Homicide and suicide during the perinatal period: findings from the National Violent Death Reporting System

Abstract

Objective: To estimate the rates of pregnancy-associated homicide and suicide in a multistate sample from the National Violent Death Reporting System, to compare these rates with other causes of maternal mortality, and to describe victims' demographic characteristics.

Methods: We analyzed data from female victims of reproductive age from 2003 to 2007. We identified pregnancy-associated violent deaths as deaths attributable to homicide or suicide during pregnancy or within the first year postpartum, and we calculated the rates of pregnancy-associated homicide and suicide as the number of deaths per 100,000 live births in the sample population. We used descriptive statistics to report victims' demographic characteristics and prevalence of intimate-partner violence.

Results: There were 94 counts of pregnancy-associated suicide and 139 counts of pregnancy-associated homicide, yielding pregnancy-associated suicide and homicide rates of 2.0 and 2.9 deaths per 100,000 live births, respectively. Victims of pregnancy-associated suicide were significantly more likely to be older and white or Native American as compared with all live births in National Violent Death Reporting System states. Pregnancy-associated homicide victims were significantly more likely to be at the extremes of the age range and African American. In our study, 54.3% of pregnancy-associated suicides involved intimate partner conflict that appeared to contribute to the suicide, and 45.3% of pregnancy-associated homicides were associated with intimate-partner violence.

Conclusion: Our results indicate that pregnancy-associated homicide and suicide are important contributors to maternal mortality and confirm the need to evaluate the relationships between sociodemographic disparities and intimate-partner violence with pregnancy-associated violent death.

Figure 1. Pregnancy-Associated Violent Death Rate

Pregnancy-Associated Violent Death Rate in our sample over the years 2003–2007.

Figure 2. Maternal Mortality: Violent Death vs. Specific Obstetric Causes

*data from 2003–2007 NVDRS (pregnancy-associated homicide and suicide; this analysis) and Berg et al. 2010 (pregnancy-related mortality due to hemorrhage; hypertensive disorders; amniotic fluid embolism); deaths from specific obstetric causes are calculated as deaths during pregnancy or within the first year postpartum