Homicide, suicide, and accidental overdoses as leading causes of pregnancy-associated deaths

Maternal mortality has reached epidemic proportions in the United States and there are significant racial disparities between Black and White women. A key factor that is frequently underreported in maternal health surveillance efforts is fatal violence.  This is a case-study of pregnancy-associated deaths (PAD) that occurred in Virginia from 1999-2005, the latest years for which data is available. Data was obtained from Virginia’s Maternal Mortality Review Team and the sample contained 309 women who died from a PAD. Violent deaths were defined as those in which the manner of death was homicide, suicide, or an accidental overdose. These were compared to the 12 natural causes of deaths, such as embolism or cardiac disorder. Rates were broken down by race and PAD ratios by race were calculated. About 13% of women in the sample were murdered, which was larger than any single natural cause of death. Nearly 60% of the homicide victims were Black and homicide was the leading manner of death for this group, with Black women dying from homicide at 4.5 the rate of White women. More than 80% of women knew their attacker and where the perpetrator’s gender is known, 90% were male. Homicide as a cause of PADs is underreported, yet may occur at a higher rate than many natural causes of death. Improvements in maternal death surveillance, a commitment to ending violence against women, and addressing the economic and social forces that reproduce racial inequality and foster violence are needed to reduce maternal health disparities.