Child Abuse & Neglect 38 (2014) 1715–1724

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Child Abuse & Neglect

Research article

Infanticide and illegal infant abandonment in Malaysia夽 Salmi Razali a,b,∗ , Maggie Kirkman a , S. Hassan Ahmad b , Jane Fisher a a b

The Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Australia Discipline of Psychological and Behavioural Medicine, Faculty of Medicine, Universiti Teknologi MARA, Malaysia

a r t i c l e

i n f o

Article history: Received 29 January 2014 Received in revised form 2 June 2014 Accepted 12 June 2014 Available online 19 July 2014 Keywords: Infant abandonment Infanticide Human development Gender inequality Malaysia

a b s t r a c t Infant abandonment and infanticide are poorly understood in Malaysia. The information available in the public arena comes predominantly from anecdotal sources. The aim of this study was to describe the prevalence and characteristics of infanticide and illegal infant abandonment in Malaysia and to estimate annual rates for the most recent decade. Summaries of data about infanticide and illegal infant abandonment were gathered from police records; the annual number of live births was ascertained from the national registry. The estimated inferred infanticide rates for Malaysia were compared with the infanticide rates among countries of very high, high, medium, and low rankings on the Human Development, Gender Inequality, and Gini indices. From 1999 to 2011, 1,069 cases of illegal infant abandonment were recorded and 1,147 people were arrested as suspected perpetrators. The estimated inferred infanticide rate fluctuated between 4.82 and 9.11 per 100,000 live births, a moderate rate relative to the infanticide rates of other countries. There are substantial missing data, with details undocumented for about 78–87% of cases and suspected perpetrators. Of the documented cases, it appeared that more boys than girls were victims and that suspected perpetrators were predominantly Malays who were women, usually mothers of the victim; the possibility of arrest bias must be acknowledged. Economic and social inequality, particularly gender inequality, might contribute to the phenomena of infanticide and abandonment. Strategies to reduce rates of infanticide and illegal infant abandonment in Malaysia will require strengthening of the surveillance system and attention to the gender-based inequalities that underpin human development. © 2014 Elsevier Ltd. All rights reserved.

Introduction The United Nations Inter-agency Group for Child Mortality Estimation (2013) reported that almost 6.6 million children under the age of 5 died worldwide in 2012 and that 44% of these deaths occurred during the neonatal period. According to the report, most newborn deaths are attributable to pregnancy-related causes, including complications of birth, congenital abnormality, and infection. Rarely, an otherwise healthy infant might die suddenly without an obvious cause. Until a medico-legal investigation is concluded, each death is described as a Sudden Unexpected Death in Infancy (SUDI). SUDI is an umbrella label incorporating explained deaths and unexplained deaths. Unexplained deaths include Sudden Infant Death Syndrome (SIDS; Blair, Byard, & Fleming, 2012). Explained deaths include rapid infection, rapid onset acute medical

夽 Sponsor: This study is sponsored by Fundamental Research Grant Scheme (FRGS), Universiti Teknologi MARA, Ministry of Higher Education, Grant number: 600-RMI/Ssp/FRGS/5/3Fsp (68/2010). SR is supported by Academic Training Scheme Bumiputera (SLAB)/Academic Training Scheme IPTA (SLAI), Ministry of Higher Education, Malaysia. JF is supported by a Monash Professorial Fellowship and the Jean Hailes Professorial Fellowship. ∗ Corresponding author address: Jean Hailes Research Unit, 6th Floor, Alfred Centre, 99 Commercial Road, Melbourne VIC 3004, Australia. http://dx.doi.org/10.1016/j.chiabu.2014.06.008 0145-2134/© 2014 Elsevier Ltd. All rights reserved.

