as abuse, neglect or caregiver frustration.

Since Texas passed the first Safe Haven Law in 1999, an estimated 4,100 infants have been safely surrendered. The laws differ, notably in age limits: 11 states and Puerto Rico allow surrender up to 3 days old, 19 states up to 1 month, and North Dakota up to 1 year.

How it was studied

CDC used linked birth and death certificates from the National Vital Statistics System, covering more than 99% of infant deaths, for 2008–2017, when Safe Haven Laws were in place nationwide. Rates are per person-years — time at risk — so risk can be compared by age in days and weeks. States were grouped by their Safe Haven age limits as of 2016.

What was found

An estimated 2,851 infants were killed in 2008–2017, an overall rate of 7.2 per 100,000 person-years — down 13.3% from 8.3 in 1989–1998.

• Most victims had White mothers (62.1%), mothers in their 20s (65.2%) and unmarried mothers (75.0%), and nearly all (95.8%) were born in a hospital — but the rates were highest in the groups above.
• Timing: homicides peaked in the first week of life (3.9% of all) and again at week 11. Of 111 killed in the first week, 73.0% died in the first 24 hours, and about two-thirds of those had been born at home.
• Safe Haven limits: 92.4% of the infants were too old to be surrendered under their state's law when they died, and rates showed no clear pattern by age limit — for example, 7.0 where the limit was 7 days but 9.4 at 14 days, and 10.6 at 45 days but 7.3 at 60.

Infant homicides by age at death in weeks. Figure from the CDC report.

What it means

Risk factors included a mother who is young, unmarried, has less education, gives birth outside a hospital, or is Black or American Indian/Alaska Native. The racial differences may partly reflect poverty and other disadvantages: inadequate childcare, housing and food make parenting harder. After the first day, perpetrators may be the mother, her male partner or the father, amid young parenthood, frustration, maternal mental illness, an unwanted child, or abuse and neglect.

Because rates didn't track age limits, and most victims were past them, states should evaluate whether their Safe Haven Laws and other strategies are working.

Limits: deaths may be misclassified or undiscovered, and it can be hard to establish a live birth or cause of death; and two states raised their age limits (one during, one after the study), though results would likely be similar.

Prevention

These deaths are preventable. Programs and policies that strengthen economic support for families, provide quality, affordable childcare, build parenting skills (for example through home visiting), ensure safe, stable, nurturing relationships for every infant, and raise public awareness of Safe Haven Laws might help. More on state Safe Haven Laws: Child Welfare Information Gateway.

Sources

Based on Rebecca F. Wilson, Joanne Klevens, Dionne Williams and Likang Xu, "Infant Homicides Within the Context of Safe Haven Laws — United States, 2008–2017," MMWR, Centers for Disease Control and Prevention; a work of the United States government in the public domain.