Abuse during pregnancy and femicide: urgent implications for women's health

OBJECTIVE: To describe the odds of femicide (homicide of females) for women abused during pregnancy. METHODS: A ten-city case-control design was used with attempted and completed femicides as cases (n = 437) and randomly identified abused women living in the same metropolitan area as controls (n = 384). The attempted and completed femicide cases were identified from police and medical examiner records. Interviews of attempted femicide victims and a proxy for the femicide victim were compared with data from abused controls, identified via random digit dialing in the same ten cities. RESULTS: Abuse during pregnancy was reported by 7.8% of the abused controls, 25.8% of the attempted femicides, and 22.7% of the completed femicides. Five percent of the femicide victims were murdered while pregnant. After adjusting for significant demographic factors, such as age, ethnicity, education, and relationship status, the risk of becoming an attempted/completed femicide victim was three-fold higher (adjusted odds ratio 3.08, 95% adjusted confidence interval 1.86, 5.10) for women abused during pregnancy. Black women had more than a three-fold increase in risk (adjusted odds ratio 3.6, 95% adjusted confidence interval 2.4, 5.5) as compared with white women. Compared with women not abused during pregnancy, controls and attempted/completed femicide victims abused during pregnancy reported significantly higher levels of violence. CONCLUSION: Femicide is an important, but often unreported, cause of maternal mortality. This is the first report of a definite link between abuse during pregnancy and attempted/completed femicide. This research documents the immediate need for universal abuse assessment of all pregnant women.