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condition, unrecognized pre-existing medical condition, accidental death, and non-accidental death. Infanticide is an instance of non-accidental death; abandonment may also be a cause of non-accidental death. Difficulties Defining and Distinguishing Abandonment, Neonaticide, Infanticide There is no precise, universally recognized definition of infant abandonment. Although the term is ambiguous, it is usually understood as leaving an infant in a public place or inappropriate site without care, protection, or supervision (Cesario, 2001). The infant may be found alive or after death from exposure, dehydration, or starvation. The infant might have been abandoned with the hope or expectation that s/he will be found quickly and saved; nevertheless, jurisdictions may assume that placing a baby without supervision in a public place is likely to lead to the infant’s death. In certain countries, such as the United States, the distinction is drawn between discarded infants, who are abandoned at an inappropriate place, and abandoned infants, who are left in a hospital and unlikely to be discharged in the custody of the biological parents (Mueller & Sherr, 2009). The death of an infant can result not only from indirect action but also from violence (e.g., intentional suffocation, assault, being thrown; Blair et al., 2012). When an infant aged less than 24 h is killed, the act is described as neonaticide, the killing of an infant aged from one day to one year is called infanticide, and filicide is the term used when a child is killed by a parent (Resnick, 1969, 1970). Discussions and reports of infant abandonment, neonaticide, and infanticide often do not distinguish clearly among these acts; there is lack of agreement in nomenclature and exact criteria for specifying infant abandonment and infanticide (Drescher-Burke, Krall, & Penick, 2004). In most cases, the study of infant abandonment and infanticide is based on data from autopsies, in which the cause of death, any motive for killing, and sociodemographic characteristics of the victim and suspected perpetrators are often undetermined. As a result, statistics of deaths from apparent abandonment are commonly combined with deaths attributed to neonaticide and infanticide (Beyer, McAuliffe Mack, & Shelton, 2008; Herman-Giddens, Smith, Mittal, Carlson, & Butts, 2003; Shelton, Corey, Donaldson, & Dennison, 2011). There are other difficulties in accurate ascertainment of the nature and prevalence of these deaths. The acts are often concealed, undiscovered, unreported, and thus, underestimated (Putkonen, Collander, Weizmann-Henelius, & Eronen, 2007; Shelton, Muirhead, & Canning, 2010; Tursz & Cook, 2011). There have been debates and controversies about infanticide and SIDS (Brookman & Nolan, 2006; Stanton & Simpson, 2001; Wilczynski, 1994). It has been suggested that inappropriate labeling and misdiagnosis conceal murder in up to 20% of SIDS cases (Wilczynski, 1994). Moreover, inadequate surveillance of infant abandonment and infanticide occurs in most countries because there is neither a national agency that has an exclusive mandate to investigate these matters nor an appropriate data collection system or repository. In order to overcome this limitation, previous investigations have drawn on multiple data sources including police databases, coronial court records, medical and psychiatric records, forensic and autopsy records, death certificates, and reports in the media (Friedman, Horwitz, & Resnick, 2005; Porter & Gavin, 2010). Evidence From High-Income Countries In countries where economic and social development are well-established, it has been possible for investigators to draw on diverse records and registries in these settings and to publish substantial scholarly articles on infant abandonment and infanticide. A recent systematic review found that, in high income countries such as England, Scotland, Wales, United States, Canada, and New Zealand, infanticide rates ranged from 2.1 per 100,000 live births to 6.9 per 100,000 live births (Porter & Gavin, 2010). In Japan, 933 cases of filicide were identified from 1994 to 2005; nearly a quarter of cases involved an unwanted pregnancy that had continued to term, after which the newborn was abandoned or killed (Yasumi & Kageyama, 2009). In these countries, neonates and infants constitute the majority of victims with almost half to two-thirds of child homicides perpetrated on infants aged less than a year (Batje, Schlafke, Nedopil, & Hassler, 2011; Overpeck, Brenner, Trumble, Trifiletti, & Berendes, 1998; Rohde, Raie, Varchmin-Schultheiß, & Marneros, 1998). Potential Risk Factors Resnick’s landmark reviews in 1969 and 1970 of reports of child-killing by a parent stimulated growth in research, especially in countries with high levels of human development and low gender disparities. Attempts have been made to delineate the potential risk factors of infant abandonment and infanticide. Identification of risk has focused on various factors related to social and gender disparities, such as perpetrator characteristics (including sex and marital and socioeconomic status), pregnancy-related factors (including gravidity, parity, and concealment or denial of pregnancy), and problems with mental health (including the perpetrator’s exposure to childhood trauma, or having a personality disorder, substance abuse disorder, intellectual disability, or severe mental illness such as schizophrenia, major depression, postpartum depression, or psychosis). The available evidence has prompted researchers to conclude that women are the main perpetrators of infanticide and neonaticide (Porter & Gavin, 2010). Women who kill their babies are often labeled “mad” (mentally ill) or “bad” (Friedman et al., 2005). Potential risk factors related to infant characteristics have also been investigated and include female sex, illegitimacy, congenital anomalies, and being born into severe poverty (Friedman & Resnick, 2009; Long, 1988; Palermo, 2003; Porter & Gavin, 2010). In countries with low human development and where social inequalities are evident, abandonment and killing

