Psychology Public Policy, and Law Copyright 2000 by the American Psychological Association, Inc.

2000, Vol. 6, No. 4, 1098-1112 1076-8971/00/$5.00 DOI: 10.1037//1076-8971.6.4.1098

THE SCIENCE OF INFANTICIDE AND

MENTAL ILLNESS
Velma Dobson and Bruce Sales
University of Arizona

Women who murder their children have been the subject of intensive media and
public scrutiny. Reactions have varied from horror at the cruelty of the act to
sympathy for the perpetrator, based on the belief that the mother must have been
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severely mentally disordered or at least suffering from a diminished mental capacity

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at the time of the offense. As a result, the English and American legal systems have
adopted very different legal responses to this crime. Underlying these legal positions
are assumptions about the effect of childbirth on mental status and the relation of
mental status to the legal criteria necessary to meet a legal defense (e.g., insanity)
or necessary to justify charging the offender with a lesser crime. This article
critically considers the scientific knowledge on infanticide and mental illness to
determine the appropriateness of these assumptions.

The Science of Infanticide And Mental Illness

In 19th-century England, the law dictated that any mother who killed her
infant should be tried for murder and, if convicted, should receive the same
sentence as any murderer, which was death. In practice, however, a woman who
committed infanticide was treated differently from other murderers. Juries rarely
convicted her of murder, judges disliked being forced to impose the death
sentence on her, and it was common practice for the Home Secretary to advise
commutation of the death penalty in such a case (Kellett, 1992). The reasoning
behind the leniency that juries showed toward mothers who killed their own
children was summarized by Abse (1967):
Those juries knew that at or about the time of birth, dogs, cats, sows, white mice,
rabbits . . . sometimes killed their own young. They were not prepared to extend
less compassion and concern to a mentally sick woman than they were to an
excitable bitch, (p. 316)
In 1872 and 1874, proposals for legislative reform were introduced to for-
malize the prevailing view that a woman who killed her child was temporarily
deprived of her self-control by an abnormal state of mind induced by childbearing
(Kellett, 1992). Neither of the proposals was adopted by the legal system, and it
was not until 1922 that the English Parliament enacted legal change, through
passage of the Infanticide Act (Bartholomew & Bonnici, 1965). The Act dictated

Editor's Note. Michael Perlin served as the action editor for this article.—BDS

Velma Dobson, Department of Ophthalmology and Department of Psychology, University of

Arizona; Bruce Sales, Department of Psychology, Department of Psychiatry, Department of Soci-
ology, and College of Law, University of Arizona.
Correspondence concerning this article should be addressed to Velma Dobson, Department of
Ophthalmology, University of Arizona, 655 N. Alvernon, Suite 108, Tucson, Arizona 85711-1824.
Electronic mail may be sent to vdobson@eyes.arizona.edu.

1098
 INFANTICIDE AND MENTAL ILLNESS 1099

that a mother who killed her child, and who showed evidence of mental distur-
bance at the time of the killing, should be tried and sentenced as if she had
committed manslaughter, not murder. In 1938, the Infanticide Act was revised to
its present form through the addition of a statement that lactation, as well as
childbirth, can be the underlying cause of the mother's mental disturbance and
through the restriction that the age of the victim had to be less than 12 months.
The exact wording of the Infanticide Act of 1938 is

Where a woman by any willful act or omission causes the death of her child being
under the age of twelve months, but at the time of the act or omission the balance
of her mind was disturbed by reason of her not having fully recovered from the
effect of giving birth to the child or by reason of the effect of lactation consequent
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upon the birth of the child, then, notwithstanding that the circumstances were such
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that but for this Act the offense would have amounted to murder she shall be guilty
of felony, to wit infanticide, and may for such offense be dealt with and punished
as if she had been guilty of the offense of manslaughter of the child. (Bartholomew
& Bonnici, 1965, pp. 1018-1019)

