Violence, Overdose Threaten Pregnant and Postpartum Women’s Lives

Spread the Message

Read Time:3 Minute, 30 Second

Recent research has revealed that maternal homicides, suicides, and overdoses pose a greater threat to pregnant and postpartum women than previously thought. A study presented at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting found that from 2005 to 2022, homicide and suicide combined accounted for 11% of deaths among pregnant women and those up to 42 days postpartum. These figures were only surpassed by deaths due to accidents, which accounted for 12%.

Dr. Hooman Azad, MD, MPH, a fourth-year resident at Columbia University Irving Medical Center, noted that 11% of maternal deaths were due to drug overdose, while obstetric causes individually accounted for less than 11%. During the study period, homicide rates increased by an average of 7% per year for pregnant and postpartum women, compared to a 2% increase for nonpregnant women.

Shifting Understanding of Maternal Mortality

Historically, cardiovascular disease, hypertension, and hemorrhage were considered the leading causes of maternal mortality. However, Dr. Kecia Gaither, MD, Director of Perinatal Services and Maternal-Fetal Medicine at NYC Health + Hospitals/Lincoln, emphasized the urgent need for policy changes to address maternal deaths from homicide, suicide, and drug overdose.

“Pregnancy-associated deaths from violence and substance use are devastating tragedies that require immediate intervention through clinical and systemic changes,” stated Dr. Misty Richards, a perinatal psychiatrist at UCLA.

Contributing Factors to Tragic Maternal Deaths

The rise in maternal deaths from homicide, suicide, and overdoses is attributed to various factors, including mental health issues, intimate partner violence, and lack of access to substance abuse treatment. Dr. Stephen Crystal, Director of the Center for Health Services Research at Rutgers Health, noted that maternal deaths often reflect broader social issues, such as widespread gun ownership and untreated mental health disorders.

Reports indicate that states with high rates of homicide and suicide among pregnant women also tend to have weak maternal health protections. Mississippi has the highest pregnancy-related homicide mortality rate, while Montana leads in pregnancy-related suicide mortality.

Dr. Jillian Neill, a perinatal psychologist, highlighted how punitive state policies deter women from seeking help for substance use disorders. Criminalization of drug use during pregnancy can lead to incarceration, loss of custody, or involuntary hospitalization, discouraging women from accessing treatment.

Strengthening Maternal Health Screening and Support

Experts stress the importance of early screening for mental health issues, substance use, and intimate partner violence during prenatal and postpartum visits. Common screening tools include the Edinburgh Postnatal Depression Scale for depression and domestic violence screening tools such as the Hurt, Insulted, Threatened with Harm and Screamed (HITS) tool.

However, time constraints in OB/GYN visits make comprehensive screening challenging. “Clinicians feel overwhelmed and ill-equipped to diagnose and treat mental health conditions within a 20-minute appointment,” said Dr. Richards. Solutions include having patients complete screening forms in the waiting room and offering brief, relevant referrals to support services.

Addressing Systemic Barriers to Maternal Mental Health Care

Experts advocate for structural changes to better integrate OB/GYN and mental health services. Training programs for healthcare providers could help bridge the knowledge gap in treating perinatal mental health conditions. “OB/GYNs should be prepared to recognize and treat depression and other mental health disorders in pregnant patients,” said Dr. Crystal.

State-led programs offer promising solutions. The Massachusetts Child Psychiatry Access Program for Moms provides training, toolkits, and real-time provider support for addressing maternal mental health needs. Similarly, New Jersey and Washington State have launched initiatives offering trauma-informed substance abuse care and confidential mental health resources for uninsured women.

The Role of Policy in Maternal Health

Experts stress the importance of Medicaid coverage in reducing maternal deaths related to mental health and substance use. Proposed cuts to Medicaid could worsen existing disparities, further endangering vulnerable pregnant and postpartum women.

As maternal deaths from homicide, suicide, and overdoses rise, a comprehensive approach involving healthcare providers, policymakers, and social services is crucial to protecting maternal health and preventing preventable tragedies.

Disclaimer: This article is intended for informational purposes only and should not be considered medical or legal advice. If you or someone you know is struggling with mental health, substance use, or domestic violence, please seek professional help or contact a relevant support organization.