Morbidity and mortality of women victims of violence in the state of Rio Grande do Norte (RN), Brazil.

Sousa Filho
Nov 1 · 21 min read

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ABOUT AUTHORS AND ADVISOR:

Kelly Christina Silva Silva Matos Pereira[a}

Alcebíades de Sousa Filho[b]

Ana Edimilda Amador[c]

Luciana Conceição de Lima[d]

[a]Statistic, Specialist in Applied Mathematics and Statistics. Master’s student in Demography. Federal University of Rio Grande do Norte (UFRN).

[b]Economist. Specialist in Sustainability and Public Policy (UNINTER). Master´s student in Demography. Federal University of Rio Grande do Norte (UFRN).

[c]Social Assistant, Master in Public Health. PhD student in Demography. Federal University of Rio Grande do Norte (UFRN).

[d]Doctor in Demography (Cedeplar — UFMG). Associate Professor, Department of Demography and Actuarial Sciences, Federal University of Rio Grande do Norte (UFRN).

Acknowledgment:

We thank the Medium environment for enabling the efficient and intuitive dissemination of content, the Higher Education Personnel Improvement Coordination (CAPES) for funding research from the Graduate Program in Demography (PPGDEM) and the Federal University of Rio Grande do Norte (UFRN) for the opportunity to use the knowledge learned within the Public University and contribute to the development of a better society.

MAIN LINES:

OBJECTIVE: To analyze the morbidity and mortality of women victims of violence in Rio Grande do Norte and its correlation with socioeconomic indicators.

METHODS: This study analyzed a group of women victims of violence in the 167 municipalities of Rio Grande do Norte, from 2008 to 2017. The distribution of mortality rates was verified.

INTRODUCTION

Today the world is increasingly observing and reporting the fact that one of the leading causes of death in the population is caused by external causes. Some of the most frequent examples are deaths from trauma, injuries, health problems, homicides, aggressions, suicides, accidental falls, burns, drownings, accidents and violence.

According to the World Health Organization (WHO) the problem is a challenge and also brings discussion to the health area that traditionally dealt only with the consequences of the events. In addition, research indicates that such public health problems are drivers of reduced population productivity and health sector costs, with a negative impact on life expectancy at birth.[1;2]

Reinforcing these previous definitions, Global Status Report on Violence Prevention (GSRVP, 2014) reports that about half a million people are murdered each year, notwithstanding the consequences of violence, which in many ways destroy people’s lives, including for decades, affecting millions of children, women and men, leading to inadequate consumption of alcohol, drugs, depression, suicide, dropping out of school, unemployment and recurrent relationship difficulties, such as schools, communities and even in homes where family violence occurs with physical aggression, sexual abuse, psychological abuse and neglect, being perpetrated by an aggressor with close, family, marital or affective ties, in conditions of superiority, whether physical, age, social, financial, psychic , hierarchical and / or gender; it may also involve employed persons, households and visitors [3; 4; 5].

Given these direct and indirect consequences of violence, according to experts, the concern with the increase of these rates and their different forms is treated today as an important social and public health issue as it affects individual and collective health, causing a strong impact on morbidity and mortality in the population besides being able to present itself for the purpose of domination, exploitation and oppression, treating a human being not as subject but as thing; it may also present itself as a result of relations and conflicts of power; and having innumerable causes, such as economic, social, cultural inequalities, drug dissemination, among others. [6;7;8]

International studies on various countries define morbidity as a health condition characterized by physical, mental, acute, chronic problems that burden the health system of countries and that tends to be acquired with the aging of the individual. In these countries, some cities studied in Denmark, the United States, Australia, and Japan most commonly presented people with conditions related to body movement, memory, and heart conditions. [9]

Given what has been exposed and following the trends of the world, some research has observed that here in Brazil, between 2000 and 2010, external causes represented the third group of more frequent death causes, with aggression as one of the main circumstances.[10]

Seeking to explore this scenario, the use of Information Systems (SIN) data, demographic surveys and surveys can contribute to the knowledge of this profile of violence, the identification of possible regional disparities, the sociodemographic profile of victims, as well as the consequences for the health system, being necessary to understand these factors to propose policies aimed at understanding and coping with this problem.

