Violence as a public health problem

Abstract

Editor—The world report on violence and health issued by the World Health Organization unfortunately does not pay attention to the growing body of evidence that shows that violent deaths among women are often associated with pregnancy events.1-1 Homicide is a leading cause of death among pregnant women and recently pregnant women.1-2,1-3 According to one study of battered women, the target of battery during their pregnancies shifted from their face and breasts to their pregnant abdomen.1-4 This redirection of the assault implies hostility toward the woman's fertility. Many women are coerced, pressured, or battered to submit to unwanted abortions by men who are opposed to birth.1-5 This may be a clue as to why a history of abortion is an important marker for increased risk of death from violence.1-2,1-3 A major record linkage study in Finland found that in the first year after a pregnancy event,women who had given birth were half as likely to die as women who had not been pregnant whereas women who had abortions were 76% more likely to die.1-2 The largest discrepancy was due to deaths from violence. The odds ratio of death for women who had abortions compared with women who had given birth was 4.24 for accidents, 6.46 for suicide, and 13.97 for deaths resulting from homicide. Another large study in the United States showed that the higher risk of death associated with a history of abortion persists for at least eight years.1-3 After controlling for age and prior psychiatric history, a history of abortion was a significant marker for 3.12 times higher the risk of death from suicide and 1.93 times higher the risk of death from homicide over the entire eight years examined. The increased risk of death from violent causes was highest in the first four years after the pregnancy outcome. While much attention is paid to the problem of unwanted pregnancies, comparatively little has been paid to the violent conflicts that erupt when pregnancies are wanted by women but not their partners. Other causes of unwanted abortions—pressure from parents, medical staff, or circumstance—can also result in grief, guilt, and loss of desire to live,1-5 which may play a part in the increased risk 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 counselling programmes for women with a history of abortion.

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