If you or someone you know is experiencing domestic or intimate partner abuse and needs help, please call 211 for local services, or text the national hotline at 88788.
When women are murdered, it’s most often by current or former partners, whose violence can be exacerbated by jealousy, resentment and mounting financial stress. All factors that can be compounded by pregnancy, which is already one of the most medically vulnerable moments in a woman’s life.
Today, an increasing number of medical professionals in the U.S. are being trained to recognize the outsized role intimate partner violence plays in the country’s maternal mortality rate, which reproductive epidemiologist Maeve Wallace says she first began studying to understand “why it’s so high in the United States relative to every other high-income country on Earth.”
In fact, compared to other wealthy nations, maternal mortality is almost two to three times higher in the U.S., where for years the Centers for Disease Control historically only tracked medically-related deaths, Wallace said, for example, “hemorrhage, hypertension, things that are brought on by the pregnancy itself.”
However, the more she delved into the numbers, the more Wallace noticed a disturbing pattern for new and expectant mothers. A pattern she learned many domestic violence experts have long known about: during pregnancy and for one year after, “it’s a dangerous time, in terms of risk of fatal violence,” said Wallace.
And she says it's significantly more dangerous than for women of the same age who were not pregnant or postpartum when they were killed.
In 2020, Wallace first published data on Louisiana, where she was a full-time professor at Tulane University until recently. Then she wanted to prove the same was true nationally, but could not, because not all states reported pregnancy-related homicides.
“Only as of 2018 did we have data coming from every single state, where we could count every single case of a homicide of a pregnant or postpartum person,” said Wallace.
Using two years worth of the new data, in 2021 Wallace published the first study showing that – when each medical issue was counted separately – homicide was the leading cause of death for new and expectant mothers. Nationwide.
The specific data on the killers of pregnant and postpartum women is still inconsistent, because not all jurisdictions track it, but Wallace’s findings hold true for former victim advocate Amanada Eyeam, who worked for decades with local survivors of domestic violence, most recently at Syracuse’s Vera House.
“I would say maybe 30% of my clients on my caseload [at Vera House] were either postpartum or they were pregnant at the time they were working with me,” said Eyeam.
Because intimate partner violence often hinges on exerting power and control over someone, including where they go and who they see, medical visits are among the few places that may offer refuge from an abuser, even if they’re just sitting in a waiting room. That’s why doctors and nurses have begun asking all of us if we feel safe.
However, Eyeam says, “It’s usually a one-time question.”
Even among obstetricians, who she wants to see track abuse before, throughout and after pregnancy, “to see if the violence has de-escalated.”
Rachael Sampson, a doctor in the Maternal Fetal Medicine department at Upstate University Hospital, wants that too. She says medical schools are increasingly teaching OBGYNs to recognize and discuss intimate partner violence, but if doctors are cold or mechanical in their bedside manner, it can alienate those in need.
“I don’t know how to bridge that,” said Sampson. “I don’t know what the answer is to really make a patient be able to come out and tell you the deepest, darkest things that could be going [on], that are beyond our imagination.”
Robert Silverman, the head of Maternal Fetal Medicine at Upstate, maintains that one of the most important jobs an OBGYN has is “to help facilitate your epiphany.” That includes helping patients recognize when their situation is not normal, medically or otherwise.
Silverman points out that OBGYNs spend more time with their patients than almost any other doctor, so being able to recognize signs beyond visible abuse is crucial.
“Not every patient that [experiences] intimate partner violence has bruises physically,” said Silverman, adding that there are plenty of "mental" bruises from emotional and psychological abuse, and he also sees many forced pregnancies.
Being coerced or threatened into carrying a baby to term, says Silverman, is another common way pregnant women are abused by their partners.
Both Sampson and Silverman say that as they became more knowledgeable on intimate partner violence, they also began working more frequently with victim services and law enforcement to provide help when needed.
Advocates warn that telling anyone to “just leave” an abuser can backfire. It often shames the person, and they may retreat into even greater isolation. And that could cause deadly harm if they are being subjected to physical violence and do not have expert, coordinated help when they try to leave.
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