Zooming in on the map of Brazil, we can see the northeast, specifically the state of Rio Grande do Norte (RN), which has been increasing in the number of deaths of men due to external causes linked to violence, which has already proved to be a Global trend towards males, plus lethal violence against women is also increasingly present in statistics, as reinforced by data from the Observatory of Intentional Lethal Violence of Rio Grande do Norte (OBVIO RN), with state femicide from domestic violence and gender, an aggravated situation because the state did not account for rape followed by death, which in 2016 were 37, out of a total of 95 women killed.[11]

Since then, the people involved, the mobilization of society, the public opinion converge to the development of actions and tools whose scope is to face this type of violence, being the Maria da Penha Law one of the most important of these actions.

So, worrying about this context, the following question arose, what is the scenario of Potiguar female morbidity and mortality in the last two decades? Thus, seeking to answer this question, this study will analyze the morbidity and mortality of women victims of violence in the RN state from 2008 to 2017, which will be done through an ecological study of the 167 municipalities of the RN state, from January 1st. from 2008 to December 31, 2017.

The spatial outline of this study is the RN, which according to the IBGE has a territorial extension of 52,809.602 km², representing 1% of the Brazilian area (8,502,365.50 km²) and 3% of the Northeast area (1,554,024 , 20 Km²), being the sixth smallest state in Brazil, however, which has the largest coastal range among the other states. It has a population of 3,168,027 inhabitants (representing 2% and 6%, respectively, of the national and northeastern population) of which 1,548,887 men and 1,619,140 women, representing a demographic density of 59.99 inhab / km² (tenth most dense in Brazil). [12]

Figure 1 illustrates the map of Brazil with the divisions in large regions and states, to situate the positioning of the RN at the national level, located in the northeast region, bordering the states of Ceará (CE) and Paraíba (PB).

Figure 1 — Map of Brazil (major regions and states) and map of RN and (mesoregions and municipalities).

SOURCE: IBGE

WHERE TO FIND DATA FOR THIS STUDY?

For data collection related to morbidity, we used data from the Notification Disease Information System (SINAN), a system fed by the notification and investigation of disease cases and diseases of the national list of diseases widely used to study health related issues. It was also used the National Health Survey (PNS) which is a survey done in homes throughout Brazil, in partnership with the Brazilian Institute of Geography and Statistics (IBGE), and was conducted in 2013, focusing on the area of health, especially in chronic noncommunicable diseases, lifestyles, and access to medical care. [13; 14]

PNS focused on Potiguar resident women over the age of 18 who answered yes to the following question: “In the last 12 months have you had any violence or aggression from a known person (such as father, mother, child spouse, partner, boyfriend, friend, friend, neighbor? ”, seeking to observe the“ Proportion of people who have suffered a bodily injury due to violence or aggression ”,“ Proportion of people who stopped performing any of their usual activities due to violence or aggression ”and“ Proportion of people who received some type of health care due to violence or aggression ”.

With these answers, the writers of this article have made calculations and maps in free computer-installed programs (such as R-studio and Q-Gis), which are very important for drawing more accurate conclusions from the large number of responses from these interviews. PNS and SINAN) as well as draw maps showing the cities that have the most cases of violence.

For data collection related to mortality, deaths from aggressions according to age were used, categorized according to the International Statistical Classification of Diseases and Related Health Problems — 10th Revision (X85-Y09). Information on deaths was collected from the Mortality Information System (SIM) of the Informatics Department of the Unified Health System (Datasus). The population data of the municipalities by age group were obtained from the Demographic Census information and IBGE projections. [15]

Here, some variables were chosen, represented by the socioeconomic indicators of the municipalities of RN, such as: (V1) Municipal Human Development Index (HDI-M); (V2) Illiteracy rate of 15 years or more; (V3) Gini Index; (V4)% of poor; (V5) Vacancy rate; (V6) Dependency ratio and applying a statistical test (called the Pearson Correlation) try to see if there is any relationship between these socioeconomic indicators and potiguar feminicides (which are represented by the variable called Standardized Mortality Rate (TMP) to see if Ultimately, femicides have some clearer explanation of why these deaths occur. The socioeconomic indicators were collected from the Human Development Atlas in Brazil, the United Nations Development Program (UNDP) www.atlasbrasil.org.br.

Descriptive analyzes were performed for the variables used in this study and to see if there is a relationship between the selected socioeconomic indicators and the mortality rate (PMT) due to violence against women in the RN, a statistical test was performed (Pearson Correlation).

This research used data available on official websites of the Ministry of Health of Brazil without identification of subjects, being exempted from consideration by the research ethics committee, in accordance with Resolution 466∕2012 of the National Health Council, ie it is free and public!

