National study finds homicide and suicide are top causes of maternal death

In the medical community, research has traditionally focused on how to prevent and treat the leading medical causes of maternal mortality, which include bleeding, infection, hypertension, and cardiovascular disease. However, new research reveals deaths by homicide and suicide are the leading causes of maternal death in the United States.

In a study presented at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting, The Pregnancy Meeting, researchers will unveil findings that suggest that nationwide more pregnant people die from homicide and suicide than any medical cause, and that firearm legislation is associated with fewer maternal deaths.

Researchers reviewed CDC data from 2005-2022 on the deaths of pregnant people and people within the first 42 postpartum days ranging in age from 15-44, making this the most extensive study of a national database on maternal deaths. Researchers note that past studies have either been done at the state level or used data from multiple databases, which can result in inconsistencies in how information is reported.

Findings show that over the 18-year period, 20,421 pregnant people died. Of that number, 11 percent (2,293) of deaths were due to homicide and suicide. More specifically, 61 percent (1,407) of those deaths were the result of homicides and 39 percent (886) were the result of death by suicide. Fifty-five percent of violent deaths (1,261) involved firearms.

“Many people are surprised when they hear that violence is the leading cause of death in pregnancy,” says the study’s lead author Hooman Azad, MD, MPH, a fourth-year resident in the Department of Obstetrics & Gynecology at New York’s Columbia University Irving Medical Center.

“Right now, the definition of maternal mortality does not include death by homicide. I’m not sure this is correct—being pregnant or postpartum significantly increases the risk of death by homicide, and more pregnant women die of violence than any individual medical cause. Part of the reason violence is not recognized as the leading cause of death during pregnancy is because we don’t include homicide and suicide in the definition of maternal mortality.”

The study also found that Black birthing people, ages 18-24, experience death due to homicide at a rate of almost eight deaths per 100,000, nearly four times the national average.

Researchers also looked at the impact of the passage of firearm legislation on maternal deaths and found a 20-30 percent reduction in firearm deaths and firearm homicides in states that had enacted firearm legislation.

“There’s a misconception that most maternal deaths happen in hospitals or health care settings, and that’s simply not the case,” says another study author Mary D’Alton, MD, a maternal-fetal medicine subspecialist and chair of the Department of Obstetrics & Gynecology and professor of Obstetrics & Gynecology at Columbia University Irving Medical Center. D’Alton also serves as director of services at the Sloane Hospital for Women at New York-Presbyterian. “We need more education about this serious national issue so we can begin to take steps to address it as clinicians as well as at the policy level.”