Intimate Partner Homicides in Pregnant Women Compared to Non-Pregnant Women: Findings from National Data

Background and Significance: The number of women who were victims of homicide in the U.S. grew by 21% in 2016 compared to the previous year. Women who are murdered in the U.S. are nine times more likely to be killed by former or current intimate partner than by a stranger. Pregnant women are at particularly high risk, and homicide is one of the leading causes of death in pregnant women. While certain risk factors for Intimate partner homicides (IPH), such as a prior history of intimate partner violence, access to firearms, and suicidality in the partner, have been established, less is known about specific risk factors among pregnant IPH victims. Developing a better understanding of IPHs in pregnancy may help in creating targeted prevention programs. The current study compared differences in female IPH victims of childbearing age (defined by the CDC as 15-44 years old) who were pregnant compared to those who were not pregnant using a national database of violent deaths.

Methods: The National Violent Death Reporting System (NVDRS) combines information from multiple sources: death certificates, coroner and medical examiner information, toxicology data, and law enforcement reports. NVDRS data are incident based so information is gathered on both the victim and the perpetrator. Data were abstracted all incidents involving IPH with female victims of childbearing age from the NVDRS for 2003–2015 for the 17 states who consistently reported across those years (N=7,799). Chi-squares and t-tests were conducted to explore differences between the two groups, and logistic regression calculated odds ratios.

Results: Roughly 15% of all women who were murdered by their intimate partners were known to be pregnant. Pregnant IPH victims were more likely to Black or multiracial than non-pregnant women. They were also more likely to have never married. Pregnant women were significantly less likely to have used alcohol and were less likely to have a history of mental health problems. Pregnant women were significantly more likely to have interacted with healthcare systems prior to death, including emergency department visits and hospital stays. They were also more likely to have experienced recent homelessness and to have a known history of engaging in sex work.

In cases with pregnant victims, perpetrators were more likely to be a current, rather than former, partner. The perpetrators were also more likely to use drugs. While the majority of IPHs were committed with firearms, deaths were more likely to be the result of head and neck injuries or sharp objects when victims were pregnant.

Conclusions and Implications: While every effort should be made to prevent all IPHs, pregnant women represent a particularly vulnerable population. The current study shows that there may be different risk factors in both the victims and perpetrators of IPH. Healthcare settings and agencies that serve homeless women may be important systems to provide outreach and advocacy for pregnant women in violent relationships. Current interventions focused on supporting sex workers could also incorporate education on the potential dangers of IPH, especially during pregnancy, into programming.