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Unnatural Female Deaths within Seven Years of Marital Life: An Autopsy based Study

Unnatural female deaths pose a major challenge for society. The study was conducted on 644 unnatural female deaths during the calendar years from 2008 to 2012, in the Department of Forensic Medicine, Andhra Medical College. Women less than 29 years of age group, in the first three years of their marital life were the major victims in our study. Improving women literacy may give employment and there by economical independency of women.


Introduction
The complexity of "Unnatural female deaths within seven years of marital life" is so deep, as it involves study of human societies and cultures, marriage systems, customs of different religions of Indian society, civilization evolving through decades and psychology of Indian women. Population explosion, illiteracy and unemployment leading to poor socio economic status, fast urbanization with unequal opportunities for female and social dependency of women may be causing more women deaths after marriage. Sizeable sections of population still believe in the die-hard traditions of social customs in regards to dowry and caste. The statement made by Carl Marx "All the human relations are economical" 1 appears to be wise in respect to Indian marriages. In Indian society, ill adaptation of women to the changing social, economical and ethical environments increase the incidence of unnatural deaths when a female gets married and goes to her in-laws house. Failure to adapt to the husband, illegal affairs of spouses, new surroundings, and harassment from the in-laws often leads a married woman to extreme steps.
In Indian society the common methods adopted by women to commit suicide are burning by pouring inflammable liquids on the body, poisoning and hanging 2 . From Manual labour stage, the twentieth century opened up new professional avenues for women entering into the Indian Administrative Services, soft ware and other educational services in increasing numbers. 4 Even though educational and occupational opportunities are providing women with new roles outside the home, their social position in the family remains largely unchanged. They are still subordinate to husbands. Legal proceedings against the husband may mean her social ostracism as public opinion still places the man in the position of "LORD" for a wife.
The reports, statistical data, existing laws create an appearance that the position of women is better in India today. On close scrutiny one can find subordination and inequality of women still prevailing in society. The laws provide protection to women against injustice, exploitation, dowry and discrimination. But in practice, in cases where the female deaths have not occurred, the crimes are being diluted in local scenario itself. An economical dependency and traditions bound wife can hardly take resource to law even if she has a valid ground for divorce. With the advent of new technology and development of personalized mobile phones, the privacy and intimacy between two persons has lead to the development of unlawful relations between male and female causing disturbance to the family life and leading to female deaths.

Materials and Method
A total of 8521 Medico legal Post Mortem Examinations were conducted during calendar years from 2008 to 2012, in the Department of Forensic Medicine, Andhra Medical College, Visakhapatnam. Out of 8521 cases, 644 cases were unnatural women deaths within 7 years after marriage. The statistics of these unnatural deaths were analyzed with available data like inquest report, autopsy report, suicide notes, panchanama report and dying declaration.
Age of the person, incident time, date, month, and period of survival, cause of incident, cause, manner and place of death were studied.

