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On the night of Dec. 4, Utah Valley dispatchers received a frantic 911 call from a woman begging for help in the last moments of her life.

Sue Ann Sands screamed in terror from inside her lime green Volkswagen Beetle, which her ex-boyfriend had rammed with his SUV before coming at her with a gun in the parking lot of a Wal-Mart in American Fork, according to police.

James Dean Smith fired at least seven rounds into Sands' car — one of them fatally striking the 39-year-old woman in the head.

Minutes later, Smith died during a shootout with police.

Two weeks earlier, Smith, 33, had been served with a protective order after giving Sands a beating that left bruises all over her face and body, her mother told KUTV.

Of the 63 homicides in Utah in 2016, at least 20 — nearly 30 percent — were reportedly the result of domestic violence, or violence at the hands of a family member or cohabitant, according to The Salt Lake Tribune's unofficial tally, which is based on information from police and prosecutors.

While that number is on par with the national average of 30 percent, Jenn Oxborrow of the Utah Domestic Violence Coalition said domestic violence-related homicides in Utah have accounted for 42 percent of homicides statewide over the last 16 years.

Utah has a "squeaky clean" reputation in a lot of things, she said, but domestic and sexual violence are not part of them. The UDVC is a private nonprofit group designated by the federal government to coordinate efforts to combat domestic violence in the state.

Of the Utah deaths related to domestic violence this year, the youngest victim was an 8-week-old girl who allegedly was abused by her father. She was one of at least six Utah children who died as the result of domestic violence and abuse.

Part of the reason so many children are victims of lethal domestic violence in Utah, Oxborrow said, is because the state has a high birth rate to begin with, and many mothers fear they will lose custody of their children if they report domestic violence because they have exposed their children to a dangerous environment.

Also, the wage gap in Utah between women and men is bigger than in many other states, she said, and women are often afraid they won't be able to survive financially if they lose their household's main income, provided by their abusers.

"It's just a really bad combination of factors," Oxborrow said. "People are staying in really dangerous relationships for a long time."

While men and women can be perpetrators or victims of domestic violence, she said that 88 percent of offenders are male.

Of the 20 deaths in 2016 resulting from domestic violence, 18 accused perpetrators were men, one was a woman and in one case a suspect has not yet been named by police.

Of the 17 women and girls who were homicide victims, 11 died as the result of domestic violence. Nine domestic-violence victims were male.

The oldest victim of domestic violence was a 73-year-old Logan woman believed to have been fatally shot by her husband who later killed himself.

"I am astonished at how many really dangerous domestic-violence abusers are allowed to have guns in Utah," Oxborrow said. "It's stunning. ... Having a gun in a domestic-violence situation is like pouring gas on fire."

A state study from 2010 to 2013 showed that of 86 domestic violence-related homicides, 59 percent were shootings, Oxborrow said. And, of those, 39 percent of the perpetrators had a prior criminal domestic-violence history.

When a gun is present in a domestic-violence situation, it increases the risk of homicide by 500 percent for women, according to a 2014 study conducted by Everytown, a gun-safety advocacy group.

Of the total number of Utah homicides in 2016, at least 35 were shootings. Nine of those were domestic-violence related, while other cases of lethal domestic violence involved starvation, drowning, physical beating, stabbing or strangulation.

At least three of the domestic homicides reported were followed by the suicide of the perpetrator.

"Utah has a lot of work to do when it comes to holding people accountable for perpetrated domestic violence," Oxborrow said.

In other parts of the country, a standard response to domestic violence is a mandatory, court-ordered 26-week intervention program, she said, but the Utah court system does not mandate such offender programming.

A 2016 amendment to the state's Cohabitant Abuse Procedures Act made domestic-violence treatment optional for those convicted of domestic abuse.

Of those with a previous criminal domestic-violence history, Oxborrow said 12 percent are enrolled in such a program, which seeks to coordinate safety and hold people "accountable to the violence they've perpetrated."

"In Utah, we've tethered this to our mental-health system, and it's one more way of watering down the accountability for a domestic violence perpetrator," said Oxborrow, a licensed clinical social worker. "If mental-health issues are a factor in it, then that should be assessed for sure," but domestic violence should be treated and prosecuted as a violent crime.

She also believes victims throughout the state need more support and resources. Oxborrow said friends and family members are too often "incredulous" and skeptical when they are clued in about a case of domestic violence.

Additionally, she said, data collected by the state show that 2 percent of female victims of lethal domestic violence in the last 16 years have had a protective order against their killers.

"That tells me people don't know where to go," Oxborrow said.

Even when they do find resources, she said, the programs frequently are overwhelmed. In Utah, she said, 17 programs partner with the UDVC to serve 29 counties.

Part of the reason there are so few programs is because there is no dedicated state funding for the cause, Oxborrow added. Most states set aside between $1 million and $8 million, she said, but "in Utah, sometimes we get about $400,000 of state money."

Despite having limited resources, Oxborrow says the UDVC has a goal to never turn away someone seeking help.

Free, confidential resources are available through the Utah Domestic Violence Hotline at 1-800-897-LINK (5465). More information can be found at udvc.org.

Editor's note: The Tribune's homicide count excludes deaths charged as negligent homicides, those caused by impaired drivers, and deaths deemed justified as self-defense by prosecutors. Also excluded from the list are officer-involved shootings determined to have been justified.

Twitter: @mnoblenews