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Date: Thu, 22 Mar 2001 14:30:34 -0500 (EST)
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Here is more information on the study you cited. People might want to join
this elist. I get very useful information from it.
Kathleen Bombach
Subj: News Flash! March 20, 2001
Date: 3/21/2001 2:40:13 PM Mountain Standard Time
From: fund@fvpf.org (Family Violence Prevention Fund)
To: fvpf-newsflash@fvpf.org
News Flash!
March 20, 2001
<A HREF="http://www.fvpf.org/newsflash/03-20-2001.html">http://www.fvpf.org/newsflash/03-20-2001.html>
In this issue:
Intimate Partner Homicide And Pregnancy
INTIMATE PARTNER HOMICIDE AND PREGNANCY
Pregnant or recently pregnant women are more likely to be the victims
of homicide than to die from any other cause, finds a new study
published today in the Journal of the American Medical Association
(Vol. 285, No. 11). The study, Enhanced Surveillance for
Pregnancy-Associated Mortality, Maryland 1993 - 1998, explores the
causes of death for 247 Maryland women who died while pregnant or
within a year of having been pregnant.
Pregnancy-Associated Mortality is accompanied by a powerful editorial
by Victoria Frye, MPH, which expands on the study's findings and uses
them as a framework to explore ways to prevent homicides in general
and intimate partner homicides specifically. The editorial focuses on
the role health care providers can play in preventing the murder of
pregnant women by their partners, and calls on health care providers
to use domestic violence screening as a tool to prevent homicides.
"The pieces in the Journal of the American Medical Association
underscore the critical role that health care providers can play in
preventing domestic homicides and saving lives through routine
screening," said Family Violence Prevention Fund (FVPF) Associate
Director Debbie Lee. "Health care providers are in a unique role to
discuss abuse with their patients and offer life saving support to
battered women. It is imperative that all health care providers take
domestic violence seriously and take steps to help their patients who
may be facing abuse."
Homicide Rates
Pregnancy-Associated Mortality - by Isabelle L. Horon, DrPH and Diana
Cheng, MD - examines death certificates, medical examiner reports and
other records to determine the causes of death among pregnant or
recently pregnant women.
Past studies on pregnancy and mortality have used the World Health
Organization (WHO) definition for maternal death that limits the cause
of death to factors directly related to pregnancy, such as hemorrhage
and embolism. Pregnancy-Associated Mortality uses an expanded
definition for maternal death that enlarges the WHO definition to
include deaths "not traditionally considered to be related to
pregnancy such as accidents, homicide, and suicide." Analyzing data
within this new context, the study finds that the "number of
pregnancy-associated deaths is substantially higher and causes of
death substantially broader than previously believed."
Pregnancy-Associated Mortality finds that homicide is the leading
cause of death for pregnant or recently pregnant women. The study
uses the term homicide, but does not distinguish between homicide
perpetrated by an intimate partner and homicide perpetrated by a
non-intimate partner.
Of the 247 women examined, 50 were the victims of homicide (20.2
percent), according to the study. Cardiovascular disorders were the
second leading cause of death, with 48 victims.
Pregnancy-Associated Mortality finds that homicide is the leading
cause of death during pregnancy (43.4 percent) and during the "43- to
365- day period following delivery or termination of pregnancy" (23.3
percent). But the study finds that homicide accounted for only 3.6
percent of the deaths occurring within 42 days of delivery or
termination of pregnancy.
Pregnancy-Associated Mortality compares the homicide rate of pregnant
or recently pregnant women with that for women "aged 14 to 44 years
who had not had a pregnancy in the year preceding death." It finds
that the homicide rate is significantly higher for women in the first
group. Homicide accounted for 11.2 percent of deaths for women who
were not pregnant prior to their murder (when adjusted for race and
maternal age), compared with 20.2 percent of deaths for pregnant or
recently pregnant women. Also, the group of pregnant or recently
pregnant women was younger and included a higher percentage of African
American women than the group of non-pregnant women.
Pregnancy-Associated Mortality notes that these factors are associated
with higher rates of homicide independent of pregnancy.
Homicide Prevention
While Pregnancy-Associated Mortality does not offer explanations for
why pregnant or recently pregnant women are most likely to be victims
of homicide, the study uses its findings to provide a framework for
homicide prevention. Pregnancy-Associated Mortality concludes that
"complete and accurate identification of all deaths associated with
pregnancy is a critical first step in the prevention of such deaths."
The study notes that many deaths associated with pregnancy may go
undetected because death certificates and medical examiners' records
do not always note whether the deceased was pregnant. Currently, only
17 states and New York City have a pregnancy check box or ask about
pregnancy status on their death certificates, according to
Pregnancy-Associated Mortality. The study adds that proper
identification of pregnancy- associated deaths will lead to an
improved understanding of the magnitude of the problem, as well as of
the "factors leading to the death."
The editorial echoes Pregnancy-Associated Mortality's call for further
research to develop prevention strategies, and highlights the social
risk factors for pregnancy-associated deaths, such as domestic
violence. The editorial also stresses the need for "strategies to
promote safe motherhood" that integrate prevention strategies that
focus on both the social and medical factors that may contribute to
maternal deaths. This includes health screening for domestic
violence.
The editorial notes that "homicide is the leading killer of young
women, pregnant or not," and that "much of the violence that women
experience during pregnancy is perpetrated by intimate partners and
that, for some, intimate partner violence begins during pregnancy."
Within this context, the editorial concludes that homicide by intimate
partners "may offer a focal point for effective pregnancy-associated
mortality prevention efforts because many of these women come into
contact with the health care system before their death."
Because most pregnant women have a relationship with a health care
provider, health care providers are in a unique position to prevent
intimate partner homicide of pregnant women by screening for domestic
violence. In 1995, approximately 72 percent of reproductive age women
in the United States received reproductive care and many pregnant
women receive some form of prenatal care during their pregnancies.
But the editorial cites a survey of obstetricians and gynecologists
that found that just 17 percent screen their patients for domestic
violence at their first visit, and only ten percent screen regularly
at "check-up visits."
"To prevent intimate partner homicides of pregnant and postpartum
women, health care professionals must be willing to undertake routine
domestic violence screening and implement sensitive interventions
where appropriate," concludes the editorial. "If they [do] not, we
will continue to read reports finding that only one-fourth of
clinicians whose patients are killed by intimate partners were aware
of a history of or suspected current abuse by an intimate partner."
##########
We encourage you to forward these articles to your friends or
colleagues, as well as reprint or adapt them for your own newsletter
or website. When you do, please do not make changes to the content and
in particular, do not delete third party credit information. Please
also include the following credit line: "Reprinted and adapted from
'News Flash' (<A HREF="http://www.fvpf.org/newsflash)">http://www.fvpf.org/newsflash)</A>, an online newsletter of
the Family Violence Prevention Fund."
_____________________________
Family Violence Prevention Fund
383 Rhode Island Street, Suite 304
San Francisco, CA 94103-5133
Phone: (415) 252-8900
Fax: (415) 252-8991
Order Line: (415) 252-8089
Email: fund@fvpf.org
Website: <A HREF="http://www.fvpf.org/">http://www.fvpf.org>
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