The act thus gave formal legal recognition to the common belief that a woman
who has given birth may have an altered and disturbed mental status for up to a
year following the delivery of the child. Similar acts granting special legal status
to the crime of infanticide were passed in other countries, including Australia
(Bartholomew & Bonnici, 1965), Austria (Adelson, 1959), Canada (Arboleda-
Florez, 1976; Deadman, 1964), Germany (Adelson, 1959), and New Zealand
(Bartholomew & Bonnici, 1965). In the United States, there has never been formal
legal recognition of a special legal status for a woman who murders her infant.
Instead, the killing of an infant by its mother is considered to be a form of
homicide and is prosecuted in the same manner as any other homicide (Adelson,
1959; Oberman, 1996).
Although there have been some arguments in support of revising the English
and American positions (e.g., Oberman, 1996), ironically what is missing from
these discussions is a critical look at the underlying science of infanticide and
mental illness. Without this information, it is impossible to know whether the
premises adopted within the legal writings are accurate. The purpose of this article
is to review critically the literature on infanticide and maternal mental status
during the 1st postpartum year, to determine whether this body of literature
supports the English legal approach, in which few obstacles prevent a mother who
murders her infant from being tried for or pleading guilty to a lesser offense, or
the American legal approach, which forces the woman to be tried for the crime she
committed, leaving her to prove, during the proceedings, whether her mental
status was sufficiently diminished to justify conviction of a lesser crime or a
reduced sentence.1 The basic issue is whether or not the year following childbirth
represents a special time, when psychological and biological forces interact to
cause mental illness so severe that there should be an assumption that a woman
should not be held fully responsible for an act of murder committed against her

'Readers who are less familiar with criminal law should consult Perlin (1989) for a general
introduction to the insanity defense and diminished capacity doctrine.
 1100 DOBSON AND SALES

newly born child and should therefore be prosecuted to a lesser degree than would
be the case if the same act of murder had been committed by another individual.
Three lines of evidence are presented. The first consists of empirical data on
the sentencing and disposition of women who kill their children. The question
addressed is whether there is widespread public sentiment, as reflected in the legal
outcome in infanticide cases, against holding a mother fully responsible for the
murder of her child. The second line of evidence summarizes the demographic,
social, and psychiatric status of women who have murdered their children. The
question addressed is whether women who commit infanticide typically show
stresses or psychiatric diagnoses that suggest that their act was the result of an
altered mental status. An important concept introduced in this section is Resnick's
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(1969) separation of infanticide into neonaticide (the killing of an infant in the

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first 24 hr postnatal) and nonneonaticidal infanticide, or filicide (the killing of an

infant during the period between 24 hr and 12 months postnatal). The final line of
evidence addresses the question of whether there is an increase in the prevalence
of mental illness that occurs in mothers during the 1st postpartum year, as is
assumed in English law. This question is examined for the three categories of
mental illness that have been associated with the postpartum period: postpartum
blues, postpartum depression, and postpartum psychosis.
In the final section we argue that data obtained since passage of the Act in
1938 indicate that use of the charge of infanticide should be greatly restricted. In
cases of neonaticide, there is little evidence that mothers suffer from mental
illness related to childbirth, and therefore it would be inappropriate to charge these
mothers with infanticide, which is based on the assumption of diminished respon-
sibility because of childbirth. Also, there is little evidence that depression is more
prevalent or different in new mothers than in nonchildbearing women; therefore,
reducing a charge from murder to infanticide in women with postpartum depres-
sion provides these women preferential treatment, which is not afforded to
nonchildbearing individuals with depression. On the other hand, we demonstrate
that postpartum psychosis, although relatively infrequent in the total population of
childbearing women, occurs sufficiently frequently among women who murder
their offspring that the criminal law should be sensitive to the possibility that these
individuals may meet the requirements of an insanity or diminished capacity
defense. This section concludes that the proper criminal legal response to infan-
ticide lies somewhere between the inappropriately broad British approach and the
myopic American position that effectively ignores the subclass of women who
deserve closer scrutiny for the relation of their serious mental illness to the
criminal defenses of insanity and diminished capacity. Our conclusion is consis-
tent with those English and Canadian authors who have argued for abolition or
restriction of the Infanticide Act, citing as support the availability of existing
criminal defenses available to women who commit infanticide.

