Introduction

Deaths by homicide of children in Mexico has not received particular attention in the country’s public policies despite the fact that the Convention on the Rights of the Child ¹, which was unanimously approved by the General Assembly of the United Nations in 1989 and ratified by Mexico in 1990, establishes in Article 19 the right of all boys, girls and adolescents to a life free of violence and binds the signatory states to adopt the appropriate legislative, administrative, social and educational measures to protect children against violence. This institutional omission is particularly problematic in a national context such as that of Mexico, where violent deaths have increased dramatically from 2007 to date in the context of the war against drug trafficking ².

In recent decades, programs related to child survival in Mexico have been geared towards diseases that are preventable by vaccination and nutritional deficiencies. As a result of campaigns such as breastfeeding promotion, growth monitoring, immunization and oral rehydration therapy, millions of lives have been saved, and the quality of life of many boys and girls has been improved ³. However, the World Report on Child Injury Prevention of the World Health Organization (WHO) ⁴ draws attention to injuries as the leading cause of death and disability among children worldwide. This report emphasizes the need to address this problem as a central part of all initiatives that are carried out to reduce damage to child health and improve overall well-being.

Therefore, it is necessary to establish differences between injuries referred to as unintentional and intentional according to the mechanism that causes them. Unintentional injuries include those produced by burns, falls, poisoning, etc. Intentional injuries produced by another person or by the injured person include homicides and suicides⁵. Although it may seem easy to make this distinction, in practice, it is difficult, especially in children under five years of age and especially those under two years of age, due to the close relationship children have with those who use violence against them. It is known that such deaths are registered precisely because of the legal implications involved ⁶. While homicide is the most visible effect of violence, it should be emphasized that deaths only represent a fraction of the total burden of violence ^6,7; for each death, an indeterminate number of violent events occur that lead to injuries or other health effects - including both physical and mental sequelae and disabilities - some of which, for various reasons, are never recorded by state institutions ⁸.

The classification of violence proposed by the WHO attempts to characterize the different types of violence and relate them to the bonds between the aggressor and the victim ⁵. In this study, reference is made to interpersonal violence between people who are well known to one another and that usually occurs in the home. In addition to the recommendations of the World Report on Violence and Health for intervening in the problem, the INSPIRE handbook, an initiative of several international and non-governmental organizations, establishes a series of recommendations with proven evidence to mitigate and end violence against children; among these recommendation are education and changes in attitudes towards life, response and support from institutions responsible for access to justice, and the establishment of norms and values in the face of situations of violence ⁹. The objective of this article is to characterize homicide deaths for children under ten years of age in Mexico through the analysis of official records of homicide deaths from 1998-2017, focusing the public attention on a problem that is one of the most severely neglected social issues in Mexican society.

Materials and Methods

Results

A total of 5,188 deaths were recorded as homicides in children ages 0 to 10 years from 1998-2017 in Mexico. Each year, 259 children under ten years of age died from homicide; 56.7% were boys. Among all these deaths, 70.1% were of children younger than five years. The girl/boy ratio was 1:1.31.

Figure 1 shows that during the 20 years of the study, there was a decreasing trend in mortality for boys and girls, although the decrease for boys was almost double, compared to the decrease observed for girls. This figure also shows that rates were consistently higher (between 10% and 30%) for boys than girls during the study period. By 1998 and 2003, the risk of dying from a homicide was as much as 60% higher for boys than for girls, but between 2004 and 2007, mortality rates were similar by sex. Although the trend was irregular until 2017, it tended to decrease over the years.

Source: Prepared from the databases of the National Health Information System (SINAIS, 1998-2017)

Figure 1 Homicide mortality rates among children 0-10 years old, in Mexico. 1998-2017 

When the linear regression for the study period was applied, it was found that boys had a mortality rate from homicides of 0.54 (95% CI: 0.30-0.79) higher compared to girls (p <0.001). Additionally, due to the one-year increase, mortality was reduced by 0.03, meaning that this decrease was statistically significant (p <0.01) (Data not shown).

The analyzes of homicides by weapon use/mechanism and by age group show that 70.1% of homicides occurred in children 0 to 4 years of age (Table 1); in this group, homicides by “other means and/or undetermined” accounted for 42.6% of homicides, and 29% of homicides in children ages 5 to 10. In this same age group, homicides in which a gun or a knife was used were the most common ones (46%). Physical force (e.g., beating, hanging, strangulation, drowning and physical abuse) was reported in approximately 23% of cases.

Among children under nine years of age, homicides caused by firearms (20.6%) and by hanging or strangulation (13.9%) were the most prevalent, while poisoning was the least reported type (0.6%). The results show that compared to boys, girls were more likely to die from physical abuse, beating, hanging (33.8%). 56.7% of victims ages 0 to 10 were boys. Given that 70% of deaths occurred in children under 5 years of age and that sex differences were observed, the following results stratified by age and sex are presented:

Discussion

The study shows that the mortality records for homicide in children between 0-10 years of age in Mexico had few changes over more than two decades. However, during some years of the study period, homicide rates in girls were almost equal to those in boys, and firearms followed by hangings and strangulation were the most common types of homicides in children.

