A pregnant woman's silhouette is seen on a wallShare on Pinterest
Andrei Box Roc/EyeEm/Getty Images
  • A new report finds that homicide is a leading cause of death during pregnancy and the postpartum period following childbirth.
  • Women in the U.S. are more likely to be murdered while pregnant or shortly after giving birth than to die from the three leading obstetric causes of maternal death.
  • Most murders of pregnant people are linked to intimate partner violence and gun violence, both of which are more common in the United States than in other high-income countries.

A new editorial in The BMJ is sharing a stark warning about the risk of violence facing pregnant people in the United States.

The authors report that homicide is a leading cause of death during pregnancy and the postpartum period following childbirth.

Women in this country are more likely to be murdered while pregnant or shortly after giving birth than to die from the three leading obstetric causes of maternal death—including pregnancy-related high blood pressure, bleeding, or sepsis.

Most murders of pregnant people are linked to intimate partner violence and gun violence, both of which are more common in the United States than in other high-income countries.

“Preventing men’s violence towards women, including gun violence, could save the lives of hundreds of women and their unborn children in the US every year,” write the authors.

They report that laws that restrict abortion access could magnify this issue by limiting people’s ability to end unwanted pregnancies, including those that result from sexual abuse or reproductive coercion by partners.

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

The new editorial follows on the heels of a recent study published this month in Obstetrics & Gynecology, which assessed violent deaths in pregnancy reported to the Centers for Disease Control and Prevention (CDC).

The study found that pregnancy-associated deaths accounted for more than 20% of all homicides of female victims reported to the CDC between 2008­­–2019.

Roughly two-thirds of pregnancy-associated homicides occurred during pregnancy itself, with the remaining third occurring during the year following childbirth.

Firearms were used in nearly 70% of pregnancy-associated homicides.

Non-Hispanic Black or African American individuals were more likely than white or Hispanic people to be murdered during pregnancy or shortly after childbirth. Black and African American people make up only 14% of the country’s population but accounted for almost 40% of pregnancy-associated homicides.

Another recent study assessed data from the National Center for Health Statistics and found the risk of homicide in pregnancy was increased for not only Black people but also young people across racial and ethnic groups, including girls and young women aged 10–24.

Intimate partner violence is a major risk factor for homicide during and around pregnancy.

Even when it doesn’t result in death, intimate partner violence has negative effects on people who experience it.

“Intimate partner violence or domestic violence is a pattern of behaviors where one partner in a relationship works to gain power and control over another partner,” Deborah J. Vagins, President & CEO of the National Network to End Domestic Violence (NNEDV), told Healthline.

“Generally, it can take a variety of forms of abuse, such as physical abuse, emotional and verbal abuse, financial abuse, and sexual abuse. The already traumatic impacts of experiencing these and other types of abuse can become even more dangerous if an abuser chooses to inflict them during pregnancy,” she continued.

Physical abuse during pregnancy can cause potentially life-threatening complications for both the pregnant person and developing fetus, Vagins said.

Emotional and financial abuse can cut a person off from the supportive relationships and financial resources they need to manage the challenges of pregnancy and parenthood.

Sexual abuse can erode their bodily autonomy and well-being—and in some cases may have caused the pregnancy against a person’s will.

Abuse can not only cause immediate harm but also raise the risk of chronic physical and mental health challenges.

“One of the most common effects on the mom-to-be is depression,” Jacquelyn Campbell, PhD, a professor at the School of Nursing at Johns Hopkins University in Baltimore, Maryland, told Healthline.

Depression in turn increases the risk of substance use disorder, drug-induced overdose, and suicide among pregnant people.

Intimate partner violence may also negatively affect a developing fetus, raising the risk of low birth weight, premature birth, and miscarriage.

“The infant is more likely to be small for gestational age, which can lead to lifetime problems with their growth and development,” said Campbell.

“We also know that children who grow up in homes where there’s domestic violence have more physical and mental health problems,” she added.

To help prevent homicide in pregnancy, the authors of the BMJ editorial call for tighter firearms controls and improved intimate partner violence screening and education by healthcare professionals.

The NNEDV is one of multiple organizations that’s currently lobbying for stronger firearms controls, as well as other laws to protect the health and well-being of pregnant people—such as The Women’s Health Protection Act (WHPA) and The Pregnant Workers Fairness Act (PWFA).

“The WHPA would create a federal law protecting abortion access from bans and restrictions nationwide,” said Vagins. “Abortion services are essential healthcare and having equal access—for all people, everywhere—is vital to their social and economic participation, reproductive autonomy, and the right to determine their own lives.”

“For domestic violence survivors,” she continued, “abortion access is a matter of safety.”

The PWFA would enable pregnant people to receive reasonable workplace accommodations to help them stay healthy while maintaining access to their paycheck and health insurance.

Vagins said this would provide important financial stability for pregnant people, including those who are experiencing or have experienced abuse.

“No one should have to choose between a job and a healthy pregnancy,” she said. “Staying employed can help provide financial stability for survivors in order to keep themselves and their children safe.”

Campbell told Healthline that domestic violence service organizations play important roles in helping women manage experiences of intimate partner violence and abuse.

“In almost every community in the country, we have domestic violence service organizations,” she said. “We used to call them ‘shelters,’ but now they have much more comprehensive services. You don’t have to go into the shelter to get services from the organization.”

“We also have the National Domestic Violence Hotline (NDVH), which is an incredible resource,” she added.

People can connect with the NDVH by:

  • calling 1-800-799-SAFE (7233)
  • texting “START” to 88788
  • chatting online at TheHotline.org

Those who use a teletypewriter to communicate can connect by dialing 1-800-787-3224.

Each U.S. state and territory also has a domestic violence coalition of local programs and service providers.

People can find contact information for their local coalition through the NNEDV.

According to Vagins, it’s important to empower people who are experiencing intimate partner violence to make decisions about their own life and develop a safety plan for if abuse escalates.

“Every domestic violence survivor knows their situation best, and every survivor is constantly weighing risks to determine what is and isn’t safe for themselves and their families,” she said.

“Creating a safety plan is an important part of many survivors’ journeys, and it can become even more critical during pregnancy,” she added.

Vagins told Healthline that a pregnant person’s safety plan might consider whether it’s safe to talk with a healthcare provider alone during prenatal appointments, without an abuser present.

Their plan might also include:

  • reaching out for help from trusted people and organizations, such as friends, family members, neighbors, parenting groups, and domestic violence organizations
  • stashing away small amounts of money, essential medications, and copies of important documents that they might need if they decide to leave an abusive relationship
  • researching legal options for people experiencing abuse, through resources such as WomensLaw.org

In some cases, people who experience intimate partner violence do not recognize it as abuse, which may prevent them from reaching out for support.

To help people assess the safety of their relationships and learn how to find support, a team from at Johns Hopkins University has developed the myPlan app.

“There’s a section where you go through and make a determination of whether or not your relationship is safe or not, and then there’s a plan that comes out that’s contextualized for the woman who is using the app,” said Campbell. “It can also be used by a family member or close friend if there’s someone they’re concerned about.”