Death is called unnatural if it results directly from an injury or poison, or indirectly by an injury which may precipitate pre-existing natural disease in an individual. In other words, death is unnatural when caused precociously against the order of nature; this could be suicidal, homicidal, accidental or of unexplained origin [1]. Death is a tragedy and unavoidable inevitable fate of human life. Death occurs by two ways either by natural and unnatural. Natural deaths are due to any pathology (disease) or ageing [2,3].

Death of a female in a family especially by unnatural deaths will affect the productive years of survivors of family. Unnatural deaths due to any kind of cause will have a serious psychological and social impact on the family and community [4]. These unnatural deaths in society are indirect reflection of the prevailing social setup and mental health status of the population. Post mortem autopsy of unnatural deaths will definitely aid in the analysis of deaths [5]. According to the National Family Health Survey (NFHS-5), conducted from 2019 to 2021 in 29 states and 7 union territories of India, unnatural mortality was found to make up to 10.3% of total deaths [6]. It was greater among the population aged between 10 and 45 years. In India, the unnatural mortality rate was 0.67 per 1000 population, 0.84 per 1000 among the male population and 0.49 per 1000 among the female population [6]. In India, the National Crime Records Bureau (NCRB) statistics showed a consistent, concerning rise in suicide rates from 9.9 per lakh in 2017to 12.4 per lakh in 2022 [7]. It is usually required to hold an inquest to determine the cause and manner of death if death occurs unexpectedly or in unusual circumstances [8]. Unfortunately, many cases of female victimization are often underreported. This study highlights to determine the pattern of unnatural deaths among females by analyzing the precipitating factors, time and cause of death, including suicides, homicides, and accidents.

MATERIALS AND METHODS:

Study Design & Settings:

This is a retrospective cohort study conducted on all female patients deceased by unnatural death in and around Kadapa, Andhra Pradesh. The study has been carried out in department of Forensic Medicine of Government Medical College, Kadapa, Andhra Pradesh. An informed consent was taken from the study population prior to the study. All the patient details were kept unlinked anonymously. A total of 115 cases according to inclusion criteria were further studied in this research work.

Study period: 01 year (January 2023 to December 2023).

Inclusion criteria: All the female patients who were died in unnatural circumstances, registered under medicolegal and brought to mortuary were included in this study.

Exclusion criteria: All natural deaths and decomposition cases among females where the cause of death could not be determined were excluded.

Data collection: Data pertaining to inquest report, first information report, statements made by the relatives and eyewitnesses, hospital records, and post mortem examination reports were collected along with general demographic data.

Statistical analysis: The data was entered into Microsoft excel sheet and calculated the results. The statistical analysis such as mean ± standard deviation, frequency, and percentages done in Microsoft excel.

RESULTS:

During the study period, out of 543 autopsies conducted in the mortuary of the Government General Hospital, Kadapa, 410 (75.5%) were male cases and 133 (24.4%) were female. Out of 133 cases, 115 (86.4%) cases were unnatural deaths and 18 (13.5%) were natural deaths. Out of 115 unnatural deaths, 112 were known females and 03 were unknown.

The maximum number of unnatural deaths among females occurred in the age group of 21–30 years, i.e., 25 out of 115 cases, constituting 22%, and the least number of cases i.e., 2%, are observed in the age group of  >80 years (Fig 1).

Fig 1. Age distribution of unnatural deaths among females

In this study, 75 out of 115cases (65%) are registered from the rural population. Most of the unnatural deaths occurred in married women, i.e 61% (70 out of 115 cases), followed by widows, i.e 22% (25 out of 115 cases) and the least cases are observed in unmarried females, i.e 13% (17 out of 115 cases). Females who are working as coolie are most common victims of unnatural deaths i.e., 38 % (44 out of 115 cases), followed by homemakers i.e., 37% (43 out of 115 cases).

Table 1. Occupation of study population

Most common precipitating factors behind the unnatural deaths among females were falling ill and family problems. In some cases accounting to 33.9% we were unable to find the precipitating factors (Table 2).

