New York, NY -- In an effort to call attention to the impact of violence on public health, 160 experts contributed to the World Report on Violence and Health issued by the World Health Organization (WHO) last week. This fruit of three years of collaboration, unfortunately, fails to call attention to the growing body of evidence which shows that violent deaths among women are strongly associated with their pregnancies.

Sadly, at least in some countries, homicide is the leading cause of death among pregnant women and recently pregnant women.(1) According to one study of battered women, the target of battery during their pregnancies shifted from their faces and breasts to their pregnant abdomens.(2) This redirection of the assault suggests hostility toward the women's fertility.

Many women are coerced, pressured, or battered to submit to unwanted abortions by men who are opposed to birth (3). This may be a clue as to why a history of abortion is an important marker for increased risk of death from violence.(4,5)

A major record linkage study in Finland found that in the first year following a pregnancy event, women who delivered were half as likely to die as women who had not been pregnant while women who had abortions were 76 percent more likely to die.(4) The largest
discrepancy was due to deaths from violence. The odds ratio of death for women who had abortions compared to delivering women was 4.24 for accidents, 6.46 for suicide, and 13. 97 for deaths resulting from homicide.

Another large study in the United States revealed that the elevated risk of death associated with a history of abortion persists for at least eight years.(5) After controlling for age and prior psychiatric history, a history of abortion was a statistically significant marker for 3.12 times higher risk of death from suicide and 1.93 times higher the risk of death from suicide.
The elevated risk of death from violent causes was highest in the first four years following the pregnancy outcome.

While much attention is paid to the problem of unwanted pregnancies, comparatively little has been paid to the violent conflicts which erupt when pregnancies are wanted by women but not wanted by their partners. Other causes of unwanted abortions' pressure from parents, medical personnel, or circumstances' can also result in grief, guilt, and a loss of desire to live (3), which may play a role in the higher rate of deaths due to suicide and accidents among women with a history of abortion. One important step in addressing this public health crisis is to expand screening and counseling programs for women with a history of abortion.

REFERENCES

(1) Horon IL, Cheng D .Enhanced surveillance for pregnancy-associated
mortality--Maryland, 1993-1998. JAMA. 2001;285(11):1455-9.

(2) Hilberman E, Munson K. Sixty battered women. Victimology 1977-78;
2:460-470.

(3) Burke T, Reardon DC. Forbidden Grief: The Unspoken Pain ofAbortion.
Springfield, IL: Acorn Books, 2002.

(4) Gissler, M., et. al., "Pregnancy-associated deaths in Finland 1987-1994
^× definition problems and benefits of record linkage," Acta Obsetricia et
Gynecolgica Scandinavica. 1997; 76:651-7.

(5) Reardon DC, Ney PG, Scheuren FJ,, Cougle JR, Coleman, PK, Strahan T.
"Deaths associated with pregnancy outcome: a record linkage study of low
income women," Southern Medical Journal. 2002; 95(8):834-41