Houston, we have a problem.
As a fierce advocate for improved maternal health outcomes in the United States, especially among people of color, seeing the stats about homicide in the pregnancy and postpartum period has deeply disturbed me. In my training and after, intimate partner violence has been mentioned as a significant problem faced during pregnancy and postpartum, but there was no discussion beyond one or two lines about it. Someone (a colleague or an instructor) would flatly state, “there’s more domestic violence in pregnancy than any other time,” and leave it at that. Or even worse, if a patient walked onto the Labor and Delivery unit with bruises, it was met with a whisper, “well you know that this happens more during pregnancy, right?”
It’s hard to even begin to describe how many times that I have witnessed victims of intimate partner violence in pregnancy in acute medical settings like the OB triage unit (aka the ER for pregnant people). I have seen them in tears, some with bloodied shirts, some with bruises, all with similar looks on their faces. A look of embarrassment, defeat, and fear. Most of them, when asked if they want us to call the police or give them resources to help them out of the situation, answer with a decisive “NO.”
It always pains me as they gather their things after we treat their physical wounds and ensure that their baby is healthy. I watch them put on their coat and walk off the unit, worried that they will go right back to the situation that brought them to the hospital in the first place – and who knows if the next time they will be able to walk in and tell me their story.
You may be wondering why I have been talking about homicide and intimate partner violence in the same breath. The reason is simple: most women who are victims of homicide at the hands of men know the men who kill them. Homicide is the most severe outcome of intimate partner violence. The CDC, one of the main organizations that provides the statistics on maternal health in the US, does not include homicide rates in its data. I find this interesting because the CDC does acknowledge that intimate partner violence is a big problem. Because IPV has been linked to homicide, which is death, and death is an adverse health outcome, it is of utmost importance that public health organizations look at ways to mitigate this harm. Homicide is a preventable form of death and so all resources should be used to prevent it. This would include public health strategies.
And when looking at disparities in these homicide rates, again, we are faced with a much higher rate of homicide among Black pregnant and postpartum people – in fact it was approximately three times higher than their White counterparts. This is heartbreaking because when looking at rates of intimate partner homicide in nonpregnant people, the rates are similar among Black and White people. It is increased in the pregnancy and postpartum period and it is not clear the reasons why. Some thoughts offered up is the higher rate of unintended pregnancy in Black communities and other social stressors that negatively impact communities of color.
It is important when we look at maternal health, we look at everything that impacts it. We can talk about disease processes like hypertension, diabetes, and preeclampsia and how those can contribute adverse health outcomes, but societal diseases, like intimate partner violence and homicide must also be considered. We need to address and decrease preventable causes of death in all people, including pregnant people, and to do that, we need to focus on those causes. I hope that more research and more policy will be dedicated to addressing intimate partner violence and reducing homicide rates in pregnant and postpartum.
If you are in need of support want to learn how to identify abuse, contact the National Domestic Violence hotline via their website or call 1-800-621-HOPE.