Homicide is the leading cause of death for pregnant women in the United States, a new study found

• A new study found that pregnant women in the US are twice as likely to die by homicide than pregnancy-related causes.
• Two-thirds of the deaths occurred in the woman's home, suggesting a partner was responsible.

In late November, Shaterica Anderson, a pregnant 28-year-old from Texas, was shot to death by her longtime boyfriend on their son's fourth birthday.

He shot her in the head four times and left her body in her home with their five children. He has now been charged with her murder.

Days later, the body of Andreae Lloyd, a 27-year-old pregnant woman from Miami-Dade, was found in a woodland area. Her boyfriend confessed to killing her.

Pregnant Brittani Duffy, 27, in New York was also killed by her boyfriend weeks before.

According to a new nationwide study, these deaths are not just individual tragedies but are part of a troubling epidemic.

The study, published in Obstetrics & Gynecology, found that pregnant women and women who have recently given birth in the United States are twice as likely to die by homicide than pregnancy-related causes such as hemorrhage or hypertension.

Researchers found that two-thirds of the fatal injuries occurred in the home, suggesting that the perpetrator was most likely a partner.

Abortion restrictions could endanger vulnerable women

Studies have long shown that intimate partner violence increases during pregnancy.

Some experts fear that increased moves to restrict abortion access, seen this year in Texas and Mississippi, could put more vulnerable women at risk.

"In a time when the ability to have an abortion has been threatened in an unprecedented way in the United States, what's going to happen when people are forced to carry pregnancies that they wouldn't have otherwise continued?" Dr. Diane Horvath, an OBGYN based in Baltimore, told Insider.

Dr. Horvath said that she sees many patients seeking abortion care, some of whom are unable to continue their pregnancies because of domestic violence.

"I worry that as more people are forced to stay pregnant when they don't want to be that we're going to see an uptick in violence, and this is actually putting people's lives at risk."

The United States has a high maternal mortality rate

The United States already has a much higher maternal mortality rate than most wealthy nations.

In 2018, there were 17 maternal deaths for every 100,000 live births in the US — more than double that of most other high-income countries, according to the Commonwealth Fund.

But when tracking deaths among pregnant women in the United States, homicide is not even classified as a cause of "maternal mortality."

Many researchers believe that this should change, arguing that there is a link between homicide and pregnancy.

"I was not completely surprised with the results," Dr. Veronica Gillispie, one of the authors of the maternal homicide study, told Insider.

Dr. Gillispie is an OBGYN based in Louisiana and serves as the medical director of the Louisiana pregnancy-associated mortality review.

"Looking at the homicides that we had here in Louisiana, we saw a lot of the causes were intimate partner violence, and we had the feeling that it probably – and there are other studies that show that – it increases during pregnancy," Dr. Gillispie said.

Together with Dr. Maeve Wallace and other researchers, Dr. Gillispie examined death certificates of women between the ages of 10 and 44 who died in 2018 and 2019.

They found that of the 4,705 women who died during that time, 273 died while pregnant or within a year of their pregnancy ending.

Although the death certificates do not state the relationship between the victim and the perpetrator, two-thirds of the deaths took place in the woman's home, implying a partner was responsible.

The study found that the killings overwhelmingly involved firearms, followed by assault with sharp objects and strangulation.

This new study shows that pregnant women are killed at a rate 16% higher than non-pregnant women and that Black women and younger women were particularly vulnerable.

This is the first nationwide study of its kind because 2017 was the first year that all states began marking on death certificates whether women had been pregnant at the time of death.

Black women and young women are disproportionately at risk

The fact that Black women face a significantly higher risk could be due to a combination of reasons, including systemic racism and socio-economic factors, experts told Insider.

Dr. Horvath explained that Black women experiencing domestic violence might not feel safe or comfortable seeking help from the authorities.

"If you're a Black person who's pregnant and has experienced racism in healthcare settings, it's entirely unsurprising to me that you might not feel safe enough to disclose this before it becomes a crisis," Dr. Horvath said.

She said that the increase of intimate partner violence surrounding pregnancy is something that has been well-documented, and can include things like reproductive coercion or forced pregnancy, or contraceptive sabotage.

"Obviously, homicide related to pregnancy is a very extreme end of this continuum. But it is well established that a homicide is not the first time that someone will have been violent to a partner," she said.

Dr. Gillispie also said that she believed that the disparity was due to systemic racism.

"Historical inequities affect social determinants of health, and black and brown people are more likely to live in communities where there's a higher level of violence," she said.

In order to improve these dire statistics, Dr. Gillispie said it's important for healthcare providers to effectively screen pregnant women for violence, and to have the resources to offer them solutions.

"If we're going to lower the mortality rate, then we need to target things outside of the hospital like," she said.