Homicide is a leading cause of death in pregnant women in the US

Women in the U.S. are more likely to be murdered during pregnancy or soon after childbirth than to die from the three leading obstetric causes of maternal death (high blood pressure disorders, hemorrhage, or sepsis), say experts in The BMJ today.

Rebecca Lawn at Harvard School of Public Health and colleagues say the majority of these pregnancy-associated homicides are linked to the lethal combination of intimate partner violence and firearms, and are entirely preventable.

They argue that ending male violence, including gun violence, could save the lives of hundreds of women and their unborn children in the U.S. every year, and is an urgent priority for the health and safety of women everywhere.

Intimate partner violence is common worldwide, with one in three women reporting experiences of violence including physical, sexual, or psychological abuse by a partner in their lifetime, they explain.

Reports suggest the U.S. has a higher prevalence of lifetime and past-year intimate partner violence than other high-income countries, and homicides by an intimate partner in the U.S. are overwhelmingly committed using firearms. Recent estimates indicate that firearms were used in 68% of homicides around pregnancy between 2008 and 2019, with black women at substantially higher risk of being killed than White or Hispanic women.

Rates of domestic homicides are also associated with state-level rates of gun ownership and firearms legislation, yet the authors note that few perpetrators of intimate partner violence are ever convicted, and many loopholes allowing access to firearms remain.

The recent dismantling of women's reproductive rights in the U.S. brings further urgency to these issues, they say. For instance, reproductive coercion, a common aspect of intimate partner violence, increases the risk of unintended pregnancy, while restricting access to abortion endangers women as unwanted pregnancies potentially amplify risks in abusive relationships.

The researchers point out that pregnancy typically increases women's interactions with healthcare providers, presenting opportunities for screening or other approaches to help women experiencing or at risk of violence. Such interventions may help stop a pattern of abuse that could lead to homicide or adverse health outcomes, they say, but these efforts must sit alongside urgent work to reduce all forms of violence against women.

Research to identify risk factors for homicide in pregnancy is also critical to prevention efforts, they add, but better quality data are needed for further analyses.

All causes of maternal mortality are important; the tragedy is that pregnancy-associated homicide is one of the preventable causes of maternal mortality, the researchers write. While the situation in the U.S. is very serious and deteriorating, they point out that intimate partner violence is a leading cause of homicide for women globally. Ending male violence, including gun violence, is therefore an urgent priority for the health and safety of women everywhere, they conclude.