Homicide is leading cause of death for pregnant women in US, data shows

Pregnant women in the Unites States are more than twice as likely to be murdered during pregnancy or shortly after childbirth than they are to die from the three main medical causes of maternal death associated with childbirth, research shows.

The majority of the homicides of pregnant women in the U.S. are at the hands of an intimate partner with a firearm, according to an editorial, which reviewed recent research and was published in the medical journal BMJ earlier in October.

"Pregnancy represents a particularly high-risk time for experiencing intimate partner violence," Dr. Rebecca Lawn, lead author of the paper and a postdoctoral research fellow at Harvard School of Public Health, told ABC News. "While these statistics are shocking, pregnancy-associated homicides are preventable."

Around 1 in 3 women have reported being the victim of physical violence from their intimate partner in their lifetime, according to the Centers for Disease Control and Prevention.

Women who are from ethnic or racial minority groups are at increased risk for even worse outcomes. These groups also tend to have a higher prevalence of intimate partner violence, according to the CDC.

Black women are three times as likely to be killed by their intimate partners around the time of pregnancy compared to white or Hispanic women, according to a study cited in the editorial, published earlier this year.

In cases of intimate partner violence, the severity of the abuse can at times increase during pregnancy, according to the American College of Gynecologists and Obstetricians.

"Many pregnant patients are not aware of the increased risk of homicide during pregnancy and after childbirth," Dr. Nita Landry, a Los Angeles-based OB-GYN, told ABC News. "Sometimes, pregnant patients are afraid to come forward."

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The editorial reports that firearms were used in over 2 out of every 3 cases of women who were killed by their intimate partners around the time of pregnancy between 2008 and 2019, based on a study published earlier this year.

"Women are more likely to be killed by an intimate partner if their partner has access to a firearm," said Lawn, who called on U.S. officials to close loopholes in gun restrictions to prevent "perpetrators of domestic violence" from having gun access. "Further restrictions and enforcement of firearm legislation in domestic abuse circumstances are critical."

According to the CDC, the rate of firearm homicides has increased in recent years.

Previous research published in the Lancet has also suggested that the U.S. has a higher rate of intimate partner violence compared to other high-income countries.

Intimate partner violence, especially when associated with a firearm, can be fatal. With these statistics, intimate partner violence has quickly become a public health emergency for pregnant women, according to the report published in BMJ.

"It is an urgent call to action for not only health care team members, but for all of us," Dr. Elizabeth Langen, an OB-GYN and associate professor at the University of Michigan, told ABC News. "As we approach an election, we need to think about the health and well-being implications of our votes. Being able to pass gun control legislation is a matter of life and death."

The American College of Obstetricians and Gynecologists already recommends that obstetricians and gynecologists, as well as all health care providers, routinely screen patients for intimate partner violence.

"This should occur at least at the first prenatal visit, each trimester and at the postpartum check," Dr. Veronica Gillispie-Bell, the lead author of one of the studies cited, and an OB-GYN and associate professor at Ochsner Health, a Louisiana-based health care system, told ABC News. "As OB-GYN's … we are well positioned to ask the questions to uncover abuse and provide resources to get help."

The U.S. Preventative Services Task Force also recommends that health care providers screen women of reproductive age for intimate partner violence.

Despite these recommendations, the prevalence of screening by healthcare providers is low, with only about 1 in 4 women reporting being asked about intimate partner violence by their doctors, according to a report from the Kaiser Family Foundation.

Intimate partner violence is associated with both medical and psychological consequences. People who have experienced intimate partner violence can go on to develop depression and post-traumatic stress disorder, according to the CDC.

If you need help or need help supporting someone else, call the National Domestic Violence Hotline at 1-800-799-SAFE (7233) or text START to 88788, or chat online at TheHotline.org. All calls are toll-free and confidential. The hotline is available 24/7.

If you are struggling with any mental health crisis including thoughts of suicide, thoughts of hurting yourself, substance use or any emotional distress text or dial 988 to reach the Crisis Line. Free help is available 24/7.

Anna Yegiants, MD, MPH, is a resident physician in psychiatry and a member of the ABC News Medical Unit.