The Public Viewpoint

Although the legal systems of England and the United States differ in their
view of the culpability of mothers who commit infanticide, the world literature
(reviewed below) on verdicts and sentencing of parents who kill their children
 INFANTICIDE AND MENTAL ILLNESS 1101

suggests that there exists an almost universal public sentiment in favor of reduced
blame for mothers, as compared with fathers who commit identical crimes.
Resnick (1969) reviewed the world literature from 1751 to 1967 and identified
131 cases in which a child between 24 hr and 20 years of age was killed by a
parent.2 In 88 cases, over half of which involved victims less than 2 years of age,
the mother had committed the killing. In the remaining 43 cases, 40% of which
involved victims less than 2 years of age, the father had committed the crime.
Overall, fathers were far more likely to be executed (9%) or imprisoned (63%)
than were mothers (no executions; 27% imprisoned or paroled). Mothers were
more likely to be hospitalized (68%) than were fathers (14%).
Ten years after Resnick's (1969) summary of the world literature, d'Orban
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(1979) confirmed that leniency toward women who killed their children remained
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common within the English court system. Of 84 women who killed their children
during a period of 6 years, only 2 were convicted of murder. The rest were
convicted of manslaughter (n = 40), infanticide (n = 23), or a lesser offense (n =
17) or were found unfit to plead (n — 2). Among the 84 women, only 18 were
sentenced to prison. Two (2%) were sentenced to life in prison and 8 (10%)
received a prison sentence of 18 months to 3 years. Twenty-five of the women
(30%) received probation or a suspended sentence without a requirement for
psychiatric treatment, and the rest were ordered hospitalized for psychiatric
treatment.
Recently, Marks and Kumar (1993) confirmed that English courts continue to
show far greater leniency toward mothers who commit infanticide than toward
fathers who commit the same crime. These authors reviewed the legal outcome of
149 cases in England and Wales in which the mother (68 cases) or the father (81
cases) was suspected of killing a child between 24 hr and 1 year of age. Overall,
there were no differences in the proportion of mothers (72%) versus fathers (80%)
indicted for the crime or in the proportion of mothers (14%) versus fathers (15%)
who were acquitted or convicted of a lesser offense. However, over seven times
as many of the fathers as the mothers were convicted of murder (15% vs. 2%). An
even greater disparity between mothers and fathers was evident in sentencing.
Among the 55 fathers convicted of a homicide (manslaughter or murder), 46
(84%) were sent to prison, 6 (11%) received probation, and 3 (5%) received a
suspended sentence or were ordered to be hospitalized. In contrast, only 8 (19%)
of the mothers convicted of a homicide (infanticide, manslaughter, or murder)
went to prison, 30 (71%) received probation, and 4 (10%) received a suspended
sentence or were ordered to be hospitalized.
In the same report, Marks and Kumar (1993) questioned whether the differ-
ences in sentencing of mothers versus fathers in the English court system was the
result of a difference in the level of violence in killings committed by mothers
versus fathers, rather than the result of a bias of judges and juries in favor of
leniency toward mothers. To answer this question, the authors compared sentenc-
ing of the subset of mothers (n = 16) and fathers (n = 44) who used wounding

2
We have no way of knowing if this is a representative sample of all cases of infanticide that
occurred during the time period reviewed. Bias could have occurred in the reporting of the crimes
and in their subsequent coverage in the literature.
 1102 DOBSON AND SALES

violence in the homicide. The results indicated that the disparity in sentencing
remained: 86% of fathers, but only 25% of mothers, were sent to prison.
In summary, in the worldwide legal system, there has been, and continues
to be, a bias in favor of leniency toward mothers who kill their children.
Mothers who kill their children are likely to be placed in a mental institution
or on parole, whereas fathers who commit the same crime are overwhelmingly
convicted of homicide and sentenced to prison. Thus, public opinion, as
expressed in the legal system, appears to hold that a woman who kills her child
is usually mentally disturbed, whereas anyone else, including a father, who
kills a child is a criminal.
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Evidence of Mental Illness Among Women Who Commit Infanticide

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As indicated in the Infanticide Act of 1938, the assumption underlying the

