Homicide is a leading cause of death for pregnant women, new study finds

The U.S. has the highest rates of maternal mortality in the industrialized world, but new research shows there's a leading cause of death for women during pregnancy or soon after childbirth that many are unaware of: murder.

Women in this country are more likely to die of homicide during pregnancy or not long after giving birth than they are to die of the main obstetric causes of maternal death: blood pressure disorders, hemorrhage (that is, bleeding) or sepsis, a life-threatening infection, according to data published in the BMJ. That's even as new research has found pregnancy-related deaths have increased nearly 80% since 2018, largely due to COVID-19.

The study found that the homicides are usually linked to intimate partner violence and firearms. "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," the researchers wrote. They also noted that reports suggest the U.S. has a higher incidence of intimate partner violence than other high-income countries, adding that this form of violence is "often fatal."

These murders seem to be on the rise. One study published in August found that the risk of homicide is now 35% higher for women in the pregnancy and postpartum period than for those who are not expecting or new parents.

The new report cites data that found that guns were used in 68% of homicides around pregnancy between 2008 and 2019, and that Black women are at a higher risk of being murdered than those who are white or Hispanic.

"Pregnancy-associated homicides are preventable," lead study author Dr. Rebecca Lawn, a postdoctoral research fellow at the Harvard School of Public Health, tells Yahoo Life. "We felt it was important to bring greater attention to these violent deaths to help better protect the health and safety of women in the U.S."

Intimate partner violence — which is defined as abuse or aggression that happens in a romantic relationship — and gun violence "appear inextricably linked" in the U.S., Lawn says, "with both reported as preceding factors in the majority of pregnancy-associated homicides." Meaning, there are typically warning signs that this may happen in the form of abuse or aggression directed at expectant women.

"Pregnancy represents a particularly high-risk time for experiencing intimate partner violence, and women are more likely to be killed by an intimate partner if their partner has access to a firearm," Lawn says.

Pregnancy can often be a time of increased stress in a relationship, Dr. Alaptagin Khan, a psychiatrist and trauma and adversity researcher at McLean Hospital, tells Yahoo Life. "For women, we usually talk about not only stress but increased anger due to fluctuating hormones, increased need for relationship commitment and a concern about the resources, which could result in arguments," he says. "For men too, the anxiety and stress due to the fear of increasing responsibilities can be significantly detrimental to relationships. ... These stressors can easily derail relationships, and if there is a history of violence, it can potentially escalate to the extreme."

Having an unplanned pregnancy is also "significantly associated" with intimate partner violence, Khan says. And, he points out, "a partner with a history of violence could again turn to violence, whether the partner is pregnant or not pregnant."

Pregnancy usually increases women's interactions with health care providers through routine ob-gyn appointments, Lawn says. "Women who have experienced these forms of violence — if they feel comfortable — may wish to share this information with their health care providers," she says.

But not everyone feels comfortable sharing that they've been the victim of abuse. That's why Lawn stresses the importance of doctors offering information on intimate partner violence to all patients. "Regardless of whether a woman discloses experiences of violence, health care providers should provide all patients with information about the availability of help in circumstances of domestic abuse," she says.

When it comes to health care providers screening for intimate partner violence, "pregnant women are either given a questionnaire or questioned directly by their health care provider," women's health expert Dr. Jennifer Wider tells Yahoo Life. It's a practice that's recommended by the American College of Obstetricians and Gynecologists (ACOG). ACOG specifically suggests that doctors screen pregnant women at the first prenatal visit, at least once a trimester and at the postpartum checkup. Health care providers should also offer ongoing support and guide patients toward resources to help with intimate partner violence, the organization says.

"There needs to be a large push by the health care industry to raise awareness and screening methods among pregnant women for intimate partner violence,” Wider says. “Women need to feel safe with their health care providers and encouraged to speak freely, with options presented to deal with the situation."

"Some people will say they're the victims of domestic violence in the questionnaire," Dr. Christine Greves, a board-certified ob-gyn at the Winnie Palmer Hospital for Women & Babies, tells Yahoo Life. "It's not that often, but we've seen it." Her practice also has a flier in the bathroom with phone numbers that can be torn off for patients who are dealing with intimate partner violence to call if they need help. If someone shares that they've been victimized, Greves says her practice can call a local home to help them find a place to stay or contact a social worker who can help with getting them to safety.

While intimate partner violence is never the fault of the victim, Khan urges women to be mindful of how their partner is behaving. "If the partner with a history of violence is becoming increasingly violent or visibly stressed, turning to drugs or alcohol, they should seek help," he says.

Ultimately, though, Lawn says the takeaway is simple: "We must urgently prevent male violence against women."

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