Induced abortion and maternal homicide

THE AMERICAN ASSOCIATION OF PROLIFE OBSTETRICIANS AND GYNECOLOGISTS

ABORTION AND HOMICIDE

The 2004 study by Gissler (Gissler, M, et.al., (1997) “Pregnancy associated deaths in Finland 1987-1994, Acta Obsetricia et Gynecologica Scandinavica 76:651-657) indicates that the pregnancy associated homicide rate for women having an induced abortion is significantly higher than for women who deliver their pregnancy. Pregnancy-associated homicide, some of which is abortion-related, is a stark reality—but obtaining and evaluating data is very difficult to do. A very informative literature review (Shadigian E, Bauer S; Pregnancy-Associated Death: A Qualitative Systematic Review of Homicide and Suicide; OB GYN Survey, Vol 60, No 3, 2005) sheds considerable light on this tragic topic. Following are excerpts from the abstract:

A systematic review of the literature on maternal homicide and suicide was performed to understand the causes of pregnancyassociated death. Forty-four studies examined homicide and/or suicide and pregnancy-associated death (defined as the death of a woman, from any cause, while she is pregnant or within 1 year of termination of pregnancy) (1). Of these studies, 747 homicides and 349 suicides were identified…. Homicide is a leading cause of pregnancy-associated death and suicide is also an important cause of death among pregnant and recently pregnant women. Healthcare providers should understand that homicide is a leading cause of pregnancy-associated death, most commonly as a result of partner violence. Therefore, screening for both partner violence and suicidal ideation are essential components of comprehensive medical care for women during and after pregnancy.

This paper suggests several reasons why this difficult, violent, tragic topic is so under-appreciated and under-reported:

“Based on data from the U.S. Department of Justice, 1247 women were murdered by their current or former male partner in the year 2000 (4). However, the total reported number of pregnancyassociated deaths each year is unknown….. the Department of Justice and the Federal Bureau of Investigation do not compile figures for homicide or suicide during or in the year after pregnancy…”

“After adjusting for demographics, the authors found the risk of becoming an attempted or completed homicide victim was 3-fold higher for women abused versus nonabused during pregnancy (OR 3.08; 95% CI 1.86–5.10) and that black women had a 3-fold increased risk (OR ı3.60; 95% CI ı 2.40–5.50) (11). In addition, Krulewitch showed that the homicide rate for pregnant women was almost twice as high as for nonpregnant women (14). Horon and Cheng reviewed 247 pregnancy-associated deaths in Maryland between 1993 and 1998. Homicide was the leading cause of pregnancy-associated death (n ı 50, 20%)…..”

In the discussion section, the authors conclude: “………Because the U.S. Federal Bureau of Investigation (and other similar national and international agencies) does not report statistics on whether or not women are pregnant at the time of homicide or suicide, caution must be exercised when drawing conclusions about pregnancy-associated death (47). Many studies rely totally on death certificates, which have very strict guidelines for reporting a maternal death, and do not report pregnancy as a category or if a woman has been pregnant in the last year.

There is no standardized method used to identify pregnancy at the time of death or close to the time of a woman’s death (7). Medical examiners often do not investigate for evidence of pregnancy or examine the uterus. In addition, beta human chorionic gonadotropins are often not routinely drawn on homicide or suicide victims who present to the healthcare system. Thus, underreporting of pregnancyassociated mortality is inevitable. Women who die from homicide during pregnancy are often not included in maternal mortality statistics. Based on reviews of 651 autopsy charts of women aged 15 to 50 who died during an 8-year period of time in Washington, DC, Krulewitch and colleagues found that 43.4% of pregnant women who were murdered were not reported as pregnant on the death certificates (14). Pregnancy is even less well documented among suicide victims….”

AAPLOG certainly concurs that there is urgent necessity for heightened awareness and investigation of the pregnancy status of women who are victims of homicide. Such violence against women, whether pregnant or not, is deplorable in a civilized society. And it is particularly repugnant when the violence involves the killing of two people, the mother and her unborn child.

Induced abortion and maternal homicide