Abortion Access, Intimate Partner Violence, and Maternal Homicide

Pregnant and postpartum women are more likely to be killed in states with restrictive reproductive policies

As of this writing, 22 states have banned or restricted abortion access earlier in pregnancy than the standard previously set by Roe v. Wade. Reproductive activists often focus on the myriad ways that these policies hurt pregnant people, including when terminating a pregnancy is necessary for the health and welfare of the pregnant person.

A darker side of this conversation is the relationship between intimate partner violence (IPV) and pregnancy. The leading cause of death of pregnant and postpartum women in the United States is homicide, most frequently by a firearm and with IPV playing a large role.

Many pregnant people may seek an abortion due to concerns around IPV and when that access is limited, more violence may be a consequence. A study that examined data from 2008 found that IPV rates were higher when women had to travel longer distances to get an abortion. A separate finding from the Turnaway Study (which I’ve previously written about) found that violence from the man involved in a pregnancy decreased over time for women who sought and received abortions; on the other hand, violence did not change for women who sought an abortion but were denied.

A study published in May by Keegan and colleagues in the Journal of the American College of Surgeons is the first to examine the relationship between state-level reproductive policies and peripartum homicide (i.e., homicides that occurred during pregnancy or within one year postpartum). They analyzed a dataset on homicides that occurred between 2018-2020 and compared states with various abortion policies. The states were categorized as one of the following classifications:

1. Restricting abortion access: The presence of targeted regulation of abortion providers, limits on abortion by medication, limits on insurance coverage of abortion, or pre-viability abortion bans at 20 weeks of gestation (25 states).

2. Protecting abortion access: The presence of a protective policy, such as a specific law protecting the legality of abortion (nine states).

3. Neutral to abortion access: Any state that didn’t meet the criteria for being restrictive or protective of abortion access (12 states).¹

The researchers examined all female homicide victims² and found that victims who were in the peripartum period were more likely to be younger, less educated, and less likely to be married compared to other female victims. They also found that Black women were disproportionally represented in the peripartum victim group (47% of victims) compared to the non-peripartum group (34% of victims). This is in line with previous research that finds that Black women are 2-3x more likely to die by homicide when pregnant or postpartum compared to other groups.

Reported IPV was more common in the peripartum group (40%) compared to the non-peripartum group (26%). However, this is likely an underestimation, as the same data set reported that 97% of peripartum homicides were due to someone known to the victim (i.e., not a random act of violence), though for whatever reason was not listed as related to IPV.

The researchers found that states that were more restrictive to abortion access had higher rates of peripartum homicide (0.644 per 100,000 total state population) compared to protective (0.368) and neutral states (0.445). In other words, states with restrictive policies had a 75% higher rate of peripartum homicide.

The researchers also looked at male homicide rates as a way to examine whether there were simply more homicides in general in states that had more restrictive abortion policies; they failed to find any significant differences between states. Abortion policies were only related to differences in female homicides, not male ones.

Figure 1 from Keegan et al. (2024). Geographic distribution of (A) peripartum homicides and (B) abortion legislation by state. Peripartum homicide rates are given in deaths per 100,000 population per state.

The authors note that including data from 2020 might have inflated the numbers due to the fact that the COVID-19 pandemic exacerbated IPV rates. However, it should also be noted that this data referred to the years before the Roe v. Wade decision was overturned.

Things have likely only gotten worse. Indeed, when we look at the 25 states that were classified as restrictive in 2017 from this data set, 18 now have more restrictive policies.³ When examining data on maternal mortality rates (of any cause) from 2018-2022, those 18 states together averaged a higher rate (30.44 per 100,000 live births) than the national average (23 per 100,000), with nine of those states ranking in the top 10 highest rates in the country.⁴

A similar pattern emerges examining (provisional) infant mortality rates from 2022: Of those 18 states, the average infant mortality rate was 6.65 per 1000 births compared to the national average of 5.75, including seven states ranking in the top 10.⁵

I could not find reliable information on state-level IPV or maternal homicide rates from 2022 or 2023. However, the National Domestic Violence Hotline has an impact report that lists the top 10 states with the largest call volume from 2023. Of those states, five of them were in that original list of 25 states classified as restrictive in 2017 (Georgia, North Carolina, Ohio, Pennsylvania, and Texas), with three now having partial or full abortion bans (Georgia, North Carolina, and Texas) .

Louisiana takes the ignominious honor of having the highest peripartum homicide rate in the country from 2018 to 2020 (0.20 per 100,000 total state population) and being in the current top ten for maternal mortality (#5) and infant mortality (#3). It currently bans abortion in almost all circumstances. Congratulations?

To put it bluntly: For some men, when a pregnancy can’t be terminated, ending a pregnant person or mother’s life is the next “best” option. These deaths are tragic for many reasons, not least of which is because they were likely preventable. Protecting reproductive choice is the least we can do to protect the lives women, mothers, and all pregnant people.

1. Forty-six states were includes in their analysis. Florida, North Dakota, South Dakota, and Idaho had insufficient data at the time. Currently, these states have full or partial bans on abortion.

2. The data set categorized homicides as only female or male; nonbinary and trans individuals that could get pregnant were classified as “female.”

3. These states are (in alphabetical order): Alabama*, Arizona, Arkansas*, Georgia, Indiana*, Iowa, Kentucky*, Louisiana*, Mississippi*, Missouri*, Nebraska, North Carolina, Oklahoma*, South Carolina, Tennessee*, Texas*, Utah, and West Virginia* (*full ban) (source: NY Times)

4. In order: Tennessee (41 per 100,000 live births), Alabama and Mississippi (39), Arkansas (38), Louisiana (37), Kentucky (35), Georgia and South Carolina (32), and Indiana (31) (source: KFF)

5. In order: Mississippi (9.11 per 1000 births), Arkansas (7.67), Louisiana (7.37), West Virginia (7.32), Indiana (7.16), Georgia (7.07), and Oklahoma (6.89) (source: CDC)