Femicide: A Forensic View

Abstract

Femicide, understood as the death of a woman, because of her status as a woman o because of her gender identity, represents a challenge from the forensic approach, which requires a critical look from the medical examiner to interpret the findings he sees in the corpses and integrate it with the context information provided by authority, in such a way that a complete and comprehensive autopsy is carried out that guides the authorities in the judicial investigation process. This chapter seeks to take a look at those aspects of the autopsy that allow a comprehensive approach to death with suspected femicide.

1. Introduction

Feminicide, understood as the death of a woman, because of her status as a woman or because of her gender identity [1], is already a recognized public health problem, in addition to a serious violation of human rights, and although it is not yet known its magnitude in the world, given the methodological difficulties in differentiating these murders from other homicides of women [2], the latest United Nations report on homicides [3] estimates that in 2012, 92,766 women were murdered and 47% of these murders were occurred by the couple or the family, being the seventh cause of premature death in women in the world.

In United States, alone the rates have fluctuated between 3.8–4.5 deaths per 100,000 women [4]. In Canada, a woman is murdered every 2.5 days — ranging from 144 to 178 murders each year between 2015 and 2019 and in 2021, of the women murdered, 50% were killed by intimate partners and 26% by family members [5]. In Pakistan, the exact figure is yet to be known but according to an estimate thousands of women are victims of dowry deaths. Moreover, nearly 500 women a year are the victims of honor killings [6].

Domestic abuse and femicide rates are particularly high in Latin America [7], a region with the second-highest female homicide rate in the world, second only to Africa [8].

In Colombia (Figure 1), femicides maintain a constant trend over time, in 2019 from 1001 homicides of women, 109 cases were femicides (10.88%); in 2020, 989 homicides of women were committed, of which 90 cases were femicides (9.1%), in 2021 of the 978 registered homicides of women, 106 were femicides (10.83%) and during the first quarter of 2022 of 264 registered homicides, 26 cases correspond to femicides (9.84%) [9]. In our population, the majority of deaths are caused by firearm projectiles and stab trauma, primarily affecting women between 29 and 59 years of age [9].

Figure 1.

Femicides in Colombia.

For medical examiners, the medico-legal approach to femicide represents a challenge that requires a holistic and integrative view to interpret the findings on the body and analyze them together with the contextual information, in such a way that a complete and comprehensive autopsy is carried out that guide the authorities in judicial investigation processes. This chapter seeks to take a look at those aspects of the autopsy that allow a comprehensive approach to deaths with suspected femicide.

2. Autopsy for suspected cases of femicide

The medical-forensic investigation of corpses whose death raises suspicions of femicide is not broadly different from the approach that should be carried out in cases where human rights violations are suspected [10]. In technical terms, the autopsy examination must follow the usual steps, beginning with the examination of the site where the body was found, continuing with the autopsy itself and ending with the complementary examinations necessary for each case [11].

3. Examination of the body discovery site

In some countries, coroners regularly attend crime scene as part of their forensic work; in Colombia, medical examiners do not have judicial police functions, that is, legally we are not empowered to process the crime scene, instead, the scenes are processed by technical staff of the CTI (judicial investigation technical body) or SIJIN (Judicial Investigation Section) who through a document known as Technical Inspection Report, where they provide all the information from the scene to medical examiners so he can proceed to perform the autopsy. In that order of ideas, it is essential that medical examiners carry out a complete analysis of the information provided prior to the start of the autopsy, including the evaluation of the photographs from the scene and details of the discovery of the corpse such as position, location, elements on and around it, clothing arrangement, blood dripping patterns and other elements from the scene that guide specific procedures and searches during the autopsy process. If the information available in relation to the scene and finding of the body is limited or insufficient, it is recommended to carry out all the necessary steps to obtain it, prior to the start of the autopsy. Likewise, it is highly relevant to have a complete context as possible in relation to the circumstances surrounding the events, in order to be able to differentiate between femicide and homicide, it is crucial to establish the elements that motivated the aggressor’s conduct [12], hence the context analysis is essential to establish a medical-legal approach to the forensic diagnosis of femicide [13] and guide the procedures, evidence and other actions within the autopsy process. Therefore, it is recommended that the investigation of femicide cases be carried out from a gender perspective with inter-institutional work geared and coupled in order to find the elements associated with criminal motivation and obtain efficient results in the judicial investigation process [11].

4. Autopsy

In all cases, a complete autopsy should be performed, including opening of the cranial and thoracoabdominal cavity with systematic dissection of the visceral block and organ-by-organ dissection [11]. Although the expert is free to choose the order in which the body is going to intervene as long as he does not omit performing procedures, it is recommended in these cases to carry out the external and internal examination with a systematic cephalocaudal order.