RESULTS

The Table 1 presents the results of responses to the 2013 PNS, ‘’ Regarding violence, how often have women experienced violence or aggression from a known person (such as father, mother, child, spouse, partner, boyfriend, friend, neighbor) ) in the last 12 months?’’ results indicate that 6.1% for women answered yes.

Table 1 — Percentage of women victims of violence by known person in the last 12 months — RN — 2013.

Source: National Health Survey (PNS), 2013.

Considering the women who answered yes to the question about having already suffered some kind of violence, Figures 2 to 7 below outline the victim’s profile:

Source: National Health Survey (PNS), 2013.

Statistical tests (chi-square) were also performed to assess possible associations between these particular characteristics of women and the fact that they are victims of violence, which showed that the fact that women suffer violence in RN does not NECESSARILY depend on age, race, working with pay, income, household status and level of education, ie all are at risk of violence.

Table 2 shows that the the profile of women who reported suffering violence from a known person and that most of the interviewees already suffered violence once (33.3%), physical, but especially psychological (51.4%) with verbal aggression (54 , 1%), in their homes (64.2%), of which (73.9%) stopped performing activities, acquired injuries (75.7%) that made them seek assistance in the health network (64.1% ) especially in the Emergency Care Units (31.5%), with (61.2%) hospitalized and (85.1%) who had some sequel.

Table 2 — Women who suffered violence from a known person, according to specific variables –PNS, 2013. RN, 2019.

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Source: National Health Survey (PNS), 2013.

The PNS Results also exposed the perception of how women victims have of themselves and of the health service provided to them, so that the most expressive answers indicate that 36.5% evaluated having good health, but with sleep problems. almost every day (38.4%), fatigue (42.8%) loss of interest (52.7%), concentration problems (65.8%), eating habits (42.8%) and presence of slowness or agitation (48.6%).

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To further complement previous PNS results, Figure 8 illustrates the types of violence suffered by women in the RN from 2009 to 2017, of which 8,455 notifications of violence were made in the SINAN Reporting Disease Information System.

Figure 8 — Notifications of violence against potiguar women according to SINAN data, from 2009 to 2017.

Source: Ministry of Health / SVS — Notification Disease Information System — Sinan Net

For notifications of occurrences of violence in SINAN, the most notifying municipalities were: Natal (4,274 cases), Mossoró (912 cases), Parnamirim (612 cases), Santo Antônio (242 cases), Caicó (218 cases) and Assú (208 cases) and to better understand where these cases occur, a map was made (figure 9).

Figure 9 — Spatialization of the Proportion of Violence Reports in Sinan, for the state of Rio Grande do Norte, from 2009 to 2017.

Source: Datasus, Notification Disease Information System — SINAN.

According to data from the Mortality Information System, between 2008 and 2012, 327 deaths of women by violence were recorded, of which 86.85% (284 deaths in women aged 15 to 59 years) with an increase for the period from 2013 to 2012. 2017 (530 deaths in women aged 15 to 59 years) a proportion of 90.19% (478 cases) (Table 3).

Table 3 — Characterization of women’s deaths from violence in the period from 2008 to 2017. Rio Grande do Norte, 2019.

Source: Datasus, Mortality Information System — (SIM).

In Table 4, for the periods from 2008 to 2012 and from 2013 to 2017, the calculations showed that there were on average 3.36 and 4.73 femicides per 100,000 inhabitants, respectively, with the highest rates being 27.75 and 29.72 per 100,000 inhabitants.

Table 4 — Descriptive analysis of the standardized mortality rate for violence against women (100,000 inhabitants), from 2008 to 2012 and 2013 to 2017. Rio Grande do Norte.

Source: Datasus, Mortality Information System — (SIM).

Then, it was found that the highest mortality rates (per 100,000 inhabitants) for the RN from 2008 to 2012 were for the municipalities of Lajes Pintadas (27.75), Tibau (20.44), Itajá (17). 88), Umarizal (17.66), Almino Afonso (16.69), Bodó (16.04), Janduís (15.78). Ferros, see the map in Figure 10.

Figure 10 — Spatialization of the standardized mortality rate due to violence against women in the period from 2008 to 2012 (RN)

Source: Datasus, Notification Disease Information System — SINAN.

Figure 11 shows the RN´S highest mortality rates (per 100,000 inhabitants) from 2013 to 2017,wich were for the municipalities of Itajá (29.72), Santa Maria (25.18), Passagem (24.42 ), Japi (23,22), Barcelona (21,61) Serrinha dos Pintos (18,06), Messias Targino (17,21). It is important to highlight that these municipalities also from the Mesorregião Oeste Potiguar, distributed in the microregions of Umarizal and Pau dos Ferros.