special status that the English legal system gives to women who kill their infants
is that these women are suffering from mental illness related to childbirth and/or
lactation. This section examines the available empirical data on the demographic
characteristics and the mental health status of women who commit infanticide.
Because there are striking differences between mothers who kill their infants
within 24 hr of birth, termed neonaticide (Resnick, 1969), and mothers who kill
their children after the first postnatal day, termed filicide (Resnick, 1969), separate
descriptions of the two groups are provided.
Resnick (1969, 1970), in his review of the literature between 1751 and 1967,
found reports of 34 women who had committed neonaticide and 88 women who
had committed filicide Women in the neonaticide group were younger (16 to 38
years old) than those in the filicide group (20 to 50 years old), and the proportion
of women in the neonaticide group who were less than 25 years of age (89%) was
far greater than the proportion of women in the filicide group who were less than
age 25 (23%). Women in the neonaticide group were invariably single (81%),
whereas nearly all (88%) of those in the filicide group were married. Psychosis
was diagnosed in only 17% of the women in the neonaticide group, but in 67%
of those in the filicide group. Similarly, serious depression was diagnosed in only
9% of the neonaticide cases, as compared with 71% of the filicide cases. None of
the women in the neonaticide group, compared with one third of the women in the
filicide group, had attempted suicide.
Resnick (1970) also noted that the motives for the killings differed greatly
between the two groups. Nearly all (83%) of the neonaticides were characterized
as the killing of an unwanted child. In contrast, over half (56%) of the filicides
were classified as "altruistic" killings, in which the mother killed the child to
relieve the child's real or potential suffering; for example, from an incurable
disease or from the suffering the child would potentially experience following the
mother's suicide. In another 24% of filicide cases, the mother was acutely
psychotic at the time of the murder, as indicated by hallucinations, epilepsy, or
delirium.
Resnick's (1969) characterization of the differences between women who
commit neonaticide and women who commit filicide received further support in
the subsequently published literature on infanticide. In his article "Women Who
Kill Their Children," d'Orban (1979) compared 11 women who committed
 INFANTICIDE AND MENTAL ILLNESS 1103

neonaticide between 1790 and 1975 in London to 78 who committed filicide

during the same time period. Those who committed neonaticide were younger
(mean age = 21.1 years) than those who committed filicide (mean age = 25.1
years), and were less likely to be married than were those who committed filicide
(0% of the neonaticide cases vs. 64% of the filicide cases). There was a previous
history of psychiatric illness requiring in-patient or out-patient treatment in only
10% of women in the neonaticide group, as compared with 45% of those in the
filicide group. Similarly, a psychiatric diagnosis at the time of the crime was found
in only 2 women (18%) in the neonaticide group, but in 69 (88%) women in the
filicide group. The psychiatric diagnosis for the 2 women in the neonaticide group
was personality disorder. In contrast, among the 69 mothers in the filicide group
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with a psychiatric diagnosis at the time of the crime, 36 (52%) had a personality
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disorder, 19 (28%) had reactive depression, and 14 (20%) had a psychotic

diagnosis. The author also calculated a stress score for each mother, based on
family, social, and psychiatric stress. The average overall score for mothers in the
neonaticide group (1.8) was considerably lower than that for mothers in the
filicide group (5.0), a finding also reflected in the mean scores in each of the three
categories of stress (family, social, and psychiatric).3
Further characterization of women who have committed neonaticide has been
provided in case histories and summaries published by Brozovsky and Falit
(1971), Arboleda-Florez (1976), Wilkey, Pearn, Petrie, and Nixon (1982), Saun-
ders (1989), and Green and Manohar (1990). In all cases reported, the women
were poor, young, and unmarried, and all had denied or concealed their preg-
nancy. None had a history of mental illness, but all were described as passive,
withdrawn, immature individuals who feared rejection by their families. Although
abortion would have been an option for them, the authors judged that the women
did not have the strength of personality to seek an abortion. Instead, in a pattern
of behavior first described by Gummersbach (1938), these young women retreated
into denial of the pregnancy until they were confronted by the infant at the time
of childbirth.
Further characterizations of women who have committed filicide have been
provided by researchers in Australia (Wilkey et al., 1982), the United States
(Husain & Daniel, 1984), and Canada (Marleau, Roy, Laporte, Webanck, &
Poulin, 1995). These reports confirm Resnick's (1969, 1970) and d'Orban's
(1979) data on the high prevalence of mental illness among filicidal women and
indicate that a diagnosis of mental illness has typically been made in filicidal
women prior to the time that they commit the crime. Husain and Daniel's (1984)
data indicate that the prevalence of mental illness in mothers charged with filicide
far exceeds that in mothers charged with nonlethal child abuse. Of 8 women
charged with filicide between 1975 and 1979 who were referred for psychiatric
evaluation to the Fulton State Hospital in Missouri, all 8 had a history of

