Miriam Centre counselling service director Patsy Henderson-Watt - who gets up to 160 referrals a month for violence in Whangarei - said treating strangulation seriously as a separate crime could prevent the escalation of violence and possibly deaths.
She agreed that strangulation was one of the most intense forms of violence and was "scarily not uncommon" in Northland. It was a "red flag" for future serious abuse or fatality.
"It's so close to murder. If someone is 'strangling' someone, they are well down the track of violence and it's not just a minor thing.
"We immediately swing into action when we hear about it, but 90 per cent of the time they are too scared to leave."
Ms Henderson-Watt said she was not surprised Northland had such a high percentage of family-violence deaths given the poverty and unemployment in the region.
Northland police criminal investigations manager Inspector Kevin Burke said strangulation was a risk factor that could result in the escalation of violence, putting the victim at further risk and police treated it very seriously.
"We treat family-violence incidents with urgency and have established processes to deal with these incidents, particularly with high-risk families," Mr Burke said.
"However, family violence is not just a police issue. We need the community, partner agencies and non-government organisations to play a part in preventing violence to ensure families are healthy and safe."
He said Northland was a region with high social deprivation that placed added stress on families and there were multiple factors that contributed to family violence.
The report data showed that 139 people were killed in family violence-related homicides between 2009 and 2012. That was 47 per cent of all New Zealand homicides.
They included 63 adults killed by partners or ex-partners, 37 children who died from abuse or neglect and 26 adults killed by family members who were not their partners.
Justice Minister Judith Collins has seen the recommendations in the report. She said they would have to be considered through the parliamentary process before they could be adopted.