Figure 11 — Spatialization of the standardized mortality rate due to violence against women from 2013 to 2017 (RN).

Source: Datasus, Notification Disease Information System — SINAN.

Finally, another statistical test (Pearson’s correlation) between feminicides (PMT) for violence against women and socioeconomic variables was performed, and it was found that there is no strong correlation, but with moderate and strong correlation between these socioeconomic variables (Table 5). Thus, while all women are at risk of violence, to put it simply, the deaths of women from violence are more related to socioeconomic factors, ie the higher the poverty level in a region, the greater the chances this kind of death occurs.

Table 5 — Correlation between Standardized Mortality Rates of violence against women and socioeconomic variables (RN).

Source: Mortality Information System — SIM; Atlas Brazil, 2019.

DISCUSSION

LINING UP THOUGHTS

In relation to the 2013 PNS survey, it was found that the majority of the declaring victims of violence in the RN are adult, brown, living with a spouse or partner, have no paid activity or earn up to one minimum wage in force. 2013, located in an urban area and with incomplete elementary school. Already the SINAN pointed increase of notifications during the period under study as well as SIM, with increase in the death records.

In this study, we highlight the high percentage of domestic violence suffered by women, which represents the power of male physical force, the inequality between men and women that has been built over time, historically and culturally, which allows, makes it acceptable or banal violent behavior against females.

These results are consistent with the results of other studies, such as a study conducted in Brazil that characterized victims of domestic, sexual and / or other violence in Brazil in 2014 and stated that physical violence was the most reported, most likely by the author of the aggression are an acquaintance or someone who has a close relationship with the victim, with a predominance of females and those of another study from Brazil, from 2001 to 2011, which estimated the occurrence of more than 50,000 femicides (the equivalent of about 5,000 deaths per year), most of them deaths through domestic and family violence against women.[16;17]

Experts says that financial dependence, religion, moral and cultural values, social isolation, hope that the husband will change attitudes, emotional blackmail, social denial of the problem, making domestic violence unreported, out of fear, shame or oppression, leave the women vulnerable to aggression; Other scholars claim that domestic violence also affects other members of the family environment, with family and social support for victims fundamental to inhibiting such conduct in the family. [18;19]

Add to this the results of other research that states that the place where aggression is most prevalent is the home, where ordinary and trivial facts become aggression; In addition, men’s sense of ownership of women and children, impunity, favor violence, a result similar to a study that analyzed intrafamily physical violence in Araçatuba-SP. household, discussions between victim and perpetrator on various subjects such as child rearing, cleaning and house organization, distribution of household chores. [20;21;22]

Here in this study, we saw low proportions of domestic violence related to people over 60 years, which is in agreement with a study of the city of Recife, state of Pernambuco, in 2012, with the types of violence, physical, psychological. However, the low number of reported cases of violence against the elderly need to alert society about the rights of the elderly, who are very vulnerable and dependent on family members who are often the aggressors. [20]

It is noteworthy here, even though it is not the objective of this study to explore violence against the elderly, Brazilian morbidity could be related to the state of the art social, cultural, economic, demographic (life expectancy) among other aspects that concentrate morbidity in older age groups. in relation to the morbidity of those developed countries, unlike the Heideberg (2016) centenary study , cited initially in the introduction, whose economies, social and health services, cultural habits, higher education and life expectancy concentrate morbidities in advanced ages.[9]

In line with these socioeconomic differentials, Preston and Taubman (1994) state that in most populations, people with more education, income and more prestigious occupations enjoy better health and longer and better lives, but other factors such as tastes, preferences, degrees of medical and technical knowledge, prices of health goods and services, and psychological factors make it possible to identify these differentials and would help to identify risk groups whose applications of health programs could be more efficient. [23]

In this context, In addition to the influence of low education, low social inclusion of the victim, non-exercise of paid activity and his dependence on the aggressor, there was also a higher prevalence of domestic violence in brown and black individuals, as in other studies of the Brazil that point out most of the victims as young people, inserted in unfavorable social contexts and coming from the black, black and brown population. [11; 16; 17; 20]

Regarding education and knowledge, Cutler et al (2006) concluded that knowledge, science and technology are the keys to explain increased health and decreased mortality, so their hypothesis is that a higher rate of introduction. of new knowledge and technologies for health will tend to raise the health gradient. What can be applied to Potiguar violence, since it is a public health problem whose consequences directly and indirectly affect the health of those involved. [24]