External examination: A thorough and detailed inspection of the body and the container or packaging in which the body was brought to the autopsy room must be carried out. The use of forensic lights is ideal [11], however, given the limitation of the resource, the use of magnifying glasses is advisable to magnify the visual field of the evaluator. After reviewing the packaging and recovering the evidence found it in a pertinent manner, proceed with the analysis of the body. Check the scalp for the presence of abrasions, ecchymoses, bruises, or areas of traumatic alopecia. Check the face, eyes, conjunctivae, ears, nose and oral cavity. Look for the presence of petechiae in the conjunctiva or oral mucosa that may be associated with asphyxia or hypoxic phenomena, rule out the presence of soft tissue trauma, especially in the nostrils and labial or peri-oral mucosa that may be associated with suffocation [14].

Rule out the presence of hidden trauma to the ears, with an otoscope (in cases where the context suggests the possibility of torture), check the tympanic membrane and rule out ruptures. Evaluate the oral cavity very well looking at the state of the teeth, the presence of trauma to the tongue, hemorrhages in the braces and in cases where an associated sexual offense is suspected, take the pertinent smears, including the interdental smear with dental floss. For the revision of the neck, it is always recommended to do it in hyperextension, ruling out the presence of grooves, bruises or abrasions that may be related to asphyxia maneuvers such as hanging/strangulation [14]. In the thorax and abdomen, rule out the presence of trauma, sugilations (especially in the breasts) and adequately document the findings according to their nature. The genital examination must be complete, initially inspecting the external part of the vagina, anus and inner thighs, looking for the presence of fluids, abrasions, bruises or sugilations. Evaluate the hymen indicating its shape, elasticity and the presence or absence of tears [15]. Check the anus to identify the presence or absence of tears and tone [15]. In the extremities, attention should be paid to any pattern of injury that indicates fight or defense and the nails and nail beds should be checked very well with recovery of trace evidence and nail clipping in cases that warrant it.

If the context suggests the possibility of an associated sexual offense and/or a corpse is observed in a sexualized position, with clothes improperly placed or naked (without a logical explanation for its nudity) with pattern injuries consistent with bites or sugilations and stains or whitish fluids to the human eye or orange under forensic lights, it is recommended to carry out a detailed sexological examination before washing the corpse and to document the morphology of the traumatic injuries [15, 16]. This sexological examination includes the evaluation of the garments, ideally with forensic lights looking for the presence of fluids (blood different from the victim, semen, saliva) or trace evidence from the aggressor that allow establishing a causal link between the victim and the aggressor in accordance with the Locard principle. Swabs should be taken from the oral cavity, breasts, vagina and anus [16]. Likewise, if fluids suggestive of saliva or semen are identified on the corpse by forensic lights, take smears of said areas [16].

If trauma by firearm or trauma by knife is evident in the corpse, the proper guidelines for dealing with this type of case must be followed, in Colombia the approach is oriented according to the guide: Deaths due to injuries by firearm projectile [17] and the guide of deaths due to Injuries by sharp weapon [18].

In cases of stab trauma, especially throat slitting or extensive soft tissue trauma, it is recommended to perform wound reconstruction (Figure 2) [14], in order to assess their morphology and guide the number, type, extent and trajectory of the injuries.

Figure 2.

Reconstruction of injuries caused with a blunt object (machete). Own source.

Particularly important is the search, documentation and interpretation of injury patterns related to death, such as [11]:

• Overkill: The number of injuries is more than necessary to cause death, it can occur both in cases of knife and firearm, the finding injuries in different stages of vitality is characteristic, which indicates that even after being dead, the person continued to be the object of aggression [11].

• Defeminization: Corresponds to depersonalization maneuvers that aim to destroy those characteristics associated with femininity, including injuries, mutilations or amputations of female organs (genitals, breasts), facial disfigurement, haircuts and even nail removal [11].

• Dismemberment: maneuver to reduce the body to fragments, which can be carried out for various reasons such as transporting the body from the primary scene, preventing the identification of the deceased, sending a message or even being the causal mechanism of death [19].

• Defense wounds [18]: These are related to wounds that, due to their cutting mechanism and their location mainly on the extremities, suggest a fight or defense by the victim during the aggression.

Internal examination: Perform bimastoid incision and lift the scalp, evaluating the presence of subgaleal hematomas. Remove the muscular plane and the galea to evaluate the skull bones and rule out the presence of fractures, proceed with the opening of the cranial vault, with extraction of the brain and a detailed review of it, seeking to rule out any type of trauma [11]. Do not forget to review and photographically document the base of the skull. After emptying the neck vessels after exploring the head, proceed with the anterior neck dissection and facial lift, seeking to document or rule out the presence of hematomas and/or fractures of the laryngeal, thyroid, and hyoid cartilages. The foregoing for cases in which asphyxiating maneuvers such as strangulation or hanging are particularly suspected [14]. If hyoid fractures are found and if radiographs are available, it is recommended to carry out radiological documentation of the fracture (Figure 3) [14].

