U.S. rates of pregnancy-associated homicide—deaths that occur among women who are pregnant or had been pregnant within one year—rose in 2020 during the COVID-19 pandemic, according to a recent NICHD-funded study. In 2020, the risk of homicide was 35% higher for pregnant or postpartum women, compared to women of reproductive age who were not pregnant or postpartum. Homicide rates were highest among adolescents and Black women, with most incidents involving firearms. The findings suggest that violence prevention programs and policies in the United States should address these risks in pregnancy and after birth.
Homicide is one of the leading causes of death among pregnant and postpartum individuals in the United States, and during the COVID-19 pandemic, firearm violence and homicide rates increased among the general public. Whether the pandemic also influenced rates of pregnancy-associated homicide was unknown prior to this study.
The study was conducted by Maeve Wallace, Ph.D., M.P.H., at Tulane University. The work was funded in part by NIH’s Implementing a Maternal health and Pregnancy Outcomes Vision for Everyone (IMPROVE) Initiative. The initiative supports research to reduce preventable causes of maternal deaths and to improve health for women before, during, and after delivery.
Dr. Wallace found that the 2020 homicide rate for pregnant or postpartum women was 5.23 deaths per 100,00 live births, while the rate for non-pregnant and non-postpartum women was 3.87 deaths per 100,000 live births. This means that women who are pregnant or postpartum had a 35% higher risk of homicide, compared to their peers. In 2018 and 2019, pregnant and postpartum women were at 16% higher risk of homicide, compared to their non-pregnant counterparts, indicating a two-fold jump in the risk associated with pregnancy during the first year of the COVID-19 pandemic.
Of the 189 pregnancy-associated homicides in 2020, 55% of victims were non-Hispanic Black women, and 45% were aged 24 years or younger. Among all incidents, 81% involved firearms and 55% occurred in the home. Fifty-four percent of victims were pregnant at the time of their death, whereas the remaining victims were up to one year postpartum. According to the study, these trends mirror previous years, with adolescents and Black women experiencing the highest rates of pregnancy-associated homicide.
This study is the first national analysis of pregnancy-associated homicide for 2020 and identifies specific risk factors, such as age and race/ethnicity, that may be addressed through programs or policies that seek to prevent violence and maternal deaths.
Wallace, ME. Trends in pregnancy-associated homicide, United States, 2020. Am J Public Health DOI: 10.2105/AJPH.2022.306937 (2022)