Still on morbidity, a study concluded that domestic violence is not exclusive to a certain class, age group or population and tends to victimize women, children and the elderly as a matter of priority, and may have physical, moral and mental consequences, constituting legal problem, to deal with criminal and health actions. [19]

Affirming this scenario of nonfatal violence found in this research, the Global status report on violence prevention (GSRVP, 2014) further explains that there are many other individuals who seek emergency treatment for the consequences of violence, for example to treat injuries in Brazil. , which within 1 month, registered 4,835 cases of violence-related injuries, 91% being victims of interpersonal violence and 9% self-directed violence. In more than half of the cases (55%) the victims were also young people between 10 and 29 years old. [3]

The lack of demand for health services occurs because victims may consider the health sector unprepared to deal with violence, police stations being more viable and not every type of violence generates assistable injuries in health services; however, they can lead to criminal prosecution that results in punishment of aggressors. [11; 17; 22]

On this legal issue, the Global Status Report on Violence Prevention (GSRVP, 2014) [3] states that on average 80% of countries reported having the laws mentioned in the survey, but only 57% of them stated that such laws are fully enforced. In the case of domestic / family violence, there are laws in place in 87% of countries, but they are fully enforced in only 44% of them. [3]

Thus, the enactment and enforcement of laws on crime and violence are essential for establishing norms of behavior and for creating safe and peaceful societies, so that existing law enforcement needs to be improved to prevent violence, strengthen mechanisms and resources. and the human capacity needed to ensure that enacted laws protect people from violence, hold perpetrators accountable, and create safe environments for all citizens. [3]

In Brazil, the Maria da Penha law is at the forefront of this battle line against violence. Law №11.340 of August 7, 2006 (Maria da Penha Law), to learn more about the law click here. [26]

One of the limitations of this study concerns the biases of participation, as the theme is surrounded by ethical, moral and cultural issues, and these factors have a strong influence on the response. There may have been omission of information about the violence suffered when questioned directly, out of fear or embarrassment about exposure.

Given this, another study for the Northeast region, concludes that a growing trend of feminicide in the younger cohorts of most states is visible, being a significant public health problem and signaling the need for public policies aimed at female protection. [26]

However, population surveys provide us with representative samples of the population from all regions of the country, and may serve to compare these results with those of other countries, as well as support the organization of public policies aimed at minimizing the problem.

SOME CONCLUSIONS

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Given this discussion, this study allowed us to identify important characteristics related to deaths due to violence against women in RN, identifying where are concentrated the portions of potiguar female victims who suffer most from the direct and indirect effects of violence against women, whose typologies permeate the psychological , physical and culminates in deaths. These data may still represent only part of the reality, since a considerable portion of intimate relationships crimes are not reported.

Aggression occurs in all age groups, social classes, races, levels of education, whether married or not, since throughout the country (not only in RN) the social, historical and cultural process has naturalized definitions of male and female identities. women, which, laden with inequalities, contribute to women being more exposed to certain types of violence, such as domestic and sexual violence. There is no significant difference between women who suffer or do not suffer aggression regarding various variables.

It calls for the need for planning public policies that mitigate the often consequent effects of population densification, above all, the development of tools that aim to confront pre-established socio-cultural patterns that increase female victimization. The prevention of these events represents a major challenge because of the need for their response to articulate different areas, requiring interdisciplinary action, as well as the involvement of various sectors of civil society and governmental organizations.

Recognizing the magnitude of violence against women through population-based research is invaluable for health system assessment and planning, contributing to knowledge advancement and policy improvements.

It is suggested for future research to explore more current studies to monitor the behavior of violence, verify the effectiveness of coping measures and understand the social and cultural realities of places of interest, enabling specific and more effective public actions according to regional peculiarities. .

The limitation of this study is related to the use of secondary data on morbidity and mortality that is subject to underreporting and underreporting, although in recent years it has been recognized that the Health Information Systems in Brazil have achieved significant gains in the quality of filing. Individual Notification Form (FNI), and Declaration of Death (DO), as well as registration in the systems.

The contributions of this study, in turn, refer to the subsidies generated for public policies with emphasis on geographically determined actions, with policies oriented to municipalities with greater cases of violence against women.

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REFERENCES

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[3]-1-BUTCHART, A., MIKTON, C., DAHLBERG, L.L. AND KRUG, E.G.,2015.Global status report on violence prevention 2014.