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of female infants has been suggested as a response to coercive population-control measures such as China’s one-child policy (Cheng, 2006; Hesketh, Lu, & Xing, 2005) or a preference for male children, which has been reported in India (DiamondSmith, Luke, & McGarvey, 2008; George, 2006). Because infanticide is a rare phenomenon, most research draws on small samples and has used only descriptive analyses and intragroup comparisons (Friedman et al., 2005; Friedman & Resnick, 2009; Porter & Gavin, 2010). Case-control and cohort studies of adequate size to delineate risk factors accurately are not available (Friedman & Resnick, 2009; Porter & Gavin, 2010). In the absence of adequate evidence, links between possible risk factors and rates of infant abandonment and infanticide cannot be made with certainty. Infant Abandonment and Infanticide in Malaysia Malaysia is an upper-middle-income country in Southeast Asia, a democracy with a population of 28.3 million people. Its neighbors are Singapore, Thailand, and Indonesia. Malay-Bumiputera (indigenous Malays who are neither Chinese nor Indian) constitute 67.4% of the population; the other major ethnicities are Chinese (24.6%) and Indian (7.3%). Islam is the official religion of Malaysia; 61.3% of the population is Muslim. Significant minority religions are Buddhism (19.8%), Christianity (9.2%), and Hinduism (6.3%; Department of Statistics Malaysia, 2010). The constitution of Malaysia provides for a dual justice system: secular laws (criminal and civil) and sharia laws. Sharia laws are restricted to Muslims and relate to personal and family matters (e.g., succession, testatory matters, marriage and divorce, and the status of children) and charitable and religious endowments (Shuaib, 2012). Cases of infanticide and illegal infant abandonment are under the jurisdiction of criminal law (Mohd Shariff, 2012). Infant abandonment and infanticide are poorly understood in Malaysia. The information available in the public arena comes predominantly from anecdotal sources. In the last 10 years there have been almost weekly accounts in local newspapers of abandoned infants (e.g., Wan Ahmad, 2010). Opinion leaders respond by arguing that poverty, fear of illegitimacy, bad parenting, poor religious education, Internet pornography, or overexposure to sexual liberalism are possible causes of this predicament. Publicity about infant abandonment drives debate among professionals over the importance of sex education in schools (Ali, 2012) and the potential impact of severe penalties for the offenders (Shankar, 2010). There are as yet no published systematic data about the prevalence and circumstances of infant abandonment and infanticide in Malaysia to inform prevention and management strategies. Nevertheless, in response to public calls for action, several programs have been implemented. One major program is a system of baby hatches designed to allow a parent to leave a baby, usually a newborn, anonymously in a safe place where the baby can be found and receive care (Shankar, 2010). Another program provides special schools for pregnant teenagers in which they can continue their normal classes as well as receive counseling and skills training in a setting where privacy can be assured (JAIM Education Portal, 2014). As a result of the perceived increase in infant abandonment, public pressure has compelled judicial authorities to classify and investigate illegal abandonment as murder or attempted murder, depending on whether the victim was found dead or alive, and to impose more stringent penalties (Shankar, 2010). In Malaysia, the English words abandonment and infanticide are used without clear definition or distinction. Both terms (in English) are used in Sections 317 and 309A of the Penal Code (Act 574; Revised – 1997), The Annotated Statutes of Malaysia, With Relevant Subsidiary Legislation, 2001 (Mohd Shariff, 2012). In this article, the term illegal abandonment is used to refer to cases in which an infant has been found – dead or alive – abandoned without a parent or caregiver, in all places except an official baby hatch. Infanticide is used only with qualification, unless a case has been finalized in law, because cause of death is rarely established. Two other terms important to the investigation of infant abandonment in Malaysia are janin, referring to the product of miscarriage or abortion, and baru lahir, a term often translated as newborn but one that encompasses infants up to 12 months of age. The aim of this study was to improve understanding of infanticide and illegal infant abandonment in Malaysia. The specific objectives were to: (a) describe the prevalence of infanticide and illegal infant abandonment in the period 1999–2011, (b) estimate the rates of infanticide and illegal infant abandonment, (c) describe the characteristics of victims and suspected perpetrators of infanticide and illegal infant abandonment, and (d) compare the estimated Malaysian infanticide rates with the infanticide rates of countries occupying very high, high, medium, and low positions on the Human Development, Gender Inequality, and Gini (economic inequality) indices. Methods Data Sources Police Records. After a case of apparent infanticide or illegal infant abandonment is reported, an investigation file is opened. Police and forensic investigations are conducted by the Child Unit of the Sexual and Child Investigation Division (D11) of the Criminal Investigation Department (CID). The Child Unit of D11 has a presence in every district in Malaysia. Following forensic investigation at the scene, a live infant is placed in the care of social welfare services and a body is sent to a hospital for autopsy. Data from the police investigations and autopsies are recorded by the Criminal Records Unit. Since 2006, the reporting and recording system has been enhanced by the introduction of a nationwide computerized system called the Police Reporting System (PRS). Infants who are deposited at baby hatches are not recorded as cases of abandonment.