Table 2. Analysis of precipitating factors among female unnatural deaths

Precipitating factors other than road traffic accidents and railway accidents are mainly due to Ill health, constituting 34% (39 out of 115 cases), 21% (24 out of 115) due to family problems, the least number of cases, i.e., 01 case is due to depression (Fig 2).

Fig 2. Time of death in the study population

In this study, most of the unnatural deaths observed are due to consumption of poisonous substances, i.e., 32% (37 out of 115 cases), followed by road traffic accidents, i.e 28% (32 out of 115 cases) (Fig 3).

Fig 3. Cause of unnatural deaths among females

DISCUSSION:

The present study is a retrospective study of unnatural deaths among female cases which were autopsied at the mortuary, GGH, Kadapa. A total of 115 cases of unnatural female deaths were analyzed for the past 01 year. Male predominance was observed and 24.4% of autopsies during one year period were unnatural deaths of females. Out of 115 cases, the maximum number of cases was between 21 to 40 years of age. These findings were consistent with the findings of Akhilesh Pathak et al [9] and the Sane et al [10] and the study by Kitulwatee et al [11]. Rajindran R et al [12] did a study on unnatural deaths in adult females aged above 18 years noted 13.04% of unnatural deaths and predominant cases were belonged to the age group of 18 to 30 years (50.1%). A study in Central India was also noted the most common age group is 21 to 30 years [13].

In this study, most cases, i.e., 61% (70 out of 115), were from the married age group, which is consistent with the findings of Sujatha PL [14] and Akhilesh Pathak [9]. Borkar JL et al [13] reported that the majority of the deceased were married (n=149, 73.04%), followed by 22% for 0-7 years and 20% for 8-14 years. Few research works also stated that unnatural deaths of females were common in married women [15-17].

In the present study, it is observed that a maximum number of unnatural deaths were coolies i.e., 38 % (44 out of 115 cases). Borkar JL et al [13] observed the majority of the deceased were house-wives (n=91, 44.61%). 26.96% of the deceased (n=55) were employed, 14.22% (n=29) were farmers, and 12.25% (n=25) were students. The occupation status of 4 (1.96%) females was not known. In the present study, most of the incidents of unnatural deaths occurred during 12:00 Noon To 06:00 pm, i.e., 43% (49 out of 115 cases). These findings are consistent with the findings of Sujatha P Let al [6].

The main cause of death is poisoning, constituting 32% (37 outof115cases), which is consistent with the study of Manogna SK et al [18] with the underlying precipitating factor mainly being ill-health. Majority of the unnatural deaths observed are due to consumption of poisonous substances, i.e., 32% (37 out of 115 cases), followed by road traffic accidents, i.e., 28% (32 out of 115 cases) as the present study (Table 3).

Table 3. Cause of unnatural deaths among females by various studies in India.

Our study findings are consistent with Narayankar P et al [19] and Parmar P et al [20]. Zohlupuii B et al [21] found hanging to be the most common suicidal method. The cause of the unnatural death is different in different studies; this variation might be due to the easy availability of low cost poisons, traffic in the regions, presence of water storage areas and the quality of life index in the community.

CONCLUSION:

Despite of implementation of stringent laws, policies, awareness programmes, providing education and employment opportunities for women, there is still a steady increase in the female unnatural deaths in recent years. In this study most common method of unnatural deaths is due to the consumption of poisonous substances, followed by road traffic accidents. This study will aid to reduce the avoidable unnatural deaths in females by implementing new health care policies, health awareness programme for females and improve the traffic rules and regulations to prevent the road traffic accidents by the state and central government authorities.

Despite some positive changes brought about by modernization, such as increased education and employment opportunities for women, the problem of unnatural deaths, particularly those related to crimes against women, is the area to be focused on in India. Research must be carried out to develop effective prevention and support strategies.

