ABSTRACT
Background:
Death is unnatural and suspicious when it is caused by external causation like injury or poisoning or other than natural course. In such deaths of married females, the inquest is carried out, and a medico-legal autopsy is conducted to ascertain the cause of death and manner of death.
Materials and Methods:
This record-based, retrospective study was carried out at RVRS Medical College, Rajasthan in the year 2021 (1st January, 2021 to 31st December, 2021) to know the pattern of the suspicious death of married females brought for medico-legal autopsy. The inquest report, medico-legal autopsy report, histopathological examination report, and chemical analysis report findings were tabulated and analyzed.
Results:
The maximum number (31.62%) of female deaths belonged to the age group of 18–22 years of age. A total of 33.82% of females died during a marriage duration of less than 5 years of married life. A total of 22.79% of female deaths were related to dowry and 60.2% of females belonged to rural areas. A total of 59.56% of females were died due to poisoning and 75% of female deaths considered suicidal.
Conclusion:
Suspicious deaths of married women brought for medico-legal autopsy must be dealt with due to precaution to determine the cause and manner of death. One must be vigilant that the suspicious death of a married female may be associated with dowry in the Indian scenario.
Keywords: Death, female, inquest, married, medico-legal autopsy, suspicious death
Introduction
Death is unnatural and suspicious when it is caused by external causation like injury or poisoning or other than natural course. Death due to intentional elements such as homicide or suicide and death caused by unintentional elements such as an accidental manner are medico-legal cases.[1] Violence against married women leading to deaths has been reported in many countries across the globe including India.[2,3] In all unnatural and suspicious deaths of married females, the inquest is carried out, and a medico-legal autopsy is conducted to ascertain the cause of death and manner of death. Primary care physician working in primary healthcare setup has to deal with such cases as and when brought to the center. Women are one of the most vulnerable groups in terms of violence in India.[4] The United Nations General Assembly (1993) defined the term violence against women as any act of gender violence that results in physical, sexual, or psychological harm to women.[5] Many times married female deaths are related to dowry. Lack of awareness regarding the legislation associated with dowry, girls’ education, and job opportunities are major reasons behind dowry deaths in India.[6] Regular amendment of the legislative structure in case of dowry to seek proper justice resulted in decreasing rate of dowry deaths in India.[6] Burning, poisoning, hanging, etc., are various means of dowry deaths.[7] This article represents a pattern of the suspicious death of married females brought for medico-legal autopsy.
Materials and Methods
This is a record-based and retrospective study carried out at RVRS Medical College, Bhilwara, which is situated in the Rajasthan state of India to know the pattern of the suspicious death of married females brought for medico-legal autopsy. RVRS Medical College is permitted by the National Medical Commission, India, and it is affiliated with Rajasthan University of Health Sciences, Rajasthan, India. All the suspicious deaths of married females in RVRS hospital in the year 2021 (1st January, 2021 to 31st December, 2021) were studied as per the inquest report, medico-legal autopsy report, histopathological examination report, and chemical analysis report. All medico-legal autopsies were carried out as per the Covid-19 guidelines by taking complete precautions as per the guidelines like wearing a complete PPE kit. The decision was taken on a case-to-case basis either for a thorough, meticulous autopsy, or a minimally invasive autopsy as well as for the preservation of viscera. Major organs like the brain, heart, lungs, liver, spleen, and kidneys were routinely preserved during autopsy in 10% formalin for histopathological examination when necessary, which was carried out by Pathology Department. For chemical analysis, routinely three bottles containing the stomach, a loop of small intestine with its contents in the first bottle, slices of liver and both kidneys in the second bottle, and blood in the third bottle were preserved. A common preservative for chemical analysis was the saturated solution of common salt. Bottles were sealed, labeled, and handed over to investigating officer to deliver to the Forensic Science Laboratory for chemical analysis. The age of females, marriage duration, geographical distribution, and death were related to dowry or not, and the cause and manner of death were studied as per inquest and medico-legal autopsy report. Findings were tabulated and analyzed.
Results
The maximum number (31.62%) of female deaths belonged to the age group of 18–22 years followed by less than 18 years of age (19.85%) and least from the age group of 43–47 years (2.21%), and 58 years and more (2.21%) as per Table 1.
Table 1.
Age distribution of married female deaths as per inquest
| Age group (Years) | Number of cases | Percentage |
|---|---|---|
| <18 years | 27 | 19.85 |
| 18–22 years | 43 | 31.62 |
| 23–27 years | 22 | 16.18 |
| 28–32 years | 15 | 11.02 |
| 33–37 years | 6 | 4.41 |
| 38–42 years | 9 | 6.62 |
| 43–47 years | 3 | 2.21 |
| 48–52 years | 4 | 2.94 |
| 53–57 years | 4 | 2.94 |
| >58 years | 3 | 2.21 |
| Total | 136 | 100 |
A total of 33.82% of females died during a marriage duration of less than 5 years of married life followed by 22.06% of females in which marriage duration was not known while 7.35% died during a marriage duration of 15–19 years and 7.35% of 20 years and more [Table 2].
Table 2.
Marriage duration as per inquest
| Marriage duration (Years) | Number of cases | Percentage |
|---|---|---|
| <5 years | 46 | 33.82 |
| 5–9 years | 25 | 18.38 |
| 10–14 years | 15 | 11.03 |
| 15–19 years | 10 | 7.35 |
| >20 years | 10 | 7.35 |
| Not known | 30 | 22.06 |
| Total | 136 | 100 |
A total of 60.2% of females belonged to the rural area while 39.71% of females belonged to the urban area as per Table 3.