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[11]-MALTA, D.C., MINAYO, M.C.D.S., SOARES FILHO, A.M., SILVA, M.M., MONTENEGRO, M.M., LADEIRA, R.M., MORAIS, O.L.D., MELO, A.P., MOONEY, M. and NAGHAVI, M., 2017. Mortality and years of life lost by interpersonal violence and self-harm: in Brazil and Brazilian states: analysis of the estimates of the Global Burden of Disease Study, 1990 and 2015. Rev Bras Epidemiol, 20(suppl 1), pp.142–56.

[12]-IBGE — INSTITUTO BRASILEIRO DE GEOGRAFIA E ESTATÍSTICA. (Acesso em 09/2019)Disponível em:<https://cidades.ibge.gov.br/brasil/rn/panorama>

[13]-SISTEMA DE INFORMAÇÃO DE AGRAVOS DE NOTIFICAÇÃO (SINAN) https://www.cevs.rs.gov.br/sinan

[14]-PESQUISA NACIONAL DE SAÚDE (PNS). 2013. https://www.pns.icict.fiocruz.br/

[15]-DEPARTAMENTO DE INFORMÁTICA DO SISTEMA ÚNICO DE SAÚDE (DATASUS). Disponível em:<http://datasus.saude.gov.br/>

[16]-MASCARENHAS, M. D. M.; SINIMBU, R. B.; DA SILVA, M. M. A.; DE CARVALHO, M. G. O.; DOS SANTOS, M. R.; FREITAS, M. G. Caracterização das vítimas de violência doméstica, sexual e/ou outras violências no Brasil–2014. Revista Saúde em Foco, Rio de Janeiro, v. 1, n. 1, 2016.

[17]-GARCIA, L. P.; FREITAS, L. R. S. D.; SILVA, G.; HOFELMANN, D. A. Violência contra a mulher: feminicídios no Brasil. Instituto de Pesquisa Econômica Aplicada, 2013.

[18]-ROSA, D. O. A.; MELO, E. M. D.; RAMOS, R. C. D. S.; MELO, V. H. A violência contra a mulher provocada por parceiro íntimo. Femina, Rio de Janeiro v. 41, n. 2, 2013.

[19]-BHONA, F. M. D. C.; GEBARA, C. F. D. P.; NOTO, A. R.; VIEIRA, M. D. T.; LOURENÇO, L. M. Interrelationships of violence in the family system: a household survey in a low-income neighborhood. Psicologia: Reflexão e Crítica, Porto Alegre, v. 27, n. 3, p. 591–598, 2014.

[20]-SILVA, M. C. M.; BRITO, A. M. D.; ARAÚJO, A. D. L.; ABATH, M. D. B. Caracterização dos casos de violência física, psicológica, sexual e negligências notificados em Recife, Pernambuco, 2012. Epidemiologia e serviços de saúde, Brasília, v. 22, n. 3, p. 403–412, 2013.

[21]-DOSSI, A. P.; SALIBA, O.; GARBIN, C. A. S.; GARBIN, A. J. I. Perfil epidemiológico da violência física intrafamiliar: agressões denunciadas em um município do Estado de São Paulo, Brasil, entre 2001 e 2005. Cadernos de Saúde Pública, Rio de Janeiro, p. 1939–1952, 2008.

[22]-SILVA, L. E. L. D.; OLIVEIRA, M. L. C. D. Características epidemiológicas da violência contra a mulher no Distrito Federal, 2009 a 2012. Epidemiologia e Serviços de Saúde, Brasília, v. 25, n. 2, p. 331–342, 2016.

[23]-PRESTON, S.H. and TAUBMAN, P., 1994. Socioeconomic differences in adult mortality and health status. Demography of aging, 1, pp.279–318.

[24]-CUTLER, DAVID, ANGUS DEATON and ADRIANA LLERAS-MUNEY. 2006. The determinants of mortality. Journal of Economic Perspectives 20(3): 97–120.

[25]-TODA MATÉRIA. Lei Maria da Penha. Disponível em: <https://www.todamateria.com.br/lei-maria-da-penha/>

[26]-MEIRA, K.C., COSTA, J.V., DE OLIVEIRA, A.F., DO NORTE, C.R., DOS SANTOS, J. AND DA COSTA, M.A.R.,2017. Femicídio nos estados da região Nordeste do Brasil, uma tragédia no cotidiano do machismo. Anais, pp.1–17.

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