Barriers to divorce during pregnancy, reproductive care pose risks for women
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Key takeaways:
- Pregnancy-associated homicide is rare but a leading cause of death for pregnant women.
- Proactive screening tools for intimate partner violence before pregnancy occurs could help identify risks early on.
Significant barriers to divorce during pregnancy and reproductive health care led to serious health risks among pregnant or recently pregnant women in the U.S. between 2018 and 2021, according to results of a cross-sectional study.
The findings provide key information for policymakers, researchers concluded.
Image: Adobe Stock.
Access to reproductive care
“I had studied violence against women for years, and I knew that homicide is a leading cause of death for pregnant women,” Kaitlin M. Boyle, PhD, researcher in the department of criminology and criminal justice at University of South Carolina, told Healio. “But in the wake of Roe v. Wade being overturned, I saw increased attention in the media about intimate partner violence against pregnant women in states where they cannot access reproductive care. Then, in early 2024, I saw several articles about Missouri state representative Ashley Aune, who proposed a bill to make it easier for women in Missouri to access divorce while pregnant. According to an attorney quoted on NPR, ‘In Missouri, it feels as though they have really closed down every door in terms of reproductive autonomy.’”
Those stories led Boyle to think about general patterns across the U.S. and over time of legislation that restricts access to reproductive care and legal barriers to divorce, and whether women are more likely to be killed while pregnant in general or by their partners in more restrictive states.
“Although I did not have access to data since the overturning of Roe v. Wade, I knew there was a lot of variation in access to reproductive care, such as contraception, family planning and abortion, across the United States even before this ruling,” she said.
Although pregnancy-associated homicide is rare, it is a leading cause of death for pregnant women, Boyle continued.
“Given there is so much variation in the types of laws and resources that shape women’s access to reproductive care, it is important that we understand the consequences of restrictive laws and the benefits of resources for women, especially those in abusive relationships,” she said. “As more states move to restrict access — and some move to protect or expand access — it is important for social scientists to study the consequences of such legislation. A well-established risk factor for lethal intimate partner violence is whether abuse occurred during pregnancy, and our study expands on that by examining the implications of laws that impact access to care during that very vulnerable time for women.”
Researchers sought to examine state laws about divorce, reproductive health care (access to contraception, family planning services and abortion) and pregnancy-associated homicide rates in U.S. states between 2018 and 2021.
They pooled data from the National Violent Death Reporting System in 181 state-years for 2018 to 2021 to assess rates of pregnancy-associated homicide by intimate partners vs. non-intimate partners, and rates among younger Black, Hispanic and white women.
Researchers then used negative binomial regression to test the hypotheses of an association between pregnancy-associated homicide rates and access to divorce while pregnant and reproductive health care.
Of note, exact sample size and other individual level data were not available for the study.
Proactive screening tools
Results showed significantly high rates of intimate partner homicide (incidence rate ratio [IRR], 2.11; 95% CI, 1.09-4.08) when state law prohibited divorce finalization during pregnancy. Researchers specifically observed high rates of intimate partner homicide among white females aged 10 years to 24 years (IRR, 2.39; 95% CI, 1.12-5.09).
Data also showed lower rates of non-intimate partner homicide in states with access to reproductive health care (IRR, 0.92; 95% CI, 0.87-0.98). They found a negative association between access to reproductive health care and homicide rates for younger Black women (IRR, 0.91; 95% CI, 0.87-0.96) and younger Hispanic women (IRR, 0.87; 95% CI, 0.79-0.96).
“Women who are in abusive relationships are less likely to seek prenatal care, putting them at risk for a host of medical problems,” Boyle said. “The consistent use of proactive screening tools for intimate partner violence before pregnancy occurs could help identify these risks early. Reproductive coercion — sexual violence and controlling or sabotaging a person’s reproductive choices — is one way that women experiencing abuse become pregnant. Screening for intimate partner violence could help physicians identify patients who may need further resources and support in selecting birth control measures and making reproductive care choices.”
Boyle noted that data have shown that screening tools do not necessarily increase the likelihood of referral to services, which is important to ensure that women receive not only the medical care but the social services they need in the face of violence.
“People tend to think of pregnancy and postpartum as a vulnerable time where women need to be protected and kept safe, so many people are surprised when I talk about how pregnancy can be the result of violence and it can also increase violence,” she said. “Increasing physicians’ knowledge of and access to victims’ advocates and other services could help make these important and potentially life-saving connections for women.”
Further research
Researchers are now working to extend this research by examining more recent data to include the time period when the U.S. Supreme Court overturned Roe v. Wade.
“Many states that already restricted access to reproductive health care before Roe v. Wade was overturned then implemented total or near-total bans,” Boyle said. “Research suggests this has led to increases in rape-related pregnancies and infant mortality, and it must be examined how these changes affect pregnancy-associated violence and homicide. This study extends that research to show that many states can and do pass legislation that could help protect women from homicide. Violence, including fatal violence, against pregnant girls and women is a public health problem that impacts not only the families who have lost a mother, daughter, sister or friend — as well as pregnancy loss — but causes significant harm to entire communities.”
For more information:
Kaitlin M. Boyle, PhD, can be reached at kb49@mailbox.sc.edu.
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