Beyond neonaticide: A forensic typology of suspicious perinatal deaths in South Korea (2015-2021)

Crisis pregnancies can lead to a spectrum of fatal outcomes, yet traditional research, focused narrowly on neonaticide and constrained by the "born-alive principle," often overlooks concealed stillbirths and forensically ambiguous cases. This study applies the broader framework of Suspicious Perinatal Death (SPD) to a national South Korean forensic dataset (2015-2021) to identify epidemiological patterns and empirical typologies during a period of significant sociopolitical change.

From all perinatal autopsies (N = 230) at South Korea's National Forensic Service, 138 cases met criteria for SPD (fetal death ≥24 gestation or neonatal death within ≤24 h under suspicious circumstances).

In this retrospective study, 64 variables were coded from forensic and investigative records. After feature selection (Boruta algorithm) and outlier removal, Partitioning Around Medods (PAM) cluster analysis on 132 cases was used to derive typologies.

Three distinct typologies emerged: 'Adolescent-Dependent' (n = 42, 31.8 %), 'Isolated Single-Mother' (n = 36, 27.3 %), and 'Socially Vulnerable-External Discovery' (n = 54, 40.9 %). A critical temporal trend was identified: confirmed neonaticide cases declined by 91.7 %, while non‑neonaticide SPD cases (e.g., induced stillbirths) increased by 150 %. Live birth status remained forensically indeterminate in 29.0 % of cases.

The SPD framework reveals that perinatal deaths in South Korea are not simply decreasing but are transforming in method, influenced by shifting legal and medical landscapes. The identification of distinct, evidence-based typologies underscores the need for a paradigm shift from punitive responses toward tailored, preventive public health interventions.