Underreported twin health crises: Gun violence & maternal mortality

Many health risks to pregnant people are well-known, whether it’s preeclampsia, gestational diabetes or hemorrhage during delivery. Another culprit at the center of the maternal mortality epidemic is firearms.

Murders are a leading cause of maternal mortality in the U.S. — and maternal homicides are most often perpetrated with guns, commonly at the hands of an intimate partner. 

“Women in the U.S. are more likely to be murdered during pregnancy or soon after childbirth than to die from the three leading obstetric causes of maternal mortality (hypertensive disorders, hemorrhage, or sepsis),” one study reads. 

The risk is worse for young women and Black pregnant people — one study examining 12 years of pregnancy-associated firearm deaths found that over half of the homicide victims were Black. That same study showed that most of the perpetrators are current or former partners of the pregnant person. 

The twin public health crises of gun violence and maternal mortality are not robustly covered. Journalists should focus their reporting on maternal homicides as they would when covering any other fatal conditions impacting pregnant people. 

The research 

There are a handful of studies that have explored firearm violence perpetrated against people who are pregnant and postpartum, especially highlighting how the maternal mortality problem is worse among Black and young women. 

One study from researchers in Massachusetts and Washington examined pregnancy and postpartum firearm deaths from 2008 to 2019. It included women ages 15 to 44 who died while pregnant or within a year of pregnancy. 

Researchers identified 1,803 homicide and 1,929 suicide deaths from firearms. About 55% of the firearm homicide victims were Black women. Meanwhile, white women made up roughly 80% of firearm suicides, according to the study. 

Deaths occurred most frequently while the women were pregnant, at 63% for homicides and 40% for suicides. The murders happened most often because of ongoing intimate partner violence. 

Lower age, increased risk

Mothers under the age of 25 are also at high risk of intimate partner violence, one study found. Researchers from Connecticut and Texas collected data from 2001 to 2005 on young women ages 14 to 25 attending OBGYN clinics in two U.S. cities. 

“Few studies have examined the role of intimate partner violence (IPV) on young mothers’ postpartum health risks despite research showing young women experience some of the highest rates of IPV,” the study authors wrote. 

Researchers found that intimate partner violence for these women spiked from 17.9% at six months postpartum to 25.3% at 12 months postpartum.

The study also examined successful violence prevention programs. Screenings during medical visits, home visitations from nurses, prenatal care groups and behavior counseling during and after pregnancy were some of the most effective models. 

The American College of Obstetricians and Gynecologists recommends clinicians routinely screen their patients for intimate partner violence and perform periodic injury prevention evaluations and counseling regarding firearms. 

“Obstetricians and gynecologists see and treat a patient population that disproportionately experiences intimate partner violence, and fatality rates associated with intimate partner violence are increased when there is access to guns,” the college says in its policy statement on gun violence.

“The evidence shows that few physicians routinely discuss the issue of gun violence with their patients.” 

Reporting examples 

The Trace recently covered the maternal homicide crisis and offers inspiration for others looking to cover this issue. 

In one story, public health reporter Fairriona Magee dug into the established research on maternal homicides and shared the stories of three women seeking justice for their daughters.

“Women experiencing intimate partner violence are not who are immediately thought of when discussions of gun legislation or changes in reproductive access come up,” Rebecca Lawn, a public health scholar at Harvard University who studies interpersonal violence, told Magee. She was shocked when she first learned the extent to which pregnant women are at risk. “But, the bottom line is, these deaths are preventable.”

Magee also highlighted maternal mortality research in her reporting. An Atlanta study conducted in 2002 analyzed the deaths of pregnant and postpartum women in one of the area’s hospitals from 1949 to 2000. Researchers found a spike in homicides outpacing other obstetric causes of death. That jump first became apparent in the 1970s. 

Magee reported that other statewide and regional studies observed similar patterns in maternal deaths. They also found that the majority of these deaths were intimate partner-related, took place in the victim’s home, and that 60% to 80% of pregnancy-related homicides are by gun.

As a follow-up to her reporting, Magee published a story explaining how a health care approach can abate the maternal homicide crisis. 

One prevention strategy she highlighted was intimate partner violence screenings by health care practitioners, which have yet to be widely implemented. One study found that nearly half of women experiencing abuse while pregnant are not screened for it.

Screenings help women in abusive relationships know if they’re at high risk for homicides — information they can use to decide how to move forward and keep themselves safe, Johns Hopkins nursing professor Jacquelyn Campbell told Magee. 

Resources

• A new reporting guide, called Better Gun Violence Reporting: A Toolkit for Minimizing Harm, offers several useful tips for covering domestic violence. 
• The National Resource Center on Domestic Violence has a reporting guide, as does the National Network to End Domestic Violence.
• Victim advocacy organizations and domestic violence shelters. In most cities and states, there are victim advocacy groups for victims of intimate partner violence. These organizations are great resources for understanding what victims face and what resources are available. Shelters are also good sources and will often remain in touch with survivors.
• The Violence Policy Center releases an annual report called When Men Murder Women that analyzes violent crime data by state.