Homicide thought no.1 cause of death during pregnancy

Fred Feldman ffeldman at bellatlantic.net
Fri Feb 28 23:25:48 MST 2003


Murder most foul

   Medical researchers now believe that homicide, not
   medical complications, is the leading cause of
   pregnancy-associated death.

- - - - - - - - - - - -
By Mary Papenfuss
<http://www.salon.com/news/feature/2003/02/27/pregnancy_death/index.html>

Feb. 27, 2003  |  Laci Peterson was due to give birth to
a baby boy -- her first child -- this month. Instead,
the 27-year-old Modesto mother-to-be is presumed dead.
Her body is missing; her husband, though not an official
suspect in his wife's disappearance, is under intense
scrutiny by detectives in the case. Weary volunteers,
scouring land and water since Peterson's disappearance
Christmas Eve, focused on the New Melones Reservoir last
weekend. Police searched the Peterson home for the
second time early last week, removing several bags of
evidence. Any hope that Laci and her baby are alive has
nearly evaporated. "When we're looking in places under
water, we're looking for a body," reported Police Chief
Roy Wasden.

There's much for a woman to fear when she's pregnant --
the "What to Expect When You're Expecting" books
gingerly spell out the many medical hazards in chapters
too frightening for some women to read: preeclampsia,
miscarriage, stillbirth, stroke and hemorrhage are
complications that American women, though they enjoy the
best prenatal care in the world, are familiar with.

But what the pregnancy manuals don't mention is a
chilling fact that has been buried in death statistics
for many years: Murder is now believed to be responsible
for more pregnancy-associated deaths in this country
than any other single cause, including medical
complications such as embolism or hemorrhaging.

For decades, the medical community has limited its
definition of "pregnancy-related death" to fatal medical
complications, and law enforcement has followed suit,
failing to collect separate data on whether female
homicide victims were pregnant. The absence of murder as
a category of pregnancy-related -- or more accurately,
pregnancy-associated death -- left a void where a
significant medical and social concern had been brewing
for years.

"We aren't doing a good job yet of surveillance of
pregnancy-associated deaths," says Dr. Cara Krulewitch,
an epidemiologist at the University of Maryland in
Baltimore, who was among the first researchers to find a
link between pregnancy and homicide. "The system isn't
in place because pregnant women are supposed to be
healthy.

"We don't expect them to die -- or be killed," she says,
"but it's beginning to change -- there's a sense that
the number of deaths may be significantly higher -- with
a frightening number caused by homicide."

And as the numbers of pregnant women murdered every year
are revealed, so, too, are their murderers. Homicide is
the fourth leading cause of death among all American
women of childbearing age; and one-third of all female
murder victims each year are killed by an intimate
partner. As pioneering medical researchers reexamine
death reports of murdered women, looking for signs that
the victim was pregnant, they are concluding that often,
the killer of a pregnant woman is the partner or spouse
of the mother-to-be.

"Why are pregnant women dying?" asks Rebecca Whiteman of
the Family Violence Protection Fund in San Francisco.
"Their partners are killing them."

- - - - - - - - - - - -

Historically, deaths defined as "pregnancy-related" were
deaths caused by a medical complication of pregnancy, or
deaths that occurred when pregnancy aggravated an
existing health problem. Traumatic deaths of pregnant
women -- deaths due to injury, accident or violence --
have generally not been systematically collected or
examined. The result is an almost complete lack of
accurate national statistics about the number of
pregnant women murdered or the circumstances of their
deaths. In the absence of those numbers, researchers
have begun to compile data, often on a state-by-state
basis, by recovering and then scrutinizing old death
records and murder reports.

Cara Krulewitch, who is also a nurse and midwife,
suspected for years that pregnancy-associated deaths --
a phrase that, unlike "pregnancy-related," includes
deaths associated not just with medical complications in
pregnancy but with trauma, including murder -- were
underreported. In an initial study in the Journal of
Midwifery and Women's Health, she took a look at death
records in Washington, D.C., over an eight-year span.
She was shocked by her discovery that 14 of 35, or 38
percent, of pregnant women who died in Washington from
1988 to 1996 were victims of homicide.

She also found that, during that same period, the
Washington Center for Health Statistics reported only 21
of those pregnancy-related deaths, those who died from
medical causes. The 13 homicide victims that Krulewitch
found were reported simply as murder victims. Their
pregnancy status wasn't noted on their death
certificates.

"I was stunned by what I saw," says Krulewitch.

In a 2001 study published in the Journal of the American
Medical Association, researchers in the Maryland
Department of Health and Mental Hygiene found that
between 1993 and 1998, homicide was responsible for more
pregnancy-associated deaths in Maryland than any single
medical cause, accounting for 20 percent of all
pregnancy-associated deaths. Homicide accounted for
twice as many deaths as the most common medical cause --
embolism.

