Last March a woman slipped onto the labor-and-delivery unit at Central Florida Regional Hospital in Sanford, Florida, changed into scrubs in an empty room, and took a newborn from his mother on the pretext that he needed an eye examination.1 She hid the one-day-old boy in a tote bag and left the hospital. Although the infant was wearing a device that sounded an alarm when he left the unit, the woman eluded security and drove away with the child.2 Police apprehended the woman about an hour later and recovered the infant unharmed. The abductor, a 39-year-old woman who had feigned pregnancy for several months, closely fit the profile of a nonfamily infant abductor published by the National Center for Missing and Exploited Children (NCMEC).
Media reports criticized the hospital for the failure of its security system. On April 15 Fox 35 News reported that the investigating state agency had identified several security issues3:
* There was no protocol telling employees to check behind them when passing through secured doors. The abductor had followed a maintenance worker onto the unit.
* No one reported the presence of a suspicious person, although at least one person had seen the woman changing clothes.
* Neither the unit alarm nor the door locks worked properly.
The hospital was eventually fined $10,000 for having lax security.4 It has implemented several changes, including posting a security guard outside the labor-and-delivery unit, requiring visitors to wear hospital-issued photo badges, inspecting large bags, and checking locked doors hourly.5
Nonfamily infant abductions are rare. In 1983, the first year that the NCMEC began documenting such abductions, five infants were taken from various locations, including hospitals and homes. The annual reported incidence jumped to 18 in 1987 and to 17 in 1989.6 To better understand this crime, the NCMEC, the Federal Bureau of Investigation (FBI), the Office of Juvenile Justice and Delinquency Prevention in the U.S. Department of Justice, and the University of Pennsylvania School of Nursing collaborated in a study of 119 infant abductions occurring from 1983 through 1992.6 That research yielded a profile of the typical nonfamily infant abductor and facilitated the creation of prevention policy directives. This information was disseminated to hospitals and other health care settings nationwide. From 1993 through 2006, the number of abductions in these settings dramatically declined, while those from homes and public places began to increase. To learn more about these changes and reveal other trends, the NCMEC decided to compare nonfamily infant abductions from the period covered in the first study with those from subsequent years. We report here on those findings.
BACKGROUND
In the original study described above,6 the five sources of data included
* demographic data on 119 NCMEC cases.
* FBI interviews with 14 abductors.
* FBI data on an additional 48 abductors.
* University of Pennsylvania School of Nursing faculty interviews with 38 family members of abducted infants.
* outcomes data on 72 criminal-court cases obtained through telephone interviews with criminal justice system staff.
A second study of 199 nonfamily infant abductions reported to the NCMEC between 1983 and 2000 found that the abductor was violent in 30 cases.7 Regarding these 30 cases, subsequent analyses of six cases involving "newborn kidnapping by cesarian section"8 and of interviews with family members caring for recovered infants were also published.9 (Three of us-AWB, CN, and JBR Jr-were each involved in one or more of these studies.)
THE COMPARISON
Sample. This report includes the 247 cases in the NCMEC's database at the time of comparison: 121 cases from 1983 through 1992 and 126 cases from 1993 through 2006. (After the original study was completed, two additional cases were reclassified as nonfamily abductions, bringing the total from 119 to 121 in the earlier period.) We compared unequal time periods in order to take into account the impact of the NCMEC guidelines on preventing infant abductions, which were published in 1993 and are discussed below (see Preventive policy, page 38).
There is no law requiring parents; guardians; or health care, social services, or law enforcement personnel to report missing children to the NCMEC. That said, the NCMEC learns of cases in several ways. Some are reported to the NCMEC from the abduction site by law enforcement personnel, clinical staff, or families. Some are reported by other agencies, including the International Association for Healthcare Security and Safety and the FBI's National Center for the Analysis of Violent Crime. And some come from health care professionals who hear of a case in the news media. The NCMEC also monitors news accounts of abductions.
The NCMEC's criteria for nonfamily infant abduction are narrow: a case must involve an infant, six months of age or younger, who is abducted by a non-family member. The definition of non-family member-a person who is not the child's parent or legal guardian or otherwise related to the child-is similar to that used in the National Incidence Studies of Missing, Abducted, Runaway, and Thrownaway Children.10 The NCMEC doesn't keep statistics on infant abductions in which a family member is the abductor.