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Birth Registration. All live births in Malaysia are registered with the Births, Deaths, and Adoptions Unit, National Registration Department. International Comparison Data. Infanticide rates of countries occupying very high, high, medium, and low positions on the Human Development, Gender Inequality, and Gini Indices were retrieved from published journal articles, reviews, United Nations Development Program (UNDP) 2012 Report (2013), World Bank Indicators (World Bank, 2009, 2012), and the Organization for Economic Cooperation and Development (OECD) Factbook 2013 (2013). Human development is measured by the Human Development Index (HDI), a composite measure of three indicators: average life expectancy, average educational attainment, and population proportion with access to resources needed for a decent living (UNDP, 2013). Gender inequality is measured by the Gender Inequality Index (GII), which incorporates three dimensions of women’s development: reproductive health (measured by the maternal mortality ratio and the adolescent fertility rate), empowerment (measured by educational attainment of secondary level and above and parliamentary representation), and economic activity (measured by gender-specific labor force participation; Permanyer, 2013; UNDP, 2013). Economic inequality is represented by the Gini Index, which measures the extent to which the distribution of income or consumption expenditure among individuals or households within an economy deviate from a perfectly equal distribution (World Bank, 2012). Data Management and Analysis For this study, assistants were nominated by the Public Relations Department and the Child Unit of D11 to retrieve data on infanticide and illegal infant abandonment and by the Births, Deaths and Adoptions Unit, National Registration Department, to retrieve annual data on live births. Data from both sources were given to the researchers. Only summary data were available; they did not enable data linkage between characteristics of victims and of any adults suspected to be associated with the abandonment. Therefore, only descriptive analysis was planned. Furthermore, the summary data pertaining to victims was presented as baru lahir (meaning that distinctions between possible neonaticide and possible infanticide cannot be made), and the summary data pertaining to characteristics of infants found dead incorporated janin (making it impossible, in the analysis of associated data such as sex of the victim, to distinguish potential infanticide from miscarriage or abortion). From these initial data, we tabulated annual cases from 1999 to 2011 of illegal infant abandonment in general and the subcategory of abandoned infants found dead, as well as characteristics of victims and adults suspected to be associated with the abandonment. Before estimating rates of illegal infant abandonment in general and of infants found dead, cases classified as janin were deducted from the total. The infant abandonment ratios and ratios of infants found dead were then estimated in separate calculations by dividing the number of infants found illegally abandoned and the numbers found dead in each year by the number of live births. Each ratio was multiplied by 100,000 to yield annual rates of infant abandonment and the subcategory of abandoned infants found dead per 100,000 live births. These calculations are adapted from the international best practice of calculating infant mortality rates as number of deaths in the numerator and number of live births in the same period of ascertainment as the denominator (Department of Education and Early Childhood Development, Victoria, Australia, 2014; Department of Statistics Malaysia, 2012b; United Nations, 2003). The ratio was multiplied by 100,000 to generate rates that could be compared with international infanticide rates, which are usually reported per 100,000 live births (Friedman et al., 2005; Herman-Giddens et al., 2003; Porter & Gavin, 2010). The estimated rates were then descriptively compared with infanticide rates of other countries. The Spearman rank coefficient was calculated for estimated infanticide rates and (a) the Human Development Index, (b) the Gender Inequality Index, and (c) the Gini index. Ethical Approval This project was approved by the Medical Research and Ethics Committee, Ministry of Health, Malaysia, the Medical Research and Ethics Committee, Universiti Teknologi MARA, Malaysia, and the Monash University Human Research Ethics Committee, Melbourne, Australia. Results The police database yielded summary information from 1999 to 2011 on the total cases of illegal abandonment; number of victims found dead; victims’ developmental stage and sex; suspected perpetrators’ age, sex, and ethnicity; suspected perpetrator-victim relationship; and descriptions of the locations where the infants or bodies were found. Few details about the victims and even fewer about the suspected perpetrators had been recorded. For the 13 years 1999–2011 a total of 1096 cases of illegal infant abandonment were documented. Within the same period, a total of 1147 individuals were arrested and investigated as suspected perpetrators. Summary data of live births were provided only for 2007–2011. Estimated Rates of Infanticide and Illegal Infant Abandonment On average, 84 cases of illegal infant abandonment were documented annually in Malaysia from 1999 to 2011, ranging from 65 cases in 2000 to 102 cases in 2008 (see Fig. 1). The estimated infant abandonment rate in Malaysia for the most recent five-year period ranged from 12.81 to 17.49 per 100,000 live births. The estimated rate of inferred infanticide (abandoned

