Violence: A Leading (but Overlooked) Driver of Maternal Death

By Malinda Rochelle Lewis, M.A.
Director of Reproductive Justice & Maternal Health, Positive Results Center

When we talk about maternal mortality, most people picture medical emergencies- hemorrhage, hypertension, or complications during childbirth. But the truth is, violence is quietly taking far too many mothers’ lives (Chan & Alter, 2021). It’s not a side issue. It’s one of the leading causes of death during pregnancy and postpartum — and one that too often goes unnamed.

In 2022, the U.S. maternal mortality rate was 22.3 deaths per 100,000 births (Hoyert, 2023). That number alone is unacceptable in one of the wealthiest countries in the world. But buried within it is another devastating reality: homicide is a top cause of maternal death, especially for Black women and girls (Wallace et al., 2021). Research from the American Journal of Obstetrics and Gynecology found that pregnant and postpartum women are more likely to die by homicide than from hemorrhage or infection (Chan & Alter, 2021). And in many states, homicide has become the leading cause of death for women during or after pregnancy (Wallace et al., 2021).

This is not just about numbers, it’s about what those numbers represent: a failure to protect mothers from the violence that begins long before birth. When a woman is carrying life inside her and simultaneously fearing for her own, that’s not just a public health crisis, that’s a moral one.

And we must name what drives this. Intimate partner violence and gun access are the common threads in many of these deaths. Studies show that nearly half of all pregnancy-related homicides involve an intimate partner, and in most cases, a firearm is the weapon used (Tobin-Tyler, 2023; Petrosky et al., 2017). These are not random acts of violence, these are preventable deaths born from systems that ignore women’s safety until it’s too late.

When we say violence begins in the womb, we mean that generational trauma, abuse, and neglect can shape the conditions of birth itself. Mothers who live in fear of their partner, or who experience violence during pregnancy, are more likely to face complications, preterm birth, and postpartum depression (Chambers et al., 2019). And their children, even in the womb, absorb that stress and pain.

If we are serious about saving mothers, then violence prevention must sit at the center of maternal health work, not at its edges. That means expanding how we define maternal care to include safety, housing stability, guaranteed income, trauma recovery, and protection from abuse (Sakala et al., 2013). Because no mother should have to fight for her life while giving life.

Saving mothers’ lives means confronting the violence they face — not just in labor rooms, but in living rooms. At Positive Results Center, we center this commitment across our prevention education, trauma‑informed workshops, and community leadership programs, ensuring every mother, young person, and family we serve is equipped for both survival and thriving.

References:

Chan, L. M., & Alter, H. J. (2021). Leading causes of maternal mortality: Violence as a top contender. American Journal of Obstetrics and Gynecology, 225(1), 86.e1–86.e6. https://doi.org/10.1016/j.ajog.2021.03.018

Chambers, B. D., Baer, R. J., McLemore, M. R., & Jelliffe-Pawlowski, L. L. (2019). Using racial equity and human-centered design to address bias in perinatal care. Obstetrics & Gynecology, 134(5), 896–902. https://doi.org/10.1097/AOG.0000000000003494

Hoyert, D. L. (2023). Maternal mortality rates in the United States, 2022. National Center for Health Statistics. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2022/maternal-mortality-rates-2022.htm

Petrosky, E., Blair, J. M., Betz, C. J., Fowler, K. A., Jack, S. P. D., & Lyons, B. H. (2017). Racial and ethnic differences in homicides of adult women and the role of intimate partner violence — United States, 2003–2014. Morbidity and Mortality Weekly Report, 66(28), 741–746. https://doi.org/10.15585/mmwr.mm6628a1

Sakala, C., Declercq, E. R., Turon, J. M., & Corry, M. P. (2013). Listening to Mothers III: Pregnancy and Birth. Childbirth Connection. https://www.nationalpartnership.org/our-work/resources/health-care/maternity/listening-to-mothers-iii-pregnancy-and-birth.pdf

Tobin-Tyler, E. (2023). Intimate partner violence, firearm injuries and homicides: A health justice approach to two intersecting public health crises. Journal of Law, Medicine & Ethics, 51(1), 64–76. https://doi.org/10.1017/jme.2023.41

Wallace, M., Gillispie-Bell, V., Cruz, K., Davis, K., & Felker-Kantor, E. (2021). Homicide during pregnancy and the postpartum period in the United States, 2018–2019. Obstetrics & Gynecology, 138(5), 762–769. https://doi.org/10.1097/AOG.0000000000004567

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Violence: A Leading (but Overlooked) Driver of Maternal Death

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