A recent study published in JAMA Network Open highlights a chilling reality: pregnant women face higher risks of homicide in states with restrictive reproductive healthcare policies and legal barriers to divorce during pregnancy. The research found that state-level rates of pregnancy-associated homicide, a leading cause of maternal death in the United States, were elevated in areas where divorce cannot be finalized during pregnancy and where reproductive healthcare access is limited. The findings underscore how legal and policy environments can shape the safety and well-being of pregnant individuals.
Homicide is a leading cause of death among pregnant women in the United States, surpassing medical complications like preeclampsia or hemorrhage. Researchers have long observed that intimate partner violence plays a substantial role in these deaths, with younger women and Black women being at the highest risk. The study’s lead researcher, Kaitlin Boyle, was motivated to explore how state laws might influence these outcomes after learning about Missouri’s prohibition on finalizing divorces during pregnancy.
“I had already been studying violence against women for years, and I knew that homicide is a leading cause of death for pregnant women,” explained Boyle, an associate professor of criminology and criminal justice at the University of South Carolina. “Then, in early 2024, I saw several articles about Missouri state representative Ashley Aune, who proposed a bill to make it easier for women in Missouri to access divorce while pregnant. Related stories made me start to wonder about general patterns (across the United States and over time) of legislation that restrict access to reproductive care and legal barriers to divorce, and whether women are more likely to be killed while pregnant in general or by their partners in more restrictive states.”
Boyle and her colleagues used data from the National Violent Death Reporting System, which compiles information on violent deaths, including homicides, from medical examiners, law enforcement, and death certificates. The researchers analyzed state-level pregnancy-associated homicide rates from 2018 to 2021 across 49 states and Washington, D.C., focusing on deaths that occurred during pregnancy or within a year postpartum. Homicide rates were calculated for all women of reproductive age (15–49 years) and for younger women (ages 10–24), a group at particularly high risk.
The researchers also examined state policies regarding reproductive healthcare and divorce. Barriers to reproductive healthcare included restrictions on abortion access, such as mandatory waiting periods, parental consent requirements, and limitations on public funding. These policies were quantified into a “Reproductive Health Care Access Index,” where higher scores indicated more expansive access. Legal prohibitions on finalizing divorce during pregnancy were documented for states like Arkansas, Missouri, and Texas, where such laws are explicitly enforced.
The study confirmed a significant association between legal and healthcare restrictions and higher rates of pregnancy-associated homicide. States that prohibited finalizing divorce during pregnancy had notably higher rates of homicide among pregnant individuals. This trend was particularly pronounced among younger White women but was observed across all racial and ethnic groups.
In addition, reproductive healthcare access—or the lack thereof—was closely linked to homicide rates. States with more restrictive policies and abortion barriers had higher rates of pregnancy-associated homicides, both by intimate partners and non-partners. These findings align with previous research suggesting that limited reproductive healthcare access increases the vulnerability of women in abusive relationships and restricts their ability to escape dangerous situations.
“It takes a lot to leave a violent relationship—women may be financially dependent on their partner, they may have children with them, and abusers isolate victims, cutting them off from important social, financial, and emotional support systems,” Boyle told PsyPost. “Pregnancy—and the inability to divorce while pregnant—exacerbate these barriers, given the medical, psychological, and economic vulnerabilities that come with pregnancy and the postpartum period.”
“People in abusive marriages need to know that even in states with barriers to divorce during pregnancy, they can begin divorce proceedings and access protective orders from violent partners. We, as members of society, need to support access to healthcare and domestic violence services and support the individuals in our lives who need help.”
The racial and ethnic disparities in homicide rates were also striking. Younger Black women faced the highest rates of pregnancy-associated homicide, followed by younger Hispanic women and younger White women. The study found that states with greater reproductive healthcare access had lower homicide rates for Black and Hispanic women, highlighting the protective effects of these policies.
“People think of pregnancy and the postpartum period as a vulnerable time where women need to be protected more than ever, so people tend to be surprised when I talk about how pregnancy can be the result of violence and it can also increase violence,” Boyle said. “Unfortunately, I was not surprised by my findings. Instead, they confirmed my concern that women, especially young and Black and Hispanic women, would be endangered by laws that restrict their reproductive care access, and that women who cannot finalize a divorce from a violent partner would be more at risk for fatal violence.”
Unfortunately, data on pregnancy status is often incomplete, even with standardized reporting systems, which could lead to underestimations of pregnancy-associated homicides. Additionally, the study relied on state-level data, which may mask local variations in policy enforcement and access to care.
“Any research study is going to have its limitations, and ours is no different,” Boyle noted. “For instance, there are state-level factors that we do not account for that might shape rates of reproductive coercion, reproductive care access, and/or homicide, such as economic factors (e.g., poverty rates) and access to healthcare more generally. State laws are more complicated than it is measured here, but it is a starting point to understand national patterns of pregnancy-associated homicide.”
Future research could address these limitations by examining data at the county level or exploring how urban, suburban, and rural contexts influence access to care and safety. Longitudinal studies could also investigate how changes in state policies—such as the overturning of Roe v. Wade—affect pregnancy-associated homicide rates over time.
“The data we examine are only from the years 2018 to 2021, but vast changes occurred in reproductive care access both before and after that time period,” Boyle explained. “Many states that already restricted access to reproductive healthcare before Roe was overturned in 2022 then implemented total or near-total bans when it was overturned. Research suggests this has led to increases in rape-related pregnancies and infant mortality, and it must be examined how these changes are associated with pregnancy-associated violence and homicide.
“In the 2024 election, there were also laws and ballot measures approved in states that increased reproductive care access. Understanding whether and how these legislative changes affect pregnancy-associated homicide rates is a goal for my future work.”
The study, “State Divorce Laws, Reproductive Care Policies, and Pregnancy-Associated Homicide Rates, 2018-2021,” was authored by Kaitlin M. Boyle, Wendy Regoeczi, and Chase B. Meyer.