In under one year, the information coincides with the results of a study in Turkey that characterized homicides perpetrated by mothers (filicide) to children under six years in which hands were used as a criminal tool; throwing their daughters from heights was the second most common method of filicide. In addition, it was identified that mothers used gauze, cloth or socks to kill their children ¹⁵.

The sex difference in mortality patterns differed from that reported in a previous study performed by other authors ⁶. In that study, the risk of dying from homicide was almost three times higher for boys under five years than for girls, while in the present analysis, the differences were considerably smaller (close to 1: 1). However, the findings coincide with those of another study, which reported a high percentage of deaths among children under one year in both sexes ¹⁶; in that study, the most frequent mechanism were nonspecific, indicating that the violence continues to be used against the most vulnerable. In Taiwan, the analysis of a decade’s data showed that children under five years of age were likely to be attacked with force, and suffocation was still the leading cause of death. Cranial and facial injuries were more prevalent in children under five years of age ¹⁷.

In a comparison of the records of violent mortality in children 0-5 years and 5-10 years with those of another Latin American country, such as Colombia, over the last three years ¹⁸, it was observed that the risk of dying due to homicide in general was slightly higher in Mexico compared to Colombia. For example, in Mexico, the homicide mortality rate in girls aged 0-5 years was 1.25/100,000, while in Colombia, it was 1.01/100,000. The same was true for girls aged 5-10 years; the rate was slightly higher for Mexican girls (0.57/100,000) than for Colombian girls (0.48 / 100,000). For boys, the differences were smaller, so much so that for 5- to 10-year-olds, the risks of mortality due to homicide were similar for both countries (0.70/100,000).

In Africa, a study of the mortality records from 38 medical-legal laboratories for children under 18 years found a higher rate of homicides in males, and this rate was highest among those older than five years ¹⁹. The behavior differed by type and place of occurrence; for females, the highest percentage of events occurred within the nuclear family (18.9%). The use of sharp objects was more frequent for males, while strangulation was more frequent among females; among children, weapons were a greater cause of death. Another finding corresponded to differences in the type of weapon used/mechanism for homicides; for children five years and older, homicides were linked to child abuse, while for girls, they were due to carelessness. The findings in Mexico were similar for the girls in terms of the place of occurrence and cause of death ¹⁹.

It is important to mention that violence against children is increasingly being perpetrated in public spaces, where it is likely that there are witnesses to such violence who at a given moment could act to reduce the severity of the damage. However, the home is where violence is reproduced and where acts of violence affect the most vulnerable ²⁰, in this case, children 0-9 years; in which, differences by sex were evidenced, with homicides in girls occurring at home being higher. Thus, home as a safe environment should be a priority in the set of interventions to prevent violence against girls, targeting to strengthen parenting skills and address social norms, and seeking to reduce the incidence of various types of injuries ²¹.

Evidence emphasizes that such violence is generated by someone close to the child or a relative ^22,23; in many cases, violence is perpetrated by the victim’s parents themselves ²⁴. It is possible that the increase in mortality in some years of the study period (especially in 2009) was related to revenge among criminal gangs, linked to drug trafficking problems throughout the country, particularly in the Mexican Northern-Area. That situation might also be associated with the confronted war made by the Government of former President Calderón against drug trafficking carried out during his mandate, resulting in many thousands of deaths ^25,26.

This study provides evidence on violent mortality among minors in Mexico; however, the following issues are recognized as potential limitations, similarly to other results found by other authors ^27,28

As has been described in other Latin American contexts, the lack of specificity of violent death mechanisms should motivate the improved investigation and recording of these events in a way that leads to the generation of effective proposals to combat them ^29-31. In this context, the observatories of violence, an intersectoral and inter-institutional coordination strategy, could contribute to the generation of reliable information, the product of the validation of data and information among the competent entities on the subject ^32,33.

Furthermore, serious and focused efforts are necessary to document the general situation of children under five years, who comprise the population most vulnerable due to violence. Several aspects that could be considered: mental health problems or dysfunction in parents or caregivers of children under ten years of age, and the presumptive signs and/or symptoms of situations of violence that can be identified by health professionals during medical consultations ^15,34. We believe that these issues need to be followed in future studies where we could identify the possible correlation among homicides in children, hospitalization due to intentional injuries and complaints of physical abuse in this population.

Conclusions

The present study identified that the trend in mortality for these population groups remained similar throughout the study period studied: on average, a child under five years of age was murdered every two days, while for those aged five and above, one death occurs every five days. This could reflect the limited efforts to combat and eradicate this form of child mortality in the country.

Evidence beyond the statistical data was presented in hopes of drawing attention to the urgent need for committed efforts from the sectors empowered to secure the fundamental right to life for boys and girls in Mexico to search for proven strategies such as those suggested in the INSPIRE handbook, an initiative of several international organizations and non-governmental organizations; such strategies establish that education and attitudes towards life, the response and support of institutions responsible for access to justice, and the establishment of norms and values that promote the participation of adolescents and young people are effective measures to end all forms of violence against children.

Other future studies could develop to identify some correlations among homicides in children, hospitalization due to intentional injuries, and complaints of physical abuse in this population. Moreover, observatory programs could be used to improve the quality of administrative records for decision-making.