The most dangerous part of pregnancy isn’t hypertension or hemorrhage; it’s murder by a partner

When people think about the dangers of pregnancy and childbirth, murder usually isn’t the first cause of death that comes to mind.

But homicide is a leading cause of death in pregnancy and postpartum, killing twice as many pregnant and recently pregnant people as hemorrhage, high blood pressure disorders or infection, according to a recent study published in the journal Obstetrics & Gynecology.

A growing body of research is examining the link between pregnancy and homicide, spotlighting the ways in which pregnancy can make domestic violence situations even more dangerous.

“Pregnancy upsets the dynamic between the abuser and the victim,” said Natalie Nanasi, director of the Hunter Legal Center for Victims of Crimes Against Women, and an associate professor of law at SMU Dedman School of Law.

“Suddenly you have a woman who’s going to doctor’s appointments and potentially disclosing what’s happening in her home,” she said. “And then it sounds strange to think of a baby as a threat, but you have this new baby coming into (an abusive) dynamic whose presence is going to ‘threaten’ the control the abuser is exercising.”

Researchers found that women who were pregnant or within one year postpartum had a 16% higher homicide rate than women in the same age group who were not pregnant.

Nearly 1 in 6 pregnant women have been abused by a partner, according to the U.S. Department of Health & Human Services. And women who experience intimate partner violence before and during pregnancy are at increased risk of complications including infection and high blood pressure. They’re more likely to deliver their babies too early, and have babies with low birth weight.

Reckon News spoke with Nanasi, who has represented many abuse survivors, about the dynamics that make pregnancy a particularly dangerous time for those with abusive partners.

Reckon: Intimate partner violence and homicide aren’t the first things we tend to think about when we think about maternal mortality, but they’re closely linked.

Nanasi: Many people think domestic violence is about anger, about mental health, about substance abuse. But what it’s actually about is power and control. It’s the desire of one person to exercise power and control over another. That’s why you see abusers who are perfectly capable of controlling their tempers when dealing with their coworkers or friends or other family members, but they abuse, either physically or emotionally, their intimate partner.

Once you get that, it’s easier to see why pregnancy is among the things that can cause abuse to escalate because pregnancy – like filing for divorce or seeking help at a shelter or reaching out for help to a religious leader – is something that an abusive person sees as a challenge to their power and control.

Any time an abuser sees or understands a challenge to their power and control over their victim, they will escalate the violence in order to regain that control. If you go to the courthouse and seek a protective order, I’m going to escalate my behavior in order to preserve that dynamic.

Reckon: We’ve heard the term ‘reproductive coercion’ in connection with intimate partner violence. What is that, and how does it contribute to making pregnancy more dangerous?

Nanasi: Same song, different verse. You may have an abusive person who is preventing (their partner) from getting pregnant when they want to, in order to retain primacy in the relationship and keep the dynamic as is. Or you see an abuser causing (their partner) to get pregnant when they don’t want to be, as a way to keep that person in their orbit. Tampering with birth control pills can be a way for him to continue to be in her life and make her life miserable because she can’t ever fully get away from him.

In my experience, I’ve seen often that even if the victim is able to leave the abusive situation, they’re still going to have to stay in contact with their abuser regarding vacations, medical decisions, child support and coparenting until the child is at least 18 years old.

Reckon: How does pregnancy or having an infant impact whether someone can get out of an abusive situation?

Nanasi: It’s impossible to overstate how hard it is to get out of an abusive situation in the best of circumstances: If you’re unmarried, childless, have a supportive family, and have all the financial resources in the world. The more you layer onto that, the more reasons you have to see each other. When a child is involved, it’s that much harder to separate.

Say an abuser has prevented his partner from working. She has no employment history. How is she going to get a job to support herself and the baby? How is she going to find child care so she can get and maintain a job? And if there’s an older child, (the abuser) can use the kids to perpetuate the abuse. He’s telling the children that mommy is the reason they can’t have an Xbox because she decided to abandon the family. Or that he would love to see them more but mommy’s not letting him.

Reckon: Some studies have found pregnancy is associated with a much higher risk of homicide for Black people and among girls and younger women (ages 10-24). Have you seen certain groups tend to be more affected by intimate partner violence?

Nanasi: Domestic violence is an equal opportunity offender. It happens to people in all communities, of all racial and economic backgrounds.

But it is harder on people who have fewer resources and support networks to help them. It impacts them differently. Women with means experience domestic violence, but they tend to have more resources available to them to free themselves from that situation. And fif you live in a community that has shelters and programs available to support you in leaving, it’s going to be easier for you to leave.

But even here in Dallas, a large metro area that’s pretty well resourced, we have a housing crisis affecting our general community and, by extension, our survivors. There are only so many shelter beds. There’s just nowhere for them to go.

And for some people, for example immigrants who don’t have documentation, sometimes you’re in a situation with no good options. You’re choosing between two evils, and sometimes an abuser is the lesser evil.

Reckon: What are some ways we can help people who need to escape intimate partner violence situations? What solutions have you seen really work?

Nanasi: First we need to start at the beginning, when kids are young, and prioritize educating our young men and women about what healthy relationships look like. We need to talk to them about bodily autonomy. Hopefully, we are raising a better generation of people who are less likely to engage in this type of behavior.

We need to make sure that we make resources available for people who are trying to get out. That looks like shelters, programs that are trauma-informed, and access to the criminal justice system if that’s something they feel comfortable taking advantage of.

We’re seeing more obstetricians who are aware of these issues and talking with their patients. But we need more providers educated about the complexity of this issue. It shouldn’t be that you go to your dentist appointment with a black eye and their first reaction is to call the cops. That’s not always a viable solution.

Finally, if we want the world to be better for women, we need to provide women with what they need: education, child care, affordable housing. That’s the kind of systemic change we need to make life manageable for people who are currently living on the margins and vulnerable.

Anna Claire Vollers

Anna Claire Vollers |

I report mainly on reproductive and maternal health, working parents and family policy at Reckon News.

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