More recently, in a study to be published in May in
Child Maltreatment, a journal of the American
Professional Society on the Abuse of Children,
Krulewitch also focused on Maryland, attempting to
calculate the risk for pregnant women in that state of
being murdered during, or in the year after, a
pregnancy. Looking at all female victims of murder in
Maryland between 1994 and 1998, Krulewitch found that
pregnant women were disproportionately represented.
Comparing the percentage of women in the total female
population who were pregnant to the percentage of murder
victims who were pregnant, Krulewitz found that pregnant
women were twice as likely to be murdered as non-
pregnant women of the same age.

A 2002 study in the Journal of the American Medical
Women's Association also found that homicide was the
leading cause of pregnancy-associated deaths in
Massachusetts from 1990 to 1999. They also determined
that the rate of pregnancy-associated deaths -- not
necessarily homicides -- was at least three times higher
for African-American women, and all women younger than
25 and between the ages of 40 to 44.

In a similar study, researchers at Winston-Salem's Wake
Forest University School of Medicine found that of 167
pregnancy-associated deaths in North Carolina from 1992
to 1994, 22 (13 percent) were a result of homicide.
Women who accounted for half of the injury-related
maternal deaths -- not necessarily homicides -- were
known to have been abused or were suspected of being
abused by either an intimate partner or an acquaintance.
The study also indicated that more than one-fourth of
them (26.8 percent) were known to have abused drugs
and/or alcohol.

Other studies have found that trauma is the leading
cause of death of pregnant women and that most trauma
deaths -- defined as injury, accident or violence -- are
due to murder. Researchers from Johns Hopkins University
School of Hygiene and Public Health examined death
certificates from the New York City Medical Examiner's
Office, and found that among pregnant women who died of
trauma in New York City from 1987 to 1991, 63 percent
were murdered. Researchers there concluded that
"homicide and other injuries are major contributors to
maternal mortality and should be (but rarely are)
included routinely in maternal mortality surveillance
systems."

And figures collected from Chicago's Cook County Medical
Examiner's Office revealed that 57 percent of pregnant
women who died of trauma from 1986 to 1989 were
murdered. A fourth of those women were shot to death, 13
percent were stabbed, and 13 percent were strangled.
Suicide accounted for 9 percent of the trauma deaths.

- - - - - - - - - - - -

Even in the realm of heinous crimes, it's hard to
imagine an act more horrifying than the killing of a
pregnant woman. That the killer of a woman carrying a
child is likely to be her intimate partner, perhaps the
father of the child, is somehow even harder to accept --
except for those familiar with the nature of domestic
violence in this country. Attacks on pregnant women,
even those that result in death, are "sadly, not
surprising, given the history of domestic violence,"
says Dr. Jeffrey Edelson, a professor at the University
of Minnesota and a national expert on domestic violence.

Juley Fulcher, policy director for the National
Coalition Against Domestic Violence in Washington and an
attorney who used to represent battered women in court,
many of them pregnant, agrees. "I can't tell you how
many times those women were beaten while their abuser
would say things like, 'I'm going to kick that baby out
of you,'" she recalls.

Fulcher believes that hurting the fetus is the most
effective way for a batterer to "get to" his wife or
girlfriend. "It's what she cares about the most, and
that's what abusers focus on," she says. "They are so
obsessed with control and power that they will do
anything. It's extraordinarily common for men to
threaten to hurt or kill a woman's pets, or threaten or
hurt the children."

Edelson believes that stress brought on by the pregnancy
itself -- such as anxiety over finances -- can lead to
increased violence. Or, he says, it may be triggered by
simple jealousy. "Suddenly, attention is focused on the
woman, and she may pay less attention to the man," he
says. "Perhaps she's tired and doesn't make the kinds of
dinner he likes, perhaps she doesn't want to have sex."

A pregnancy also tends to deprive abusers of the
isolation they count on to be able to control and hurt
their partners with impunity. Pregnant women have to
leave the house often for checkups. "This can be
threatening to an abusive spouse who may feel he's
losing control over the situation and that his actions
may come to light during an examination," said Lisa
James of the Family Violence Prevention Fund.

Reflected in general research on abuse are indications
that domestic violence is a frequent and increasingly
common cause of maternal injury. Many women who
experience violence during pregnancy have a history of
reported abuse before pregnancy, though battery often
begins -- or intensifies -- during pregnancy, experts
say. James says pregnancy is often the point at which
the emotionally or verbally abusive partner escalates to
physical violence. Experts say once a victim is
pregnant, beatings tend to change from general body
blows to target the face and abdomen.

Sherrie, who asked that her last name not be used, was
abused by a 17-year-old boyfriend who beat her badly
while she was pregnant.

"I was young. I had zero experience. I didn't have
anyone to talk to," she says. "I got caught up in
everything he said -- that I was worthless, that no one
else was going to like me. It was confusing. I kept
trying to figure out what was going on in my head," says
Sherrie, who now helps counsel victims of domestic
violence.

"It got worse during the pregnancy. There was a point I
really wanted to leave him."

But when Sherrie, 18 at the time and four months
pregnant, left her boyfriend, he began to stalk her. He
finally confronted her at a supermarket in their small
Northern California hometown, and they argued as she
shopped for groceries. Suddenly, he picked up a heavy
bag of potatoes and slammed her in the back, knocking
her to the floor.