Figure 3.

Fracture of the left lateral horn of the hyoid bone in a case of strangulation. Own source.

Proceed with the internal examination of the thoracic and abdominal cavity plane by plane with extraction of the visceral block, inspection and section of each organ. In cases where an associated sexual offense is suspected, carry out a special dissection of the pelvic block with a smear of the rectal mucosa, cervix and uterine cavity. If the context is suggestive of cruel and inhuman treatment or torture, apply all the recommendations mentioned in the Minnesota protocol [20]. Always keep in mind the practice of additional special procedures in cases that require it [11]:

• Exploration by anatomical planes of the face: In all cases where facial injuries are documented or suspected. Special emphasis is placed on femicides associated with domestic violence, femicides associated with organized crime, femicides within the context of war and armed conflict, and femicides with evidence or suspicion of related sexual activity (Figure 4).

• Exploration by anatomical planes of the neck: In all cases in which injuries are suspected or evidenced at the cervical level; asphyxia due to neck compression, penetrating firearm projectile wounds to the neck, penetrating stab wounds to the neck, blunt force trauma to the neck (Figure 5).

• Examination by anatomical planes of the back extended to the extremities: In all cases where back trauma is suspected. Special emphasis: femicides associated with organized crime, femicides within the context of war and armed conflict (Figure 6).

• Extraction of complete female genitalia: Where traumatic injuries are suspected at the level of internal genital organs. Particularly important in femicides with suspected related sexual activity (Figure 7).

Figure 4.

Special dissection with complete facial lifting, in which comminuted fracture in the frontal region and linear fracture in the left zygomatic bone can be seen. Own source.

Figure 5.

Special anterior neck dissection by anatomical planes with laryngeal cartilage dissection. Own source.

Figure 6.

Posterior special dissection in elongated X, which seeks to reveal the presence or absence of occult trauma. Own source.

Figure 7.

Special dissection of the female pelvic block, in which the bladder, the uterus and vaginal cavity, and the rectum are successively illustrated. Indicated in cases of deaths with suspected associated sexual crime. It is recommended to take smears of the cervix, uterine cavity and rectal mucosa during the dissection. Own source.

Finally, it should be kept in mind that the entire procedure must be accompanied by adequate and sequential photographic documentation [11, 20] of both the positive findings and the absence of relevant findings that allow hypotheses related to the cause of death to be ruled out.

5. Complementary tests

The type of samples recovered and the tests requested will depend on the context of the case and the state of the body [11], however, the possibility of obtaining matrices suitable for toxicological analysis and samples for biology must always be guaranteed, especially if there is an associated sexual offense. Regarding the matrices for toxicological examination, it will always be ideal to recover blood and urine, however, other matrices such as vitreous humor, bile, gastric content, bladder lavage, CSF, liver, kidney, muscle, purging fluid, among others, can also be considered, among others; the selection of one or another matrix will finally be limited to the state of the corpse and the demonstrative capacity according to the context of the case [11]. In firearm cases, it is imperative to recover all possible ballistic evidence [17] (weapons, projectiles, pellets, projectile sleeves, clothing, among others) and seek the respective processing in the corresponding laboratory. In cases of stabbing [18], if the traumatic element is found, seek detailed photographic documentation of it, as well as the determination of its dimensions and guarantee the fingerprint search, as well as the genetic examination looking for different profiles from that of the victim. For cases of strangulation, gagging and forced immobilization, if constrictor elements are available, remember the possibility of analysis looking for the epithelial cells of the aggressor [21]. In cases of dismemberment, corpses abandoned inside plastic containers or suffocation with a bag, keep in mind the possibility of looking for fingerprints on these materials [20]. In relation to the garments, their analysis includes a detailed description that ranges from their position on the body to the type, brand, color, material, size and presence of any fluid, tear or damage that calls the attention of the evaluator [17, 18]. It is advisable to use forensic lights for the analysis of garments, however, if the resource is not available, remember to use a magnifying glass, in order to carry out a more detailed and thorough analysis. As for X-Rays, their use will depend on the availability of the resource. If available, it is particularly useful in cases of firearm projectiles, decomposed, burned or calcined, skeletonized and throat-cut corpses [11]. Histopathology is very useful to document the dating of lesions or pathophysiological processes associated with the mechanism of death when there are periods of survival after trauma [11].

Regarding the autopsy expert report, in analysis and conclusion [11] sections, it is important to carry out an interpretation of the findings integrated with the analysis of the context where not only the cause and manner of death are sought to be clarified, but it is also highly relevant to guide to the authority on the type of femicide and the presence or absence of circumstantial elements that guide precautionary measures by the aggressor or punitive aggravating factors associated with the victim, such as pregnancy, age under 18 year old, inability to resist or states of helplessness associated with substance use or forced immobilization, physical disability and associated sexual assault, among others.