3
Only one article mentioned criminal records in their analysis. Marks and Kumar (1993)
reported that for infanticidal parents,
Fathers were more likely to have committed a previous criminal offence than mothers: 3 (4%)
of mother suspects and 18 (21%) of father suspects had a criminal record. This probably
reflects the general tendency that men are more likely to have a criminal record than women.
(p. 334).
 1104 DOBSON AND SALES

psychiatric disorder requiring treatment by a mental-health professional and all

were judged to have had a major psychiatric disorder at the time of the crime. In
contrast, among 52 women charged with child abuse, 23% had a history of a
psychiatric disorder requiring treatment and 8% were judged to have had a major
psychiatric disorder at the time of the crime. Thus, mothers who commit filicide
differ substantially from abusive mothers in the frequency of mental illness both
before and at the time of the crime.
In summary, there appear to be two distinct types of women who commit
infanticide. The first group, those who kill their infants within 24 hr of birth, tend
to be young, unmarried women with no history of mental illness who deny or
conceal their pregnancy, fearing disapproval or rejection by their family. When
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confronted with the child at childbirth, they see killing and concealment of the
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infant as the only way to continue their denial of the pregnancy. The second group
of women, those who kill their infants after the first postnatal day, tend to be older
and married, and to have a history of mental illness. The women in the second
group are frequently psychotic or depressed. They are often in situations of family
and social stress, and may believe that killing of the child is the only way to
alleviate the child's suffering or potential suffering.

Childbirth and the Risk of Mental Illness

Because mental illness is diagnosed in a large proportion of women who
commit infanticide, especially among those who kill their children after the first
postnatal day, it is important to question whether these women were equally likely
to have demonstrated mental illness before, during, and after pregnancy, or
whether the manifestation of the mental illness was triggered by childbirth. As
noted earlier, the English legal position is that a woman is at increased risk for
mental illness during the 1-year period following childbirth. This section reviews
epidemiological data on the prevalence and timing of mental illness during the 1st
postpartum year.
Mental illness during the postpartum period falls into three categories: post-
partum blues, postpartum depression, and postpartum psychosis. The most prev-
alent of these is postpartum blues, a condition that occurs in 25% to 85% of
women following childbirth (Affonso & Domino, 1984; O'Hara, 1995; Pitt, 1973;
Stein, Marsh, & Morton, 1981; Stowe & Nemeroff, 1995). Symptoms include
crying, irritability, anxiety, confusion, and mood lability (Affonso & Domino,
1984; Pitt, 1973; Yalom, Lunde, Moos, & Hamburg, 1968), beginning within a
few days of delivery and lasting from a few hours to a few days, but rarely
continuing past Day 12 (Affonso & Domino, 1984; Millis & Kornblith, 1992;
Scott, 1992). Comparison of the frequency and timing of blues symptoms in
childbearing and nonchildbearing women suggests that the blues are directly
linked to childbirth, because the prevalence is higher in childbearing than in
nonchildbearing women (O'Hara, 1995), and because postpartum blues occur at
a very specific time (3 to 8 days) following childbirth (lies, Gath, & Kennerley,
1989; Kendell, Mackenzie, West, McGuire, & Cox, 1984; Kennerley & Gath,
1989; Levy, 1987; O'Hara, 1995). The theory that there is a specific link between
childbirth and postpartum blues is further supported by the difference in timing of
blues symptoms in childbearing women as compared with women who have
 INFANTICIDE AND MENTAL ILLNESS 1105

undergone a nonchildbirth-related surgical procedure. Specifically, blues symp-

toms occur several days after the triggering event in childbearing women, and at
a time when hormonal fluctuations are occurring, whereas blues symptoms in
postsurgical women occur immediately after the surgery and decrease in subse-
quent days (lies et al., 1989; Kendell et al., 1984; Levy, 1987). Thus, there is
considerable evidence that the mental disturbance known as postpartum blues is
directly related to childbirth. However, this mental disturbance is unlikely to play
a major causative role in either neonaticide or filicide, because it occurs too late
to affect mental status in women who commit neonaticide, and because its
duration of less than 10 days is too short to play a major role in filicide, which can
occur at any time during the 1st postpartum year.
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Postpartum depression is a clinical depression occurring during the weeks and