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Fig. 1. Annual numbers of infants found abandoned in Malaysia 1999–2011.

infants found dead, excluding janin) ranged from 4.82 per 100,000 live births (2007) to 9.11 per 100,000 live births (2011; see Table 1). Inter-country Comparisons of Infanticide Rates and Positions on the Human Development, Gender Inequality, and Gini Indices Malaysia has lower (inferred) infanticide rates than China, India, and Tanzania but higher rates than Finland, Australia, New Zealand, the United States, and the United Kingdom. Malaysia has slightly higher economic inequality, measured by the Gini Index, than countries with lower infanticide rates (see Table 2). The estimated infanticide rates were found to be inversely correlated with the Human Development Index (r = −0.828; p = 0.006) and positively correlated with the Gender Inequality Index (r = 0.862; p = 0.003). There was no significant correlation between the estimated infanticide rate and the Gini Index. Table 1 Numbers of illegally abandoned infants and estimated rates of illegal infant abandonment and infanticide 2007–2011. Year

Janin excluded

Infants found alive

Infants found deada

2007 2008 2009 2010 2011

11 14 12 16 12

41 46 37 40 38

24 42 30 35 48

a b c d

Total abandoned infantsa 65 88 67 75 86

Live birthsb

497,638 503,165 522,756 510,462 526,632

Estimated illegal abandonment rate (per 100,000 live births) c 13.06 17.49 12.81 14.69 16.33

Estimated inferred infanticide rate (per 100,000 live births)d 4.82 8.35 5.74 6.86 9.11

Excluding janin: product of miscarriage or abortion. Data from department of statistics. Estimated infant abandonment rate = total N abandoned infants (found alive and found dead, excluding janin) per year/N live births per year × 100,000. Estimated inferred infanticide rate = Infants found dead (excluding janin) per year/N live births per year × 100,000.

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Table 2 Correlation between infanticide rates and Human Development Index, Gender Inequality Index, and Gini Index of selected countries. Country Finland Australia New Zealand United States United Kingdom Malaysia India China Tanzania Spearman correlation (r)

Infanticide rate

Human Development Index

0.8a 2.7b 4.5c 2.1–6.9c 4.3–6.3c 4.82–9.11 12.3d 15.5d 27.7e

0.89f 0.94f 0.92f 0.93f 0.87f 0.76f 0.46g 0.59g 0.61f −0.828*

Gender Inequality Index 0.08h 0.14h 0.20h 0.29h 0.21h 0.28h 0.64i 0.58j 0.35h 0.862*

Gini Index 26k 34k 33k 38k 34k 46l 33m 43n 37o 0.511

Notes: Infanticide rates (per 100,000 live births) from: a Putkonen et al. (2009). b De Bortoli et al. (2013). c Porter and Gavin (2010). d Reza et al. (2001). e Outwater et al. (2010). The Human Development Index (HDI) can take values from 0 to 1, where 1 equals the highest potential human development. HDI is categorized as Very High (HDI ≥ 0.80), High (HDI 0.71–0.80), Medium (HDI 0.53–0.71), and Low (HDI < 0.53) (UNDP, 2013). f HDI for 2010, the year for which infanticide rates have been published. g HDI for 2000, the year for which infanticide rates have been published. The Gender Inequality Index (GII) can take values from 0 to 1, where 1 equals maximum potential inequality between women and men (UNDP, 2013). h GII for 2010, the year for which infanticide rates have been published. i GII for 2005, the only year for which it is available. j GII for 2000, the only year for which it is available. The Gini Index is a measure of economic inequality, the result of multiplying the Gini coefficient by 100. The Index can take values from 0 to 100, where 100 equals maximum potential economic inequality. k Gini Index for 2010 (Index results from OECD, 2013). l Gini Index for 2009, the only year for which it is available (Index results from World Bank, 2012). m Gini Index for 2005, the only year for which it is available (Index results from World Bank, 2012). n Gini Index for 2002, the only year for which it is available (Index results from World Bank, 2012). o Gini Index for 2007, the only year for which it is available (Index results from World Bank, 2012). * P < 0.01.

