The signal Homicide — not hemorrhage, not preeclampsia, not embolism — is now the leading cause of pregnancy-associated death, at 3.62 per 100,000 live births, more than double every obstetric cause combined. It is predominantly intimate-partner and predominantly firearm; the modal scene is the victim’s own residence. Yet there is no federal mandate to screen for intimate partner violence in prenatal care.
If you are pregnant or know someone who is: homicide is now the #1 cause of death during pregnancy and the year after birth. Most of these deaths involve abuse in a relationship, and most involve a gun. If you feel unsafe, tell a doctor, nurse, midwife, or doula. There are free, confidential hotlines (1-800-799-7233) and shelters. You deserve to be safe.
What it means — by audience The same signal, translated for the people who act on it.
For OB Providers
Homicide is the leading cause of pregnancy-associated death — 3.62 per 100,000, exceeding every obstetric cause combined by more than twofold; 68% involve firearms. Screen for intimate partner violence at every prenatal visit and document it as part of the social history. Ask with the partner out of the room, and know your same-day DV referral pathway before you need it.
For Midwives (CNM/CPM)
Homicide is now the leading pregnancy-associated cause of death. Screen clients at intake and the first visit; out-of-hospital birth carries additional risk if IPV is present. Partner with local DV agencies for warm referrals, and build IPV screening + documentation into your charting. If a client discloses, believe her and connect her to help the same day.
For Birth Workers & Doulas
Homicide is the #1 killer of pregnant people, and 68% of these deaths involve a firearm. You are often the trusted person a client talks to first. Watch for controlling partner dynamics — a partner who answers every question, controls the phone, won’t leave the room. Listen without judgment, keep local DV hotlines, shelters, and legal-aid numbers ready, and if a client discloses abuse, believe her and connect her to help.
For Institutional Leaders
Maternal homicide is the leading cause of pregnancy-associated death (3.62 per 100,000 live births), and it disproportionately kills young Black women — those 18–24 die at four times the national rate. Develop mandatory IPV screening protocols, staff training, social-work integration, private screening space, and trauma-informed care standards.
For Everyone
If you are pregnant or know someone who is: homicide is now the #1 cause of death during pregnancy and the year after birth. Most of these deaths involve abuse in a relationship, and most involve a gun. If you feel unsafe, tell a doctor, nurse, midwife, or doula. There are free, confidential hotlines (1-800-799-7233) and shelters. You deserve to be safe.
Sources & provenance Homicide rate ~3.62 per 100,000 live births among pregnant and postpartum women (2018–2019 national death records).
Black and Indigenous women face roughly 3–4× higher pregnancy-associated homicide risk than white women.
In pregnancy-associated homicide, the perpetrator is almost always a male intimate partner.
Source: Labora Rounds · Research Intelligence — pregnancy-associated homicide (Wallace et al., Obstetrics & Gynecology).
Status: Active crisis · No federal IPV screening mandate exists.
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