NEW DELHI: Homicide is the leading cause of maternal mortality in the US, more than twice as frequent as any pregnancy-related complication. This shocking fact was revealed through an evaluation of death certificates from the national database of all women aged 10-44 years who had died in 2018 and 2019. Almost two-third of the fatal injuries during pregnancy or within 42 days of the end of pregnancy occurred inside homes and most (69%) involved firearms.
The study done by researchers in New Orleans, Louisiana, was published in the journal Obstetrics and Gynecology. Using data from the National Center for Health Statistics, the researchers showed how risk of death from homicide during pregnancy or post-partum period exceeded hypertensive disorders, haemorrhage and infection by more than two-fold.
The study concluded that women of reproductive age (10-44 years) are at higher risk of being murdered when pregnant or in the post-partum period than other women in the same age group. It also found that pregnancy was associated with higher risk of being murdered for Black women and for those in the younger age group of 10-24 years.
In 2003, the US introduced a revision to the standard certificate of death that included a pregnancy checkbox to classify female deaths, the categories being: not pregnant at time of death, pregnant, within 42 days, or 43 days to 1 year after pregnancy. It was not until 2018 that all 50 states had implemented this change. Hence, the researchers used data from 2018 and 2019 to do the analysis.
“Homicide and other violent causes are, by definition, not counted in estimates of maternal mortality, which fails to capture the totality of preventable death occurring among girls and women who are pregnant or in the postpartum period,” the study pointed out.
Even without counting homicide as a cause of maternal mortality, the maternal mortality rate (MMR) of the US, 23.8 deaths per 100,000 live births in 2020, was the highest in the developed world. The MMR of almost all European countries, Australia and Japan is in single digits. MMR was lowest in Norway, Italy and Belarus, just two deaths per 100,000.
The MMR in the US has been getting worse, going up from 17 in 2017 to 20 in 2019 and then to 23.8. The increase was mostly due to the spike in mortality rates for Hispanic and Black women. For Black women, the MMR is 55.3 compared to 19.1 among white women. To put those numbers in perspective, India’s MMR was last measured at 103 in 2017-19 but varied widely between states, from a low of 30 in Kerala to a high of 205 in Assam.





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