"Everybody around us stopped and stared, but nobody
helped me," recalled Sherrie. "I thought, 'Gosh, I'm in
this alone."

She fled to her car, but her boyfriend wrestled the keys
from her, grabbed her by the throat and lifted her off
the ground. "My feet were dangling in the air," she
says. "People watched us in the parking lot but no one
helped. He threw me in the back of the car and drove
off. He was crying and apologizing for hitting me. He
said he didn't want me to leave."

He parked outside his parents' home, and disabled the
engine so Sherrie couldn't drive off. But she fled on
foot to a gas station, where an attendant hid her and
called police.

Her boyfriend was initially charged with kidnapping and
assault and served half of a three-year sentence. They
continued to talk and see each other, but Sherrie's
pregnancy and the birth of their daughter was the
beginning of the end of their relationship. "I wanted to
take care of her." Eventually, she decided, "This is
what happened to me. It's not going to happen again."

There has been no public indication that Scott Peterson
abused Laci Peterson. On the contrary, her family
initially reported that Laci was happy in her marriage
and thrilled at the prospect of adding a child to the
family. But a month after his wife disappeared, Scott --
who says he was fishing the day Laci vanished --
admitted he was having an affair with a local woman at
the time his wife vanished. Last month he sold off
Laci's Land Rover, and referred to his wife in the past
tense -- then quickly corrected himself -- in an ABC
interview with Diane Sawyer.

- - - - - - - - - - - -

Researchers like Krulewitch, as well as domestic
violence experts and activists, believe that the
discovery and analysis of the homicide-pregnancy link
through statistics could bring a new awareness in the
medical community about the cause of death and injury
associated with pregnancy. Up until now, medical
literature has focused almost exclusively on medical
complications related to pregnancy, such as high blood
pressure and toxemia, that could be fatal.

In an editorial accompanying a recent study on the
pregnancy-homicide link, Victoria Frye of the Center of
Gender and Health Equity points out that traditionally
ignored "social causes" as well as medical causes of
maternal death provide important clues to solving
pregnancy problems. She concludes: "Pregnancy-associated
death represents a largely preventable source of
premature mortality among young women in the United
States and devastates the children, families, and
communities left behind."

 Many states already have begun to acknowledge the high
 incidence of murder in pregnancy-associated deaths by
 including a place on death certificates to indicate
 that the deceased was pregnant. It is meant to provide
 a way to more easily track the number of pregnant women
 murdered each year, but domestic violence experts say
 the paperwork is often ignored. Meanwhile, the FBI
 still doesn't isolate the number of pregnant women from
 the total number of homicide victims listed in annual
 crime statistics.

Besides pushing for data collection that accurately
reflects the number of pregnant women murdered every
year, domestic abuse organizations are asking for
routine medical screening to help stem the tide of
violence against pregnant women. "We find that violence
represents more of a threat to pregnant women than
diabetes, yet doctors screen routinely for diabetes, but
not for abuse," said James.

The Centers for Disease Control and the American College
of Obstetricians and Gynecologists also are pushing for
increased screening, but Whiteman said in some cases
it's a battle.

"There's too often this disconnect between medicine and
behavior," says Whiteman. "You have a doctor who says,
'I'm an internist, I don't do that behavioral stuff.'
But it's a key aspect of health."

Domestic abuse organizations are scrupulously avoiding
any tactic that would establish or increase penalties
for intentional harm to a fetus. Such a law played a
role in the case of former NFL player Rae Carruth, who
was convicted of hiring a hit man to kill his pregnant
girlfriend in 1999 so he wouldn't have to pay child
support. Cherica Adams, 24, was shot four times and died
a month later. Her baby boy, Chancellor, survived the
attack and is being raised by Adams' mother, who
testified at Carruth's trial that Chancellor is
developmentally disabled because of the shooting.
Carruth was sentenced to 19 years in prison. A 10-month
portion of the sentence was attributed to a finding that
Carruth used "an instrument in attempting to harm an
unborn child."

Such laws, domestic violence experts worry, can too
easily be turned against the women they're supposed to
protect, shifting focus from a mother to a fetus, and
creating precedent for antiabortion laws in other areas.

"These laws tend to be promulgated by anti-abortionists
that can easily do more harm than good," says Fulcher.
Edelson calls the laws "cynical."

"The problem is we aren't doing enough adult to adult,"
he says. "The woman alone apparently isn't reason enough
to prosecute. But if we protect the woman, the baby
she's carrying is protected."

Ultimately, and sadly, the link between pregnancy and
homicide is just one aspect -- perhaps the most
frightening -- of domestic abuse in this country. An
estimated 1,500 to 2,400 young women are killed each
year by their intimate partners. Every 15 seconds in
this country a woman is physically assaulted by her
husband, boyfriend, or live-in partner, according to
statistics from the U.S. Department of Justice. The
agency also estimates that approximately 2.5 million
women are abused annually, with as many as 50 percent of
all women experiencing at least one episode of battering
during their lifetime.

"There's all this talk about terrorism," says Whiteman
of the Family Violence Protection Fund in San Francisco.
"What people don't know or want to forget about is the
violence in our own neighborhoods, in our homes."



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