All nonfamily infant abductions, occurring in the United States and reported to the NCMEC were reviewed and coded according to the following variables:
* infant: age, race, sex, year of abduction, and whether the infant was injured
* parent: whether the infant was taken from its mother, father, or guardian; whether the parent was injured; and whether a weapon was used against the parent
* location of the abduction
* abductor: age, sex, race, employment status, prior arrests, obstetric history, marital and parental status; whether impersonation or disguise was used; whether the abductor's partner was aware of the abduction; whether an accomplice was involved; the abductor's explanation of motive; and whether the abductor was arrested, indicted, and sentenced
* recovery of infant: location, time to recovery, source of tip, and positive identification of the child
The 247 cases were analyzed using descriptive statistics (primarily frequencies and percentages) and Pearson's [chi]2 tests.
FINDINGS: THE ENTIRE SAMPLE, 1983-2006
Location of abduction. One hundred sixteen infants (47%) were taken from hospitals and other health care settings such as birth centers and prenatal or pediatrics clinics. Another 131 infants (53%) were taken from non-health care locations: 97 (74%) from homes and 34 (26%) from "other" places.
Infants. Roughly equal numbers of infant boys (n = 126) and girls (n = 121) were abducted; 103 infants (42%) were black, 75 (30%) were white, 61 (25%) were Hispanic, and eight (3%) were from other races. The vast majority of abducted infants (95%) were found; 12 (5%) remain missing.
Abductors. The vast majority (237 of the 247 abductors) were women (96%); six were men (2%); the abductor's sex was not recorded in four cases (2%). Ninety-nine (41%) were black, 93 (39%) were white, and 47 (20%) were Hispanic; in eight cases (3%) race wasn't recorded. (We defined race according to the categories that law enforcement agencies used at the time, which were based on definitions from the National Crime Information Center. Many agencies now define Hispanic as an ethnic, rather than racial, category.)
The abductors ranged in age from 14 to 53 years: 90 (36%) were in their 20s, 64 (26%) were in their 30s, 49 (20%) were in their teens, 24 (10%) were in their 40s, and three (1%) were 50 years of age or older. Age was not recorded in 17 (7%) cases. Of the 156 cases with data on the abductor's obstetric history and parental status, 69 (44%) had living biologic children, 27 (17%) reported having had a miscarriage or a stillbirth, and 11 (7%) had both living children and a history of miscarriage. Ninety-one (37%) of the 247 cases were missing these data.
Abductors were known to have made a prior visit to the abduction site in 157 (75%) of the 210 cases reporting this information. One hundred ten abductors (45%) impersonated a health care worker during the crime, and 33 (13%) had made a prior abduction attempt. (We considered impersonation and disguise separately: not all those who impersonated health care or social services personnel wore a disguise such as a uniform, and not all those who wore disguises attempted impersonation.)
Forty-four abductors (18%) used violence, which occurred in nine (8%) of the 116 abductions at health care facilities and in 35 (27%) of the 131 abductions at non-health care locations. (See Abductions Involving Violence, at left.)
SIGNIFICANT FINDINGS: 1983-1992 VS. 1993-2006
Statistical comparison tests revealed significant differences in abduction patterns from the earlier to the later period. Not all variables were reported for all cases. Figures illustrating significant findings appear on these pages; additional tables can be found online at http://links.lww.com/A520.
Race of infant. The proportion of Hispanic infants who were abducted increased significantly from 17% to 32% from the earlier to the later period, while that of white infants decreased significantly from 40% to 21%. The proportion of black infants who were abducted changed relatively little from the earlier to the later period (41% and 43%, respectively). See Figure 1, page 34.
Age of infant. The proportion of infants abducted before they were one day old grew from 7% to 11% of cases. This coincided with an increase in cases of fetal abduction (kidnapping by cesarian section) from 1% in the earlier period to 6% in the later period. The percentage of abducted infants older than 10 days also increased from 45% to 61% of cases. But the percentage of infants taken at one or two days old decreased from 30% to 15%; the percentage of those taken at three to five days old dropped from 13% to 7%. See Figure 2, at right.
Abductor marital status. From the earlier to the later period, the percentage of suspects who were married dropped from 28% to 19%, while the percentage of those who were unmarried increased from 32% to 52%. The percentage of divorced suspects remained at 2%. (In the remaining cases, marital status was unknown.) See Table 2, online.
Location of abduction. In the earlier period, a greater proportion of infant abductions happened in hospitals and in other health care settings than anywhere else; but since 1993 more abductions have taken place in homes and in public places such as shopping malls, parking lots, and social services offices. From the earlier to the later period, infant abductions from health care facilities declined (63% to 32%), whereas those from private residences nearly doubled (29% to 49%), and those from public places tripled (3% to 9%). See Figure 3, at right.