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months following childbirth. It is diagnosed according to standard clinical criteria,

for example, research diagnostic criteria (Spitzer, Endicott, & Robins, 1978) or
the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American
Psychiatric Association, 1994), and is characterized by dysphoric mood, loss of
interest in usually pleasurable activities, loss of appetite, sleep disturbance,
fatigue, difficulties in making decisions, excessive guilt, and suicidal thoughts.
Duration of the postpartum depressive episode is typically several months
(O'Hara, 1991, 1995). Watson, Elliott, Rugg, and Brough (1984) reported that
50% of the depressed mothers in their sample had episodes lasting more than 3
months, whereas the depressive episodes lasted more than 6 months in 50% of the
depressed mothers in Kumar and Robson's (1984) study.
Early studies reported that postpartum depression was common among child-
bearing women, with a prevalence that was estimated to be as high as 45% (Tod,
1964). More recent studies, in which accepted diagnostic criteria were used to
define postpartum depression, revealed more conservative prevalence figures,
ranging from 7% to 17% in North America (Campbell & Cohn, 1991; Gotlib,
Whiffen, Wallace, & Mount, 1991; O'Hara, Neunaber, & Zekoski, 1984;
Whiffen, 1988) and from 9% to 19% in Great Britain (Cooper, Campbell, Day,
Kennerley, & Bond, 1988; Kumar & Robson, 1984; Nott, 1987; Watson et al.,
1984).
Recent studies have also contradicted earlier reports that postpartum depres-
sion is a form of mental illness that is specific to childbearing women. Instead,
when accepted diagnostic criteria were used, researchers in both North America
(O'Hara, 1995; O'Hara, Zekoski, Philipps, & Wright, 1990; Troutman & Cutrona,
1990) and Britain (Cooper et al., 1988; Cox, Murray, & Chapman, 1993; Kumar
& Robson, 1984) failed to find significant differences in either symptoms or
prevalence of depression in matched samples of childbearing versus nonchild-
bearing women. Thus, in contrast to postpartum blues, which appear to be a direct
consequence of childbirth, there is little convincing evidence that postpartum
depression differs from depression occurring at other times in a woman's life.
Thus, whereas depression is certainly a form of mental illness that has been shown
to be present in some women who commit infanticide (d'Orban, 1979), research
on postpartum depression does not support the English legal position that the
postpartum period is a time of increased mental disturbance.
The third form of mental disturbance that has been associated with the
postpartum period is postpartum psychosis. Postpartum psychosis is the most rare
 1106 DOBSON AND SALES

and most severe form of postpartum mental illness. It occurs in approximately

0.2% of childbearing women (Herzog & Detre, 1976; Kendell, 1985; O'Hara,
1995) and results in severe dysfunction requiring hospitalization. Postpartum
psychosis often involves hallucinations or delusions, severe depression, and
thought disorder. It is closely tied to childbirth, and usually has an onset within the
first few weeks postpartum (Herzog & Detre, 1976; Millis & Kornblith, 1992).
A number of epidemiological studies have provided clear scientific evidence
supporting the link between childbirth and postpartum psychosis. One of the
earliest studies was conducted by Pugh, Jerath, Schmidt, and Reed (1963) in
Massachusetts. The results indicated that the rate of admissions of women of
childbearing age to public mental hospitals dipped below the prepregnancy
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baseline rate while the women were pregnant, but soared above the baseline rate
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during the first 3 months after pregnancy.

The most definitive epidemiological research on postpartum psychosis and
childbirth was conducted by Kendell, Chalmers, and Platz (1987) in a 12-year
population-based study conducted in Edinburgh, Scotland. In this study, Kendell
et al. cross-linked Scottish Health Service records on all women with an episode
of childbirth over a 12-year period (n = 54,087) to records of the Edinburgh
Psychiatric Case Register on all women 15 to 44 years of age during the same
period. As shown in Figure 1, the average number of admissions with a diagnosis
of psychosis decreased slightly during pregnancy and then increased sharply in
the first 3 months following childbirth. Thereafter, admissions for psychosis
declined, but remained at an elevated rate for the 2 years following childbirth.
Kendell et al. (1987) calculated that the risk of psychiatric admission with a
diagnosis of psychosis was 24.6 times higher over the first 30 days after childbirth
than prior to pregnancy and 14.3 times higher during the first 90 days after
childbirth. When the first 90 days were excluded from the analysis, the rate of
psychiatric admissions with a diagnosis of psychosis remained elevated above the
prepregnancy rate by a factor of 2.1.
In summary, epidemiological research indicates that the risk of psychosis
requiring hospitalization is extremely elevated during the 1st month after child-

50 PtydKMte admissions

Admission.

