With homicide a leading cause of maternal death, doctors urged to screen pregnant women for domestic violence

By Jacqueline Howard, CNN

Two researchers are urging health-care providers to educate and screen pregnant women about intimate partner violence, as women in the United States are more likely to be murdered during pregnancy or postpartum than to die of common obstetric causes such as high blood pressure, hemorrhage or sepsis.

Other research suggests that they are also at higher risk of homicide than women who are not pregnant.

Pregnancy-related homicides are often linked to domestic violence and firearms — but they are preventable, Rebecca Lawn and Karestan Koenen of the Harvard T.H. Chan School of Public Health wrote in an editorial published Wednesday in the medical journal BMJ.

“Women are likely to have multiple visits with healthcare professionals during pregnancy, providing opportunities to identify and help women at risk of violence and potentially prevent pregnancy-associated homicides,” Lawn wrote in an email to CNN on Thursday. “However, recent legislation in the US to restrict women’s access to reproductive care and abortion reduces these potential opportunities to help and could place women at further risk of violence.”

She also cited legislation around firearms as affecting women’s risks of intimate partner violence.

“While many factors contribute to the high maternal mortality rates observed in the US, the inextricable and lethal link between intimate partner violence and gun violence must be considered. 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 said. “Firearm legislation is more lenient in the US and rates of both intimate partner violence and gun ownership are higher than in other high-income countries — this backdrop likely contributes to the high rates of pregnancy-associated homicide we observe in the US.”

Most people tend to think of clinical causes of maternal death — such as preeclampsia or gestational diabetes — but Lawn and Koenen’s editorial provides insights into intimate partner violence as another cause, said Dr. Zenobia Brown, senior vice president of population health and associate chief medical officer at Northwell Health, a health-care network in New York.

“I applaud the article because I think it surfaces things that we otherwise don’t want to look at because they’re very difficult and because traditionally, health care hasn’t really dealt with those issues well,” she said.

Brown added that intimate partner violence has been part of discussions around maternal health at Northwell’s Center for Maternal Health, as well as assessing women for risks of intimate partner violence.

“There is a very heavy focus in general on assessment, asking the right questions and listening, and in particular, assessing for these things that traditionally we have not assessed for, like intimate partner violence, like history of trauma, behavioral health,” Brown said.

“We tend to think about maternal mortality, or maternal issues, as a point in time or a moment in time for women and I think what people need to understand more and more is that it is about the entire lifecycle of a woman, of her family, of everyone who touches that familial unit,” she said. “We should not be waiting for a woman to be pregnant to be asking these questions.”

A study published in August in the American Journal of Public Health found that pregnancy-associated homicides in the United States have risen substantially in recent years, and the risk of homicide was 35% higher for pregnant and postpartum women than for their counterparts who are not pregnant nor postpartum.

Data on maternal deaths related to intimate partner violence is often lacking — but screening can help, said Kamila Alexander, an associate professor at the Johns Hopkins School of Nursing.

She also said that Black women are at higher risk of maternal deaths due to homicide than white women and that monitoring those racial disparities is important.

“There’s not consistent screening in the clinical setting. So documented violence occurring during the time of pregnancy is likely inconsistent — so linking it to a death can be challenging,” Alexander said. “There’s a lot of holes in the data that we have.”

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