Characteristics of Victims Because only aggregate figures were available, victims classified as janin could not be excluded from the descriptive data presented here. Developmental Stage and Sex. Of the total 1,096 victims, 601 (54.8%) were found alive, 978 (89.2%) were classified as baru lahir, and 118 (10.8%) were classified as janin. Sex was given for 833 (76.0%) victims: 452 were male and 381 were female (see Table 3 for details). Place of Abandonment. About 1 in 5 (235: 21.4%) of the 1,096 victims were found in the vicinity of a dwelling. Others were found by a roadside (100: 9.1%), in a garbage dumping area (98: 8.9%), at a place of worship or religion (82: 7.5%), by a river, pond, or beach (77: 7.0%), in bushes (63: 5.8%), in a toilet or sewer (60: 5.5%), or at a school or student dormitory (10: 0.9%). Less common sites included a hospital, clinic, bus station/stop, parking area, school compound, playground, and graveyard. Characteristics of Suspected Perpetrators Despite recording that 1,147 suspected perpetrators were arrested and that each case was investigated, data were documented for only about 20% of the suspects. It was not possible to establish the number of victims with which these 1,147 suspected perpetrators were associated. Of the 224 identified suspects for whom age was recorded, 110 were aged 18–25 years and 39 were younger than 18 years. Sex was stated for 248 suspected perpetrators; the majority (189) were female and 59 were male. Ethnicity was also identified for 248 suspected perpetrators: 192 were citizens of Malaysia (168 Malays, 13 Indian, and 11 Chinese) and 19 were non-citizens (16 from Indonesia, 22 from Myanmar, and 1 from the Philippines). Data about occupation were available for 146 suspected perpetrators, of whom the majority were students (43) or non-professionals (39). Characteristics of suspected perpetrators can be found in Table 3. Relationship Between Victim and Suspected Perpetrator Of the total adults arrested in connection with the abandonment, details of their relationship to the victim were recorded for only 220 cases: 164 were mothers, 38 were fathers, 1 was a grandfather, and 1 was a grandmother. The remainder (n = 16) were categorized as other. The number of victims associated with these 220 perpetrators was not specified.

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Table 3 Characteristics of suspected perpetrators and victims 1999–2011. Characteristics of suspected perpetrators (N = 1147)

N (%)

Age • Unknown • 25 yrs Sex • Unknown • Female • Male Ethnicity • Unknown Citizen = 229 • Malay • Indian • Chinese • Other Non-citizen = 19 • Indonesian • Myanmarian • Filipino Occupation • Unknown • Student • Nonprofessional • Unemployed • Private sector • Public service • Self-employed • Other

1001 (87.3%) 43a 39a 17a 14a 9a 9a 15a

Characteristics of victims (N = 1096)

N (%)

Developmental stage • Baru lahir: up to 12 months • Janin: product of miscarriage or abortion Condition • Alive • Dead Sex • Male • Female • Unknown a

923 (80.5%) 39a 110a 75a 899 (78.4%) 189a 59a 899 (78.4%) 168a 13a 11a 37a 16a 2a 1a

978 (89.2%) 118 (10.8%) 601 (54.8%) 495 (45.2%) 452 (41.2%) 381 (34.8%) 263 (24.0%)

Frequency too low to be presented as a percentage.