REFERENCES:

1. Meera T, Nandeibam P, Fimate L, Maring SK, Sangma M. Spectrum of unnatural female deaths in Manipur: a postmortem study. J Med Soc2015. 
2. Ahmed M, Rahman M, Hossain M. Pattern of unnatural death in two districts. TAJ. 1992;5:65-66.
3. Kumar MTS, Kanchan T, Yoganarasimha K, Kumar PG. Profile of unnatural deaths in manipal, Southern India. 1994-2004. Journal of Clinical Forensic Medicine. 2006;13:117-120.
4. Zine KU, Mugadlimath A et al. Study of some socio-etiological aspects of unnatural female deaths at government medical college, Aurangabad. Journal of Indian Academy of Forensic Medicine. 2009;31(3):210-7.
5. Chourasia S, Dhaka S, Rautji E, Radhakrishna K. Epidemiological profile of in-hospital deaths in a tertiary health care centre: a 3-year retrospective study and western maharastra. J Med Acad. 2020;3(2).
6. International Institute for Population Sciences(IIPS) and ICF. 2017. National Family Health Survey (NFHS-5), 2019-2021: India. Mumbai: IIPS.
7. National Crime Records Bureau (2022). Accidental Deaths and Suicides in India 2022. Ministry Of Home Affairs, Government of India, New Delhi.
8. 8.KSN Reddy. Essentials of Forensic Medicine and Toxicology.
9. Akhilesh Pathak, Shweta Sharma. The Study of Un-Natural Female Deaths in Vadodara City. Journal of Indian Academy of Forensic Medicine. 2010;32 (3): 220- 223.
10. Sane, Mandar, Karibasavaiah, Ananda. (2014). Unnatural Deaths Of Adult Females In South Bangalore: An Autopsy Study. Journal of The Indian Academy Of Forensic Sciences. 36. 130-132.
11. Kitulwatte, Indira Edirisinghe, Anuruddhi, Mendis, Pratheepa Pavithra KNL, Wijesinghe, Fernando, Anton, Abeyrathne M, Rishani AA. Study on The Pattern of Unnatural Deaths of Women Brought For Medico-Legal Autopsy. Sri Lanka Journal of Forensic Medicine, Science and Law. 2017;8:13-2.
12. Rajindran R, Sharma G, Yadav V, Saini H, Lamba R. Profile of unnatural deaths in adult females - A retrospective study conducted at a tertiary care hospital in Haryana. Indian J Forensic Community Med. 2024;11(2):56-59.
13. Borkar JL, Jaiswani AK, Jaiswani K. The pattern of Unnatural Deaths in Females in Central India. Sri Lanka Journal of Forensic Medicine Science & Law. December 2024;15(2):12-18.
14. Sujatha PL, Shankar BS, Shivakumar BC Shaji S. Profile of unnatural deaths in adult females in Bangalore North. Journal of Indian Academy of Forensic Medicine. 2022;44(1):40-43.
15. Dere RC, Rajoo KM. Study  of unnatural  deaths  in  females:  A  medicolegal  study  at  Rural  Medical  College,    Journal of Indian Academy of Forensic Medicine. 2011;33(3):211- 213.
16. Kumar A, Pandey SA. Prevalence of unnatural death  among  reproductive  aged  females  in  Varanasi  area;    International Journal of Science and Research.2014:3(6):2144-2147.
17. Accidental & suicidal deaths in India. 2007. National Crime Bureau of India.
18. Manogna S, Babu JS, V., Rao, C., GM, S.ARetrospective Study Of Postmortem Examinations at MGM Hospital, Warangal. Journal of Indian Academy of Forensic Medicine. 2024;46(2):227-231.
19. Narayankar P, Jagannatha S. An autopsy study of pattern of unnatural deaths among youth conducted at a tertiary care teaching hospital in South India. J Indian Acad Forensic Med. 2023;45(1):36-40.
20. Parmar P, Rathod G, Bansal P, Maru A, Pandya B, Bansal A. Pattern of suspicious deaths of married females brought for medico-legal autopsy at teaching institute of India. J Family Med Prim Care. 2023;12(9):2110-3
21. Zohlupuii B, Sungoh J, Meera T. Pattern of female deaths in Manipur: an autopsy based cross sectional study. Indian J Forensic Community Med. 2020;7(4):183-6.