Time to recovery of the infant decreased significantly from the earlier to the later period. The proportion of cases in which recovery happened within 12 hours of the abduction increased from 20% to 27%; that in which recovery happened within 12 to 24 hours increased from 30% to 36%. Infants were not recovered in 6% of the earlier cases and in 4% of the later cases. See Table 3, online.
When the relationship between time to recovery of the infant and location of the abduction was considered, the data show that, since 1993, infants taken from health care facilities have been recovered faster than those taken from other locations. The percentage of infants taken from health care facilities and recovered within 24 hours increased from 57% in the earlier period to 85% in the later period. Infants abducted from non-health care locations didn't fare as well; in both the earlier and later periods, a smaller percentage of infants was recovered within 24 hours (38% and 52%, respectively). See Table 4, online.
Disguise and impersonation. Disguise, which sometimes involved wearing a uniform, was used significantly more often in health care facility-based abductions during the earlier period, when 41% of abductors did so, compared with 11% in the later period. Similarly, the proportion of abductors who impersonated a health care worker also dropped markedly, from 60% in the earlier period to 29% in the later one. See Tables 5 and 6, online.
Parental injury. Although a vast majority of cases in each time period didn't involve parental injury, the incidence of it increased significantly in the later period. The percentage of parental injuries (minor, serious, and lethal) went from 9% to 17%. The percentage of lethal injuries doubled, going from 6% to 12%. See Figure 4, at left.
Weapon use. The proportion of abductions involving use of a weapon nearly doubled, from 11% in the earlier period to 20% in the later one. See Figure 5, at left.
ADDITIONAL FINDINGS: 1983-1992 VS. 1993-2006
Some other findings are worth noting, although these were not statistically significant.
Abductor's race. The proportion of Hispanic abductors nearly doubled, from 14% to 25%; that of black abductors also increased, although less dramatically, from 40% to 43%. The proportion of white abductors decreased from 46% to 32%. See Table 7, online.
Source of tip. The proportion of cases in which family members reported the abductor to law-enforcement authorities increased from 12% to 17%. The proportion in which news reports resulted in tips from the general public to law enforcement authorities increased from 20% to 30%. See Table 8, online.
Arrests and indictments. The proportion of suspects arrested increased from 88% to 94%; the proportion indicted increased from 87% to 94%. See Table 9, online.
Partner awareness. The term partner refers to the abductor's significant other, whether or not the two were married or cohabiting. The data suggest that partners in the later period were less aware of the abductors' actions than those in the earlier period. The percentage of partners who were aware that the abductor had taken an infant declined, from 17% to 10%, while the percentage of those who were unaware increased from 40% to 47%. The percentage of cases in which partner awareness was unclear remained stable at 44%. See Table 10, online.
Prior visit. A greater percentage of abductors made a prior visit to the abduction location in the later period (80%) than in the earlier period (69%). See Table 11, online.
WHAT NURSES NEED TO KNOW
Regarding the site of abduction, a trend was seen away from health care facilities and toward homes, which may be reflected in a rise in parental injury and a greater use of weapons during abduction (perhaps abductors anticipated stronger opposition from parents than from health care facility staff). Abductors' prior visits to abduction sites increased in the later period perhaps because factors such as physical layout and the presence of others are less predictable in non-health care settings, and it may have become more important for abductors to familiarize themselves with locations ahead of time.
The increased numbers of suspects arrested and indicted in the later period may be due to heightened public awareness of nonfamily infant abduction. And the decline in partner awareness may be related to a decline in the number of abductors who were married or cohabiting or both.
Our data suggest some differences in the profiles of nonfamily abductors who take infants from health care settings and those who do so from non-health care settings. See Nonfamily Infant Abductor Profiles, at right.
Parent education should include familiarizing expectant and new parents with their hospital or birthing facility's protocols concerning routine care, visitation, and security. They should be cautioned to be watchful of anyone they don't know well, especially anyone whom they met during the pregnancy, anyone who shows excessive interest, and anyone who arrives at their home unannounced or who can't provide checkable identification. If an abduction occurs, it's essential that parents contact local law enforcement immediately; all such incidents should be reported to the NCMEC as well.
