The statistic the CDC doesn’t include in its reports
Pregnancy is a scary time. The body is changing; it’s literally producing another tiny human being. There can be a lot of stress, as new changes induce concerns and fears.
During this time, there can often be late-night online reading sessions, digging into potential risks of pregnancy. Can pregnancy be deadly? What parts of the body are under the most stress, and what are the potentially fatal outcomes?
First, the good news: in the United States, like in most developed countries, the overall rate of mortality during pregnancy is fairly low. In 2020, there were approximately 3.6 million births in the US. And according to the CDC, last year, there were approximately 700 reported deaths from “complications due to pregnancy.” That’s roughly 17 deaths per 100,000 women.
(Although this statistic may be outdated; data from the early pandemic suggests that it may have climbed to approximately 25 deaths per 100,000, in part due to the increased mental toll of pandemic-linked lockdowns.)
But this statistic is missing an important component, argue researchers who investigate this area. And it’s a grim one: homicide.
Here’s how researchers tried to approximate homicide rates among pregnant women or new mothers, and some potential concerns with this scary result.
Attempts to figure out homicide rates
Since 2003, the United States has required that a death certificate indicates whether a person was pregnant, or if they were within 42 days of the end of a pregnancy (aka had just given birth). It took a while for this to roll out across all states, but it was required in all 50 states by 2018.
Epidemiologist Maeve Wallace at Tulane University and colleagues worked to analyze this new source of data. They found that, across 2018 and 2019, there were 273 homicide deaths of women who were either pregnant or had just given birth.
Of course, some of these could have been random chance, not targeting the woman specifically because she happened to be pregnant. But about 2/3 of the homicides occurred at the woman’s home, indicating that they were likely caused by the woman’s domestic partner.
Being killed by homicide while pregnant is also most likely for Black, younger mothers (under the age of 25).
An additional risk factor: access to firearms. The data also showed that nearly 2/3 of the deaths (68%) were from a gun.
The other (medical) risks during pregnancy
According to the CDC, the highest medical risks during pregnancy are cardiovascular (blood pressure) issues, cardiomyopathy (heart issues), and sepsis (bacterial infection). Deaths among pregnant women since 2016 break down as:
- 16% — cardiovascular issues
- 14% — sepsis
- 12.5% — cardiomyopathy
- 11% — hemorrhage
- 9% — embolism
- 0.2% — anesthesia complications (just putting this on here to show how low it is compared to other causes)
Additionally, most of these deaths happened after delivery, rather than while the woman was pregnant. Only about 22% of the women died during pregnancy, and about 13% of the deaths were during the actual labor and delivery.
Scary statistic, what can we do about it?
The homicide rates are scary, but perhaps there’s a silver lining; a lot of these deaths are preventable.
Now, that might not seem like good news on the surface. It may make the statistic seem even sadder — but it also offers a potential path to solutions.
Let’s start with that link between maternal mortality and gun violence. Not to get political here, but lowering the availability of guns would likely decrease the rates of gun-related violence. Many perpetrators of domestic violence are not convicted, which means that their right to own a firearm is not restricted.
Additionally, we could provide additional resources to help victims of domestic violence, ensuring that they can escape a dangerous situation before it escalates to potential killing.
And when it comes to giving birth, healthcare providers could be incentivized to provide additional follow-up care, including monitoring for a risky situation at home.
Finally, we can simply collect more data. The current data, for example, doesn’t show for certain whether a domestic partner committed the homicide; more information on the rates, as well as the groups most vulnerable to this occurring, would better allow for targeted interventions on high-risk cases.
In summary: best way to avoid dying during pregnancy is to get rid of firearms
Overall, data from the last few years suggests that, at least in the United States, the greatest risk to pregnant women is their partner — and any gun that is in their house. Homicide is the leading cause of death in pregnant women and new mothers; the majority of those homicides occur in the home, with a firearm.
One way to look at this is as a success of modern medicine; we’ve driven down the rates of pregnancy-linked medical death to levels low enough where pregnancy is far less risky than it was in the past. Your odds of dying from a medical issue during pregnancy are currently at less than 0.1%.
But this is still a failure of our system, given that the majority of these homicides are likely preventable through some combination of greater access to counseling and resources, a better healthcare-enabled support system to separate victims from abusers, and stronger laws to protect victims of domestic violence.
With new Supreme Court rulings removing the right to abortion, doesn’t that mean it’s time to step up and allocate more funding and resources to supporting those new lives?
Data suggest that homicides are the unspoken biggest worry for many pregnant women.
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