For decades, the medical community has primarily focused on preventing and treating maternal deaths caused by medical conditions such as bleeding, infections, hypertension, and cardiovascular disease. However, new research presented at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting, The Pregnancy Meeting, sheds light on a shocking and often overlooked reality: homicide and suicide are now the leading causes of maternal mortality in the United States.
Findings from the National Study
The study, conducted by researchers from Columbia University Irving Medical Center, analyzed data from the Centers for Disease Control and Prevention (CDC) spanning an 18-year period from 2005 to 2022. It examined the deaths of pregnant individuals and those within the first 42 postpartum days, aged 15-44, making it the most extensive analysis of a national database on maternal deaths to date.
In total, 20,421 maternal deaths were recorded during this period. Surprisingly, 11% (2,293 deaths) were attributed to homicide and suicide, making violent deaths the leading cause of maternal mortality. Of these, homicides accounted for 61% (1,407 deaths), while suicides made up 39% (886 deaths). Alarmingly, over half (55%) of these violent deaths (1,261 deaths) involved firearms.
Violence and Maternal Mortality
“Many people are surprised when they hear that violence is the leading cause of death in pregnancy,” said Dr. Hooman Azad, MD, MPH, lead author of the study and a fourth-year resident in the Department of Obstetrics & Gynecology at Columbia University Irving Medical Center.
The current definition of maternal mortality focuses on deaths caused by medical conditions related to pregnancy, excluding homicide and suicide. However, this study raises the question of whether this definition should be reconsidered, given that being pregnant or postpartum significantly increases the risk of experiencing fatal violence.
“More pregnant women die of violence than any individual medical cause,” Dr. Azad noted. “Part of the reason this issue is not widely recognized is because homicide and suicide are not included in the definition of maternal mortality. This exclusion prevents a full understanding of the risks faced by pregnant and postpartum individuals.”
Racial and Age Disparities in Maternal Violent Deaths
The study also highlighted significant racial disparities in maternal mortality due to violence. Black birthing individuals aged 18-24 experienced homicide rates nearly four times the national average, with almost eight deaths per 100,000 people. These numbers reflect broader systemic issues, including racial inequities in healthcare, socioeconomic disadvantages, and higher exposure to intimate partner violence.
Firearm Legislation and Maternal Death Rates
One of the most significant findings of the study was the correlation between firearm legislation and maternal deaths. Researchers found that states with stricter firearm laws experienced a 20-30% reduction in firearm-related deaths and firearm homicides among pregnant and postpartum individuals. This finding suggests that policy measures aimed at controlling firearm access could play a crucial role in reducing maternal mortality.
“There’s a misconception that most maternal deaths happen in hospitals or healthcare settings, and that’s simply not the case,” said Dr. Mary D’Alton, MD, a maternal-fetal medicine specialist and co-author of the study. “We need more education about this serious national issue so we can begin to take steps to address it as clinicians and at the policy level.”
Implications for Policy and Healthcare
Given the study’s findings, experts argue that maternal mortality definitions should be expanded to include deaths caused by violence, particularly homicide and suicide. Recognizing these causes as part of maternal health data could lead to increased funding and policy interventions aimed at reducing the risks.
Additionally, healthcare providers should be trained to recognize warning signs of intimate partner violence and mental health crises during prenatal and postpartum visits. Enhanced screening, community-based interventions, and improved access to mental health resources could help address the underlying factors contributing to these preventable deaths.
The Need for Comprehensive Solutions
The findings of this study call for a multi-faceted approach to maternal health that extends beyond medical conditions. Addressing violence as a public health issue is crucial to improving maternal survival rates. Some key recommendations include:
- Expanding Maternal Mortality Definitions: Including violent deaths in official maternal mortality statistics to reflect the true risks faced by pregnant and postpartum individuals.
- Stricter Firearm Regulations: Implementing policies to reduce firearm access in domestic violence situations.
- Enhanced Screening and Support Services: Training healthcare providers to recognize signs of domestic abuse and mental health concerns during routine pregnancy checkups.
- Community-Based Interventions: Expanding social support programs for vulnerable populations, particularly young Black women, who face higher risks of violence.
- Mental Health Resources: Increasing access to mental health services for pregnant and postpartum individuals to prevent suicides.
The study presented at SMFM’s annual meeting highlights a pressing and overlooked issue in maternal healthcare. Homicide and suicide, particularly involving firearms, now surpass medical causes as the leading contributors to maternal mortality in the U.S. Recognizing violence as a maternal health issue, implementing policy changes, and providing targeted interventions are essential steps toward protecting pregnant and postpartum individuals from preventable deaths.
As the medical and policy communities continue to grapple with improving maternal health outcomes, acknowledging the impact of violence and mental health crises is a critical component of ensuring the safety and well-being of all pregnant individuals.