Discussion This study is, to our knowledge, the first systematic review of official data on infanticide and illegal infant abandonment in Malaysia. The study was made possible by continuing development and improvement in Malaysia’s overall reporting and surveillance of infanticide and illegal infant abandonment and the willingness of relevant authorities to permit the available data to be used for scholarly research. There is, however, an exceptionally high percentage of undetermined data, partly because progress in this area is very recent. A major limitation, possibly reflecting the recent development in reporting, is lack of clarity in definition. That an infant had been abandoned was evident. Nevertheless, even when an infant was found alive, the summary data did not allow distinction by age, with all being described as baru lahir: effectively, from newborn to one year of age. Data for those found dead were even more ambiguous, with summary data encompassing potential neonaticide, potential infanticide, and janin. It can be difficult to make distinctions more confidently because, when infants are not found alive, decomposed remains are frequently discovered, yielding inconclusive autopsy results on cause of death (Ong & Green, 2003). DNA analysis has rarely been used in investigating infanticide and illegal infant abandonment cases in Malaysia, making the parents difficult to identify. Without parental identification, there is limited opportunity to investigate background or details of specific cases, which might support any tendency to assume that the infant’s mother is responsible for abandonment or death. The lack of documentation, especially of details of those arrested in connection with abandoned or murdered infants, means that characteristics of those who commit such crimes cannot yet be ascertained with confidence. It suggests that implementation of protocols for collection, recording, and reporting of data might require review. Evidentiary problems in reporting autopsy data for neonaticide and infanticide are well documented elsewhere (Beyer et al., 2008; Herman-Giddens et al., 2003; Shelton et al., 2011). Wilczynski (1994) concluded that limited data and lack of

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confidence in the quality of available data at every stage in investigating infant abandonment and infanticide contribute to unwillingness by relevant authorities to pursue formal forensic processes and to bring cases to court. It is likely that arrest bias, previously identified in North America (Maxfield, Weiler, & Widom, 2000; Schulenberg, 2014), contributes to the limited data available in Malaysian police records. When police must decide where to search for suspected perpetrators, whom to arrest, and which charges to file, arrest and record-keeping are open to influence by gender, race, socioeconomic status, and assumptions about the type of person most likely to commit the offense. There is evidence that women are assumed to be the most likely perpetrators of infanticide (Friedman & Resnick, 2009; Porter & Gavin, 2010) and that marginalized people are assumed to be perpetrators of crime (Sealock & Simpson, 1998). It is possible internationally that abandoned infants who have died from neglect and exposure or murdered infants whose bodies are concealed are not discovered and that official statistics underestimate the incidence of infant abandonment and infanticide. It is also possible that the rate of infanticide in Malaysia is an overestimate because, despite excluding janin from the total, some infants might have died from unascertainable causes other than infanticide. Nevertheless, the task of recording, interpreting, and (if possible) intervening in the phenomena of infanticide and illegal infant abandonment must proceed with the data in hand. It is thus justifiable to advance some modest interpretations of the available Malaysian data. Malaysia’s social and economic position is pertinent to this endeavor. Malaysia has had notable economic success, with an average of 3.6% annual growth in gross national income from 1990 to 2012 (UNDP, 2013). Within this period, Malaysia has been acknowledged as one of 15 countries categorized by the United Nations as high achievers in human development (UNDP, 2013). Countries with a very high HDI, such as Australia, New Zealand, Finland, United States, and United Kingdom, tend to have low rates of infanticide (De Bortoli, Coles, & Dolan, 2013; Porter & Gavin, 2010; Putkonen, Weizmann-Henelius, Lindberg, Eronen, & Hakkanen, 2009). Countries with a lower HDI, such as China, India, and Tanzania, tend to have higher rates of infanticide (Outwater et al., 2010; Reza, Mercy, & Krug, 2001). The implication to be drawn is that exposure to the social and economic adversities which contribute to low life expectancy, inequitable opportunities for education, and insufficient resources on which to live also increase risk of unwanted pregnancies or incapacity to care appropriately for an infant, which are recognized risks for infanticide (Friedman et al., 2005; Porter & Gavin, 2010). Despite its great achievement, it is evident that estimated rates of infanticide and illegal infant abandonment in Malaysia have not yet decreased. This suggests that progress in social development might not have kept pace with the rapid progress in economic development that Malaysia has achieved. In common with other countries, income is not evenly distributed in Malaysia. The predominant ethnic group in the population, Malay-Bumiputera, had the highest incidence of poverty in 2009 (5.3%), followed by Malaysian Indians (2.5%) and Malaysian Chinese (0.6%) (Department of Statistics Malaysia, 2012a). Poverty is more prevalent in rural areas (8.5%) than urban areas (1.7%) in Malaysia; rurality and ethnicity overlap, with rural areas occupied predominantly by Malay-Bumiputera (Department of Statistics Malaysia, 2012a). Since 2005, the concept of poverty in Malaysia has been revised and a national indicator has been used which takes into consideration the size, demographic composition, and location (urban/rural) of each surveyed household. The incidence of poverty calculated using the revised indicator is slightly different from the incidence estimated internationally by the World Bank (Department of Statistics Malaysia, 2012a; UNDP Malaysia, 2007). Malay-Bumiputera also had the lowest mean gross household income in 2009 (RM 3624) in comparison with Malaysian Indians (RM 3999) and Malaysian Chinese (RM 5011; Department of Statistics Malaysia, 2012a). The greater proportion of Malay-Bumiputera among identified suspects in cases of infant abandonment is to be expected, given the population distribution. However, the high rates of illegal abandonment and inferred infanticide may be a product of poverty. Economic barriers not only limit purchasing power for basic necessities but also reduce access to the social protections of primary and secondary education and comprehensive health services. Acting in concert with economic inequity in Malaysia is the position of women in this traditional society. In Malaysia, 91.1% of the female population aged 6 years and older are attending or have attended school, and more women than men aged 15 years and older have completed tertiary education (Department of Statistics Malaysia, 2013). However, there is evidence of limited knowledge of sex and reproduction, especially among teenagers (Low, 2009; Low, Zulkifli, & Yusof, 1994). Malaysia’s comparatively high score on the Gender Inequality Index suggests that work remains to be done in order to approach social equality between the sexes. Inequalities experienced by women within marriage and in education, employment, property, and political participation (Department of Statistics Malaysia, 2013; Ismail & Jajri, 2012; OECD, 2013) limit their access to appropriate services and sources of support. These inequalities also reduce women’s capacity to make autonomous decisions about fertility management and reproductive health and to be able to access the care that is needed to maintain physical and psychological health. Intimate partner violence (Othman & Adenan, 2008; Yut-Lin & Othman, 2008), rape, incest (WAO, 2011), adolescent pregnancy (Shah, 2014), and violence against migrant workers in Malaysia may also contribute to unwanted pregnancy and thus to infanticide (Friedman et al., 2005; Porter & Gavin, 2010). Only about 30% of married women in Malaysia use modern contraceptive methods, such as the oral contraceptive pill or intrauterine device; this appears to be because of cultural constraints and myths, fears of side effects, limited commitment by men to contraception, and inadequate access to reproductive health care (Najafi, Abdul Rahman, & Hanafiah Juni, 2011). Lack of access to effective contraception increases the likelihood of unintended and unwanted pregnancy, which has been identified as a contributor to infanticide (Friedman & Resnick, 2009). According to the National Registry Department Malaysia, an average of 2,500 ex-nuptial babies are born each month (Nasir, 2010). Malaysia does not prohibit abortion (s312, Penal Code Amendment Act 1989) and Islamic leaders have agreed to permit abortion to protect women’s physical and psychological health. However, many women continue to perceive