30

•« Pngrancy--*-

10-

-iVew Childbirth +2Y«ara

Figure 1. Temporal relation between psychiatric admissions with a diagnosis of

psychosis and childbirth (Kendell et al., 1987).
 INFANTICIDE AND MENTAL ILLNESS 1107

birth, remains substantially elevated during the next 2 months, and continues to be
somewhat elevated into the 2nd postnatal year. These data on postpartum psy-
chosis do not address the issue of severe mental illness during the 24-hour period
when neonaticide occurs, but they do provide strong evidence that the 1-year
period during which filicide occurs is a time during which the risk of severe,
debilitating mental illness is greatly increased. Thus, these data support the
English legal position that the 1st postpartum year is a time of high risk for mental
disturbance. However, the increased risk is only for psychosis or mental illness so
severe that it requires hospitalization, not for affective disorders that are typically
treated on an outpatient basis.

Summary and Conclusions: The Case For A Middle Ground

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Implications of the Data

The English Infanticide Act was passed first in 1922, and modified to its
present form in 1938. The goal of passing the act was to provide a system whereby
a woman who killed her child prior to its reaching 1 year of age could be tried for
a lesser crime—one that allowed a variety of sentencing options—rather than for
the crime of murder, for which the only sentencing option was the death penalty.
The stated rationale for the new law was that, following childbirth, women
experience a diminished mental capacity that renders them incapable of carrying
out the act of murder.
As indicated in the preceding sections, data collected over the 60 years
following the passage of the 1938 Infanticide Act indicate that it is incorrect to
assume that all women who commit infanticide are suffering (as a result of
childbirth) from a mental illness that is sufficient to justify a legal conclusion of
diminished capacity or insanity. This is especially true in the case of neonaticidal
mothers, few of whom show evidence of mental illness either before or after the
crime, and whose criminal act takes place before the onset of the forms of mental
illness—postpartum blues and postpartum psychosis—that have been shown to be
related to childbirth.
Data collected over the years following the passage of the Infanticide Act
have also provided specific details on the nature of the various types of mental
illness that have been associated with childbirth. These data suggest that it is
incorrect to assume that childbirth itself produces a mental state so altered that
most women in the postpartum period are incapable of understanding the act of
murder. Studies have shown that the most common mental disturbance that results
from childbirth, namely, postpartum blues, occurs too long after delivery to be a
factor in neonaticide and is too short in duration to be a factor in most filicides.
Also, a more long-lasting and serious mental disturbance that has long been
thought to be associated with childbirth, that is, postpartum depression, is not
different in symptomatology or in prevalence from depression at other times in a
woman's life. Thus, there is no reason to treat women suffering from postpartum
depression in a manner different from those suffering from clinical depression at
any other time of life. Furthermore, this form of mental illness historically has not
justified a finding of diminished capacity or of insanity.
On the other hand, psychosis, one of the most severe forms of mental illness,
increases greatly in prevalence in the 1st months after childbirth and continues to
 1108 DOBSON AND SALES

show an elevation in prevalence into the 2nd postpartum year. This form of mental
illness is rarely reported in neonaticidal women, but is frequently documented in
filicidal women both prior to and at the time of the crime. A psychotic state can
provide justification for both diminished capacity and insanity defenses. Unfor-
tunately, the scientific literature (as opposed to clinical anecdotes) is devoid of
studies that indicate whether the psychosis in infanticidal women is uniform or
varies in its manifestations, and whether all infanticidal women exhibit symp-
tomatology that would meet the specific requirements of either of the above two
defenses.