Observations and Discussion
A total number of 8521 postmortems were conducted in the department of Forensic Medicine Andhra Medical College, Visakhapatnam. Among these, 644 cases of unnatural female deaths were recorded basing on the history given by the inquest report.
More number of unnatural female deaths were observed in the age group of <29 years (94.25%), among which 441 deaths were recorded in the age group of 20-29 yrs (68.47%) followed by <20 years (25.77%) and 30-39 years (5.74%). Post marital life pressure, financial problems; illegal affairs of either spouse in house may be responsible for more deaths in the age group of 20-29 years. Less number of deaths in 30-39 years can be explained on basis of adjustment of relation between husband and wife, better environment in in-laws house with time. Our study correlates with Naresh karukutla 5 and Sandhya arora 6 studies.
More number of unnatural female deaths occurred in in-laws and husbands place (86.18%) followed by victims parents residence (11.64%). As per Indian tradition staying with husband and in in-laws house is more common and coming back to victim's parent's residence is less. Our study correlates with Naresh karukutla 5 study.
Fire, while cooking or lighting kerosene lamps accounted more deaths (43.01%) followed by Husband and in law's harassment (31.52%). The other common predisposing causes were forced marriage (11.95%) and ill health (13.5%). This study correlates with Sandhya arora 6 and contrasts with Rajesh kumar varma etal 7 , Radhika R.H 8 .
Death in most of the cases was during day time from 6am to 6pm (58.53%). After quarreling, husband may go out on work and house wife staying alone are vulnerable to unnatural deaths in day time which correlates with Madar ramchadra sane 9 study.
In summer season more number of deaths were recorded (37.57%) followed by winter season (36.80%).
Among summer, May month recorded highest number (n=86) of deaths. More number of deaths in summer can be explained on basis of increased temperature causing more exhaustion, irritation, more family unions due to holidays, more friction in families due to discussion about dowry and financial issues.
Most of the victims (n=375) died within 72 hrs including 99 spot deaths. More fatality in early hours can be explained on basis of severity of injuries, disease and lack of proper health care facilities at village /mandal level implying the need to focus on patient care at early hours. This study correlates with Naresh karukutla etal 5 study.
Majority of the victims (81.52%) died after admission in to the hospitals followed by deaths at crime scene (16.30%). As explained earlier, Burns were the common cause of death where fatality is more common even in hospitals also. Services like 108 ambulances, arogyasri, are helpful to admit the victims in hospitals there by increased number of hospital admission and deaths. This study correlates with Naresh karukutla etal 5.
Maximum number of deaths occurred within first 3 years of marriage (51.08%). More deaths in first three years can be explained on basis of lack of awareness about marriage life, misunderstanding, financial problems, husband and in-laws harassment for dowry, ill adjustment in in-laws house, and extramarital affairs in early married life. Staying of newly married couple in female's house for first 3 years may decrease the unnatural female deaths. Deaths in 4 to 7 years (n=315) of married life may be due to problems of infertility and husband bad behavior, forced female feticide. Decreased number of victims in 4-7 years (n=315) may be due to better adjustment of couple, for the sake of children and emotional bonding of family members .This study correlates with Naresh karukutla et al, 5  Most of the victims died from Burns (74.06%) followed by Poisoning (16.45%). Burns as the common cause of death, can be explained on the basis of daily cooking, easy availability of explosive materials like gas cylinders and kerosene. More fatality in burns can be ascertained to loss of skin resulting in decreased resistance of the body to the micro organisms leading to septicemia, shock, multiple organ failure etc., which explains burns as predominant cause of death.This study correlates with Naresh 5 ,Sandhya arora 6 Rajesh c dere 10 ,Kailash u zine 11 ,.However M Ramachadra study 9 differs which states that Hanging was the most common cause of unnatural female deaths. Accidental Burns were common (56.18%) followed by suicides (39.20%).
Suicide is the most common manner of death (n=324) followed by accidental deaths (n =274).

Conclusions
1. <29 yrs of Age group is more vulnerable for unnatural female deaths.
2. Most of deaths occurred during the day time between 6:00am to 6:00 pm.
3. Summer recorded highest number of deaths, with peak incidence in May Month.

4.
Deaths occurred mostly in first 3years of marital life.

5.
Majority of deaths occurred at husband and inlaws home.
6. Most victims died in hospital, after admission with period of survival <72 hours.
7. Burns were the major cause of death.
8. Commonest manner of death is suicide.

Suggestions and Recommendations:
1. Women protection cells have to be established in all mandal /district headquarters. They should collect the statistical data of all the new couples of their region and counsel the couple in immediate post marital life problems.
2. All marriages have to be registered mandatorily either at panchayath, municipal or at registrars' offices wherever possible.
3. The society may be educated through audiovisual aids like T.V., Radio, Daily newspaper, Advertisements to prevent unnatural female deaths. 4. The Government should take personal protection measures for women to supply safety cooking devices, especially for low socio economical families. 5. Selling of pesticides and dangerous drugs should be stopped to women.
6. There is a great need for opening suicide prevention centers for prevention of suicides.

7.
Improving women literacy may give employment and there by economical independency of women.
8. Parents showing large gap of disparity between daughters and sons should be counseled to realize their responsibilities.
9. Educate the parents and counsel them to stop early marriages in girls.