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abortion as illegal and sinful, and abortion is rare in Malaysia (Whittaker, 2012). At the same time, an ex-nuptial child is a particular source of stigma and discrimination for women in Islamic cultures that proscribe premarital sexual relationships; women with an ex-nuptial child in Malaysia can be expected to be overwhelmed by shame (malu) because Malay Muslim society might condemn her for heinous behavior. Concealment of extra-marital sexual activity is far more possible for her male sexual partner. Women’s sense of being stigmatized when they have an ex-nuptial infant has been shown to be associated with infant abandonment and infanticide, for example in Jamaica (Altink, 2007). The strong influence of Malaysian culture and tradition (adat) on the predicament of single pregnant women is illustrated in the Malay proverb “Biar mati anak, jangan mati adat”: “Let children die as long as our traditions live on.” The greater susceptibility of female infants to infanticide has been described in China and India (Cheng, 2006; DiamondSmith et al., 2008; George, 2006; Hesketh et al., 2005). However, the available Malaysian data reveal no greater likelihood that female babies will be abandoned or killed, with more than half of the abandoned infants for whom sex was identified being male. Furthermore, although the populations of China and India contain a higher than expected proportion of men than women (George, 2006; Kaufman, 2012), the sex ratio in the Malaysian population has remained within global norms (Department of Statistics Malaysia, 2012b; United Nations, 2013). Conclusion The outcomes of this investigation of infanticide and illegal infant abandonment in Malaysia, including its limitations, are in keeping with what has been found internationally. When they become available, other data sources (such as psychiatric, forensic, judicial, and children services records) will enrich evidence available to future researchers. Two main conclusions can be drawn. The first, and most specific, is that reporting and surveillance systems for infanticide and illegal infant abandonment in Malaysia, which have advanced substantially in recent years, might require stronger implementation protocols. It appears, in particular, that data collected during police investigations of suspected perpetrators are not recorded consistently or comprehensively on the national database. 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