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AUSTIN, Texas -- Non-fatal strangulation continues to be a domestic violence issue, but some states still have not passed laws declaring it a felony, researchers said here.

Although understudied and underreported for years, a growing body of research on non-fatal strangulation -- usually defined as impeding the airway or blood circulation -- is now developing, said Christopher Marett, MD, MPH, director of forensic psychiatry at the University of Cincinnati, and colleagues sin a poster presentation at the American Academy of Psychiatry and the Law annual meeting.

Up to 10% of women have been strangled by an intimate partner, and those women are at higher risk for sexual assault, traumatic brain injury, and homicide.

Within last couple of years, a lot of states have passed laws to make strangulation a felony, but six jurisdictions -- North Dakota, Ohio, South Carolina, Kentucky, Maryland, and the District of Columbia -- still haven't done so, Marett told MedPage Today. And of those states which do have laws, they categorize the offense in different ways, with some categorizing it as domestic violence, others categorizing it as assault, and still others listing it as a stand-alone felony.

States also delineate strangulation in different ways, the researchers said. Differences include:

• Specifying whether the victim is a family member
• Role of self-defense
• Presence or severity of injury
• Presence of malicious intent
• Descriptions of the anatomy of the crime (some states require strangulation to be in the neck; others include sitting on someone's chest to the point they can't breathe)
• Whether the offender needs to attend special classes or programming
• Enhancement of other crimes if strangulation is involved

In addition, "some states specify that other types of strangling don't really count -- so if pressure to the neck is applied during a medical procedure, that's not under this," Marett said. "Also if it is part of sex play and if you're doing it mutually and there's consent, that's not part of this."

Most of the time, these cases involve a man strangling a woman, Marett noted. And although there's usually a pattern of violence, strangulation "often doesn't occur until 5 years into a relationship; it's a late-stage sign," Marett said. In addition, "there's a very high risk that if you've been strangled that the partner will kill you at some point -- a 70-fold risk of that happening."

In Ohio -- one of the states that hasn't yet acted -- the state legislature is considering a bill making non-fatal strangulation a felony. "Monica's Law" is named after Monica Weber-Jeter, a Cincinnati woman who died in 2014.

Weber-Jeter woke up one day in March of that year and found her husband yelling at her. He blocked the door, threatened to kill her and their children, and strangled her; she survived. He pled no contest to domestic violence and served 11 days in jail. In October, he stabbed Weber-Jeter 28 times; she died from her wounds about a month later.

"The family has really taken up the banner to advocate for this law, with the belief that had Mr. Jeter been [convicted of] a felony and been in prison, Mrs. Jeter would have had time to get away, get the kids away, and potentially still be alive," Marett said, adding that the motivation for this and similar laws "is to save lives ... We're hoping that the law will be passed in the next year."

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