These factors drive pregnancy-associated suicides and homicides. Here's how you can help.

By Jules Murtha | Fact-checked by Barbara Bekiesz
Published October 31, 2022

Key Takeaways

  • Experts say that one-fifth of all deaths during pregnancy and the postpartum period can be attributed to drug overdose, suicide, and homicide.

  • Research suggests that mental health problems, and intimate partner violence are the primary drivers of pregnancy-associated homicides and suicides.

  • To help prevent pregnancy-associated deaths, doctors can routinely assess their patients’ risk for suicide, homicide, and drug use throughout the prenatal care period and afterward.

Pregnancy-associated deaths—those arising from unrelated conditions that occur within 1 year of pregnancy—are largely under-investigated contributors to maternal mortality rates, according to a study published by Obstetrics & Gynecology.[]

Physicians can help prevent pregnancy-associated deaths through extensive screening and intervention.

Drivers of homicides and suicides

Maternal mortality rates are rising in the US, reaching up to 23.8 deaths per 100,000 live births.

As a result, researchers have prioritized understanding the mechanisms behind pregnancy-related deaths—those deaths caused by a pregnancy complication, by events linked to pregnancy, or by the pregnancy’s physiologic impact on an underlying condition.

The Obstetrics & Gynecology study stated that nearly 20% of all deaths during pregnancy and the postpartum period can be attributed to homicide, suicide, and drug overdose.

The study, which used data from the CDC’s National Violent Death Reporting System from 2008–2019, pointed to two primary drivers of these outcomes:

Mental health issues. The study found that for individuals who died by suicide, a sizable proportion were being treated for mental health issues at the time: 31.2% of pregnant individuals, 44.9% of early postpartum individuals, and 41.1% of late postpartum individuals. Further data showed that those who struggled with mental health problems—including substance use disorders (SUD)—were more likely to die by suicide (77.4%) than homicide (7.2%).

Intimate partner violence (IPV). Pregnant patients who died by suicide and homicide commonly experienced IPV. The rates of IPV were significantly higher for individuals who died by homicide, however, than for those who died by suicide (57.3% vs 37.1%, respectively). Also, the homicide group had higher rates of other violent crimes compared with those who died by suicide (24.8% vs 1.7%, respectively).

Other factors such as age, race, and education level also played a part in the likelihood of a pregnant individual dying by suicide or homicide.

The Obstetrics & Gynecology study authors urged clinicians to consider the deaths resulting from these causes as avoidable.

"Every pregnancy-associated violent death should be considered preventable. There is an urgent need for scientific evidence informing actionable strategies to eliminate these maternal deaths. "

Modest, et al., Obstetrics & Gynecology

Prevention methods

According to an article published by the Journal of Women’s Health, providers can implement universal screening and referral for pregnant patients who may experience SUD, IPV, and mental illnesses like anxiety and depression.[]

It is important to initiate a conversation about the presence of firearms in the patient’s home, as their removal may prevent both suicide and homicide.

Pregnant and postpartum patients who’ve made trips to the ED or hospital during the first year or more after delivery may be at higher risk of homicide, suicide, and drug overdose, so clinicians who take steps to identify these patients may help to avert these unfortunate outcomes.

For patients with SUD, one way you can mitigate risk is to propose alternatives to opioids. This would allow the patient to manage chronic pain without the possibility of developing an addiction.

Another option is to build programs that train patients to use naloxone and inform them about other aspects of comprehensive treatments for SUD.

Finally, consider referring your patients to trauma-informed community services.

What this means for you

Nearly 20% of all deaths that take place during pregnancy and the postpartum period are due to suicide, homicide, and drug overdose. These deaths are often the result of substance abuse, intimate partner violence, and mental health issues. Physicians can help prevent pregnancy-associated deaths by screening patients for risk of suicide, homicide, and drug abuse.

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In our Women's Health Focus feature, we'll offer insights and practical guidance to support you in providing the comprehensive and personalized care that women need throughout their life stages. We invite you to submit any topic you'd like to see covered and let us know if you'd like to be a guest author.

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