Pregnant women more likely to be murdered than die from other causes

For pregnant women in the United States, homicide is more likely than death by the top three causes of maternal mortality — hypertensive disorders, sepsis and hemorrhage — according to experts.

“These pregnancy-associated homicides are preventable, and most are linked to the lethal combination of intimate partner violence and firearms,” Rebecca B. Lawn, PhD, a postdoctoral research fellow in the department of epidemiology at Harvard T.H. Chan School of Public Health, and Karestan C. Koenen, PhD, of Massachusetts General Hospital, wrote in BMJ. “Preventing men’s violence towards women, including gun violence, could save the lives of hundreds of women and their unborn children in the U.S. every year.”

Globally, one in three women report abuse by a partner in their lifetime, according to the authors. Although this is a worldwide issue, current data indicate that the U.S. sees a higher prevalence of intimate partner violence than most European countries and Australia.

Between 2008 and 2019, most pregnant women — 68% — who were killed by their partners were murdered with a firearm, according to data published last month in Obstetrics & Gynecology. So, with rising numbers of firearm homicides in the U.S., “gun violence has become a health emergency for pregnant women,” Lawn and Koenen wrote.

“Rates of domestic homicides are associated with state level rates of gun ownership and firearms legislation,” they wrote. “Recent legislation to further prevent firearm purchases by current or former dating partners with convictions for domestic violence are a step in the right direction. But further restrictions and enforcement of current firearms legislation are needed urgently.”

The overturning of Roe v. Wade has brought “further urgency to these issues,” Lawn and Koenan wrote.

The authors noted that restricting abortion access “endangers women because unwanted pregnancies potentially amplify risks in abusive relationships.” Black women have been disproportionately affected by the recent changes to abortion legislation because they are at a “substantially higher risk” for being murdered by their partners around pregnancy than Hispanic or white women, Lawn and Koenen wrote.

Other contributing factors that may influence these disparities are structural racism, inequities in access to and quality of reproductive health care and longstanding socioeconomic oppression.

“Restricting women’s access to reproductive care, including abortion, also limits opportunities for services to identify and help women experiencing gender-based violence,” they wrote.

Because pregnancy usually means that women are seeing health care providers more frequently, there are opportunities for interventions like screening that might help women facing abuse.

“However, these efforts must sit alongside urgent work to reduce all forms of violence against women, including advocacy by healthcare professionals for legislation to control access to firearms in circumstances of domestic violence,” Lawn and Koenan wrote.

The authors further called for research to better understand risk factors for homicide during pregnancy.

“All causes of maternal mortality are important. The tragedy is that pregnancy associated homicide is one of the preventable causes of maternal death,” they concluded. “The situation in the U.S. is serious and deteriorating, but intimate partner violence accounts for a large proportion of women killed globally. Ending male violence against women, including gun violence, is an urgent priority for the health and safety of women everywhere.”

Reference:

• Modest, A M, et al. Obstet Gynecol. 2022;doi:10.1097/AOG.0000000000004932.