A Reconsideration of the English and Canadian Approaches

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Should the Infanticide Act be retained in the English legal system or should
it be modified? Over the past 20 years, this question has been the focus of three
study groups in England and one in Canada. The first of these was the Committee
on Mentally Abnormal Offenders (the Butler Committee), which published its
report in England in 1975 (Home Office and Department of Health and Social
Security, 1975). A primary recommendation of the committee was the abolition of
the mandatory life sentence for murder. This would lessen the need for the
Infanticide Act, as it would permit the judge in a murder case to hand down a
sentence that fit the circumstances of the case. Another recommendation of the
Butler Committee was that, if the mandatory life sentence for murder were not
abolished, the existing legal system could accommodate the type of cases tried
under the Infanticide Act through the defense of diminished responsibility, which
provides that a person with impaired mental responsibility can have a criminal
charge reduced from murder to manslaughter.
In agreement with the Butler Committee, the Law Reform Commission of
Canada (1984) concluded that there was little evidence to support the underlying
rationale of the Infanticide Act. As the provisions of the act were deemed to be
redundant with other legal provisions, the Law Reform Commission recom-
mended that infanticide as a separate legal entity be abolished.
A contrasting point of view was presented by the Royal College of Psychi-
atrists' Working Party on Infanticide (Blueglass, 1978) and the Criminal Law
Revision Committee's Report on Offenses Against the Person (1980). These study
groups expressed the view that prosecution of cases of infanticide under the
defense of diminished responsibility would be too restrictive and would exclude
cases currently included under the Infanticide Act, such as neonaticide, in which
there is typically no evidence of psychiatric abnormality at the time of the crime.
Also, both study groups recommended extending the scope of the Infanticide Act
to include killing of older siblings, to limit the sentence to no more than 2 years,
and to permit the charge of attempted infanticide.
Although not members of any of the study groups, Parker and Good (1981)
in England and Osborne (1987) in Canada have written position papers on the
Infanticide Act, criticizing its preferential treatment of a subgroup of individuals
who have committed homicide. Parker and Good point out that the legal and
moral principles supporting preferential treatment of women who commit infan-
ticide have never been clearly stated, and that, in its preferential treatment of the
perpetrator, the Infanticide Act discriminates against another segment of the
 INFANTICIDE AND MENTAL ILLNESS 1109

population, in that it reduces the protection of law with regard to the young
victims of infanticide. Osborne (1987) questions why women who kill their
infants should be treated differently from other homicidal individuals, and why
mental disturbance related to childbirth should have different legal consequences
from mental disturbance not related to childbirth. Furthermore, she points out that
the Infanticide Act, in its preferential treatment of women, perpetuates the sexist
attitude that women should not be accorded full responsibility for their actions.
In summary, the English and Canadian legal systems and individual scholars
have begun to call for the reform of the law regarding infanticide. The overriding
argument is that the Infanticide Act is too broad in that it prevents a case-by-case
determination of whether mental illness contributed to the crime. Scholars argue
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that, as currently articulated, the law incorrectly assumes that all infanticidal
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women are deserving of a reduction in criminal charges. In addition, they argue

that an act that singles out homicidal mothers for special treatment discriminates
against other individuals who have committed the same act and reduces the
protection afforded to potential victims of infanticide. Thus, the Infanticide Act,
which was passed to accommodate public opinion in favor of leniency toward
new mothers, appears to have become an anachronism.
Conclusion
In conclusion, the scientific data presented in this article fail to support the
underlying assumption of the Infanticide Act, that is, that all women who murder
their infants are suffering from serious mental disorder. There is certainly little
evidence that women who kill their infant within the first 24 hr of birth are
seriously mentally ill, and furthermore, many women who kill their infant after
the first 24 hr do not exhibit symptomatology that meets the requirements for
diminished capacity or insanity. On the other hand, the data suggest that the
potential role of psychosis in infanticide should not be underestimated, at least in
cases of filicide. Resnick's (1970) review of the literature indicated a diagnosis of
psychosis in two thirds of filicidal women, whereas d'Orban (1979) reported that
approximately one fifth of filicidal women were psychotic at the time of the crime.
Thus, simply allowing these defendants to avail themselves of existing criminal
defenses may not be sufficient, because juries are not likely to be aware of or to
believe the high prevalence of psychosis among filicidal women.
A solution to juror prejudice against a potential role of mental illness in
filicide is to encourage the law to permit two types of expert testimony related to
this issue. The first would educate the jury about the prevalence and severity of
mental illness in filicidal women to indicate to them that such defense tactics are
not necessarily frivolous.4 The second type of testimony would then address the
unique clinical characteristics of the particular defendant in the case so that the
jury can decide whether the defendant at trial meets the requisite legal standard for
diminished capacity or insanity. This is critical because we do not know in
advance whether the psychotic symptomatology in a particular woman satisfies
the criteria for an insanity or diminished capacity plea.

4
Such testimony is consistent with courts admitting experts to provide educational expert
testimony (also referred to as context or social framework expert testimony).
 1110 DOBSON AND SALES

Finally, this same observation also has relevance to proposals for new
legislative responses to infanticide. Some argue that society ought to impose
a lesser criminal sanction (e.g., manslaughter rather than murder) on filicidal
women. Those using this argument incorrectly assume that all women in the
subclass are incapable of meeting the criteria for the higher offense (e.g., murder).
The science underlying infanticide and mental illness does not justify changing
the fundamental American legal response to it—at least at this point in time.

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Received July 24, 1998
Revision received January 5, 1999
Accepted February 15, 1999 •