State-Level Analysis of Intimate Partner Violence, Abortion Access, and Peripartum Homicide: Call for Screening and Violence Interventions for Pregnant Patients

Abstract

Background: Despite representing 4% of the global population, the United States has the 5th highest number of intentional homicides in the world. Peripartum people represent a unique and vulnerable subset of homicide victims. This study aims to understand the risk factors for peripartum homicide. Study Design: We used data from the 2018-2020 National Violent Death Reporting System to compare homicide rates of peripartum and non-peripartum people capable of becoming pregnant (12-50 years of age). Peripartum was defined as currently pregnant or within one year postpartum. We additionally compared state-level peripartum homicide rates between states categorized as restrictive, neutral, or protective of abortion. Pearson’s chi-squared and Wilcoxon rank-sum tests were used. Results: There were 496 peripartum compared to 8,644 non-peripartum homicide victims. The peripartum group was younger (27.4 ± 71 vs 33.0 ± 9.6, p<0.001). Intimate partner violence (IPV) causing the homicide was more common in the peripartum group (39.9% vs. 26.4%, p<0.001). Firearms were used in 63.4% of homicides among the peripartum group compared to 49.5% in the comparison (p<0.001). There was a significant difference in peripartum homicide between states based on policies regarding abortion access (protective 0.37, neutral 0.45, restrictive 0.64; p<0.01); the same trend was not seen with male homicides. Conclusion: Compared to non-peripartum peers, peripartum people are at increased risk for homicide due to IPV, specifically due to firearm violence. Increasing rates of peripartum homicide occur in states with policies that are restrictive to abortion access. There is a dire need for universal screening and interventions for peripartum patients. Research and policies to reduce of violence against pregnant people must also consider the important role that abortion access plays in protecting safety.