Reply #6: no national system exists for tracking maternal homicides

[Breeze54]

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"Expanding on these findings, The Washington Post conducted a year-long survey of state death
record data and documented more than 1,367 maternal killings nationwide since 1990. As startling
as the findings are, however, they represent only part of the toll, because no national system
exists for tracking maternal homicides."

http://www.washingtonpost.com/wp-dyn/articles/A12359-2004Dec19.html

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Researchers Stunned By Scope of Slayings

Further Studies Needed, Most Agree

http://www.washingtonpost.com/wp-dyn/articles/A10785-2004Dec18.html

In the mid-1990s, Cara Krulewitch sat in a dark, cramped file room in the office of the D.C. medical examiner, poring over autopsies for days that became weeks, then months. She was an epidemiologist with the Centers for Disease Control and Prevention, assigned to the District.

Krulewitch wanted to see whether maternal deaths were being undercounted, as was common elsewhere across the country. Granted access to confidential death files, she assumed she would find more deaths from medical complications of pregnancy -- embolism, infection, hemorrhage -- than anyone knew.

What she stumbled upon instead was a surprising number of homicides: 13 of 30 maternal deaths, more than 40 percent. "I was just stunned," she recalled. "You assume it's a quirk in the numbers. A blip."

Krulewitch dug into medical archives and came across a 1992 journal article from Chicago and a 1995 study from New York City. In both, homicide had emerged as a significant cause of maternal death. It was difficult for the uninitiated to comprehend: Were pregnant women being killed in notable numbers?

"I didn't understand it at all," said Krulewitch, whose study was published in the Journal of Midwifery & Women's Health.

Her research came at a time when maternal mortality rates in the United States had fallen a full 99 percent from the last century, with fewer than 500 women a year dying of medical problems related to childbearing.

Health officials considered this a major achievement but also had set optimistic new goals to bring the death toll closer to what is called an irreducible minimum.

Still, there was a growing interest in doing a better job of capturing every possible case -- and taking note of homicides, suicides, car accidents and drug overdoses. In the larger public health world, the "social" causes of death were increasingly viewed as an important health issue.

"For a long time, violence was not defined as a public health problem," said Jacquelyn Campbell, who studies domestic homicides at Johns Hopkins University.

Even now, studies that analyze maternal homicide are relatively rare.

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