Media involvement, including news reports and public service announcements, has proven to be invaluable in recovery efforts. One rapid-response program, America's Missing: Broadcast Emergency Response (AMBER), was created in 1996 in Texas and is now used nationwide. Through collaboration between local law enforcement agencies and the news media, "AMBER Alerts" enlist the public's help in finding abducted children. According to data from the Bureau of Justice Statistics, nearly 400 children have been saved as a result of these alerts.12
Staff education. In 1999, for the first time since record-keeping began in 1983, the NCMEC reported that no nonfamily infant abductions from health care facilities had occurred.13 That "zero period" actually lasted 17 months, from November 1998 through March 2000; since then there have been two more zero periods of a year or more.14 We believe this is the result of collaboration between nursing organizations (such as the Association of Women's Health, Obstetric, and Neonatal Nurses and the National Association of Neonatal Nurses) and security organizations to sponsor educational programs such as Safeguard Their Tomorrows. That program, developed by these organizations with the NCMEC, involves training staff, implementing security measures, and creating policies in facilities for prevention and response.13 And since 1987 the NCMEC has provided technical assistance, consultation, and training to more than 950 hospitals, nursing associations, and hospital security and law enforcement groups regarding infant safety in hospital settings.15 Indeed, we believe such training may explain the faster recovery times for infants taken from health care settings in the later period.
Preventive policy. In 1993 the NCMEC published evidence-based guidelines on preventing infant abductions; the current edition is available for free at http://www.missingkids.com/en_US/publications/NC05.pdf. The NCMEC also periodically sends revised policy directives to health care agencies for possible inclusion in their safety management programs. For example, in March 2007 one of us (JBR Jr), representing the NCMEC, e-mailed a revised directive noting that in five of 10 cases in which the infant wore an electronic security tag, the abductor was able to remove it quickly; the directive warned facilities not to delay in activating or responding to an alarm.
Further research is needed in nonfamily infant abduction, so that more specific preventive guidelines can be developed. Additional study of abductors could provide insight into their characters, thinking patterns, and motivations. We were particularly troubled by the higher incidence of violent abductions; research might help clarify the reasons for this increase. Follow-up on the impact of infant abduction on families is critical.
Abductions Involving Violence
Because there were relatively few data on abductions that involved violence, we considered all cases occurring from 1983 through 2006 together. Violence, defined here as the use of a weapon or force or both against the target infant's parent or guardian, occurred in 44 (18%) of the 247 cases. Forty-two of the violent abductors were women; two were men. Eighteen already had biologic children. Twenty-nine of the violent abductors took an infant from a residence, six did so from a public place, and nine did so from hospitals or other health care settings. Sixteen of the violent cases (36%) involved accomplices: the accomplice was a man in 12 cases and a woman in four. Five of the violent abductors have never been caught and three of the children are still missing.
In 22 cases, the infant's mother was killed; in two cases, both parents were murdered. A cesarean section was forcibly performed in nine cases: eight of these mothers and three fetuses died. Weapons data were collected in 42 of the 44 cases. Of these, 38 involved the use of a weapon, including guns in 19 cases and cutting instruments such as knives, scissors, or car keys in 12 cases. (For more on the types of weapons used, see Table 1, online at http://links.lww.com/A520.) Hands were used in four cases to strangle or beat the mother. Two mothers were drugged. When a weapon-particularly a gun-was used, the mother's death was more likely.
Nonfamily Infant Abductor Profiles
The National Center for Missing and Exploited Children's "typical" nonfamily infant abductor profile was originally developed from data from the 1983-1992 study of infant abductions and has been periodically updated. Several points are specific to abductions from health care facilities. The current version, which is based on data from 248 cases from 1983 through 2007,11 states that a typical abductor
* is a woman between the ages of 12 and 50 and is often overweight.
* is compulsive and frequently uses manipulation and deceit to gain access.
* often indicates she has either lost a baby or cannot have one.
* lives in or is familiar with the community in which the abduction occurs.
* can provide good care for the baby once the abduction occurs.
* is often married or living with a man.
* visits nursery and maternity units at more than one facility before the abduction and asks detailed questions about procedures and unit layout; the abductor "may also try to abduct from the home setting."
* usually plans the abduction but doesn't necessarily target a specific infant; often seizes any opportunity that presents.
* frequently impersonates a nurse or other health care provider.
* often becomes familiar with facility staff and work routines, as well as with parents of intended victims.
A cautionary note adds, "There is no guarantee an infant abductor will fit this description."
The characteristics of nonfamily infant abductions from non-health care settings differ somewhat. The first five characteristics listed above still apply. Our data suggest four new characteristics, although only the first demonstrates statistical significance. We believe the typical abductor in the non-health care setting also
* is more likely to be single while claiming to have a partner.
* often targets a mother-whom she may find by visiting hospitals-and tries to meet the target family.
* often both plans the abduction and brings a weapon, although the weapon might not be used.
* often impersonates a health care or social services professional when visiting the home.
REFERENCES