Table 3.
Geographical distribution as per inquest
| Geographical distribution | Number of cases | Percentage |
|---|---|---|
| Urban | 54 | 39.71 |
| Rural | 82 | 60.29 |
| Total | 136 | 100 |
A total of 57.35% of female deaths had no relation to dowry, but 22.79% of female deaths were related to dowry while 19.85% of female deaths were not known as per inquest [Table 4].
Tables 4.
Death in relation to dowry or not as per inquest
| Death in relation to dowry as per inquest | Number of cases | Percentage |
|---|---|---|
| Yes | 31 | 22.79 |
| No | 78 | 57.35 |
| Not known | 27 | 19.85 |
| Total | 136 | 100 |
A total of 59.56% of females died due to poisoning, 16.91% of females died due to hanging while only 3.67% died due to mechanical injuries as per Table 5.
Table 5.
Cause of death after medico-legal autopsy
| Cause of death | Number of cases | Percentage |
|---|---|---|
| Burns | 11 | 8.08 |
| Hanging | 23 | 16.91 |
| Drowning | 7 | 5.14 |
| Poisoning | 81 | 59.56 |
| Mechanical injuries | 5 | 3.67 |
| Natural | 9 | 6.62 |
| Total | 136 | 100 |
A total 75% of female deaths considered as suicidal, 16.18% were accidental, 6.62% were natural, and 2.20% were homicidal as per Table 6.
Table 6.
Manner of death after medico-legal autopsy
| Manner of death | Number of cases | Percentage |
|---|---|---|
| Suicidal | 102 | 75.00 |
| Homicidal | 3 | 2.20 |
| Accidental | 22 | 16.18 |
| Natural | 9 | 6.62 |
| Total | 136 | 100 |
Discussion
In our study, the maximum number (31.62%) of female deaths belonged to the age group of 18–22 years, which can be correlated with other studies.[1,3] In a study by Gupta M, et al.;[3] most commonly affected age group was 21–40 years (54.60%). Together, the two age groups, i.e., 13–20 years and 21–40 years, constituted an alarming 74.25% of the total female cases. As per Kitulwatte I.D.G., et al.,[1] 37% belonged to 21–40 years of age and 51% were below 40 years of age out of the 139 deaths reported for medico-legal examination.
A total of 33.82% of females died during a marriage duration of less than 5 years. Suspicious death of a woman within 7 years of her marriage duration and death is associated with demand of dowry then such deaths are termed as dowry death. Imprisonment for a minimum of 7 years which may extend to imprisonment for life can be awarded for dowry death.[8]
A total of 60.2% of females belonged to the rural area while 39.71% of females belonged to the urban area, which can be correlated with another study.[3] In a study by Gupta M, et al.,[3] 86.92% of females belonged to rural areas.
A total of 57.35% of female deaths had no relation to dowry but 22.79% of female deaths were related to dowry as per inquest. Dowry death is a burning day-to-day problem in the Indian society. Improvement in the educational status of the females and providing easier job opportunities at the doorstep or self-employment facilities among women will help to restrict the incidences of dowry deaths.[8] Torture and violence are associated with humans since the beginning[9] and are associated with dowry death too. Illiteracy is considered one of the fundamental elements in Indian society that is leading to an increase in dowry deaths in India.[6] The authority to decide a “dowry death” follows complex social processes, but the police are important arbiters.[7]
The Protection of Women from Domestic Violence Act, 2005 defines violence as any act, omission or commission, or conduct of any adult male person of the family, which harms or injures or endangers the health, safety, life, limb, or well-being, whether mental or physical of the women or tends to do so and includes causing physical abuse, sexual abuse, verbal and emotional abuse, economic abuse, and harassment or coercion to meet any unlawful demand for any dowry constitutes domestic violence.[10,11] Crime scene investigation plays an important role along with medico-legal autopsy in the suspicious death of young married females.[12]
Maximum (59.56%) females died due to poisoning while in a study by Gupta M, et al.,[3] only 7.88% died due to poisoning. As per the study of Kitulwatte I.D.G., et al.,[1] 31% of deaths were due to poisoning and 26% were due to hanging among all suspicious suicides of women.
Maximum (75%) female deaths were considered as suicidal, which is similar to a study done by Gurbani V (2018)[13] in which 47.9% of deaths were suicidal in nature. As per the study of Kitulwatte I.D.G. et al.,[1] 32% of deaths were suicidal in nature and 40% were accidental deaths. The homicidal, suicidal, and accidental deaths were 87, 129, and 240, respectively, out of total 456 unnatural female deaths in Lucknow as per Kumar S, et al.[14]
A medico-legal autopsy is a requirement for confirming or correcting clinical diagnosis, and determining the cause and manner of death along with the inquest. It is very helpful for the betterment of justice in the court of law by determining the exact cause of death.[15] Proper training of the investigating officers who conduct the inquest, proper methodical crime scene investigation in the necessary case, and a thorough medico-legal autopsy is required to overcome the discrepancies observed between the investigating officer and the doctor in ascertaining the cause of death and manner of death in all unnatural community deaths in India.[16] In India, medico-legal autopsies are also conducted by physicians working in the primary healthcare setup. To deal with the suspicious death of married female, regular training of medical officers are necessary to enhance their autopsy skills.
Conclusion
Suspicious deaths of married women brought for medico-legal autopsy must be dealt with due to precaution to determine the cause and manner of death. The correlation of inquest findings with medico-legal autopsy reports along with proper crime scene investigation is essential in delivering justice. One must be vigilant that the suspicious death of a married female may be associated with dowry in the Indian scenario.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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