The impact of social determinants of health on feminicide in the second-largest state of the Brazilian Amazon: a spatial epidemiological analysis.

Abstract

Introduction: Despite global advancements in gender equality and legal frameworks, feminicide remains a persistent issue worldwide. Spatial analysis is a powerful tool to use in obtaining evidence-based recommendations for more effective policies to fight it. In Brazil the state of Pará was highlighted with the sixth highest increase in the feminicide rate between 2019 and 2022. In this study, we spatially analyzed feminicide rates in Pará, from 2016 to 2021, employing spatial distribution and autocorrelation, spatio-temporal, and geographically weighted regression (GWR) techniques.

Methods: Annual number of feminicide incidents from all municipalities in Pará were provided by Secretariat of Intelligence and Criminal Analysis of Pará. Municipalities crude feminicide rates were calculated and analyzed using spatial distribution and spatial autocorrelation (Getis-Ord G analysis) to identify areas with a high burden of feminicide. Spatio-temporal risk analysis was employed to assess the influences of policies and social factors on feminicide trends over space and time. GWR was used to evaluate the influence of social determinants of health in the spatial variability of feminicide rates.

Results: During the study period, feminicide rates expanded spatially in Pará, with municipalities in Belem metropolitan area and in the northeast, southeast and southwest mesoregions of Pará being the most affected. Between 2016 and 2018, there was a hotspot cluster (neighbor municipalities sharing high feminicide rates) located in southwest and southeast of Pará. From 2019 to 2021, this hotspot contracted, and a new one appeared in the northeast. The spatio-temporal risk zone comprised municipalities situated in the northeast, southeast, and southwest mesoregions of Pará from 2018 to 2021. The spatial variability of feminicide was promoted by the "high school pass rate," the "youth homicide rate," and "primary healthcare services coverage."

Conclusion: Our findings highlight the need for policy interventions, including increased investment in women's shelters, expanded access to legal and psychological support for victims of gender-based violence, and the integration of gender equality education into school.