Murder most foul

Medical researchers now believe that homicide, not medical complications, is the leading cause of pregnancy-associated death.

By Mary Papenfuss

Feb 27, 2003 | Laci Peterson was due to give birth to a baby boy -- her first child -- this month. Instead, the 27-year-old Modesto mother-to-be is presumed dead. Her body is missing; her husband, though not an official suspect in his wife's disappearance, is under intense scrutiny by detectives in the case. Weary volunteers, scouring land and water since Peterson's disappearance Christmas Eve, focused on the New Melones Reservoir last weekend. Police searched the Peterson home for the second time early last week, removing several bags of evidence. Any hope that Laci and her baby are alive has nearly evaporated. "When we're looking in places under water, we're looking for a body," reported Police Chief Roy Wasden.

There's much for a woman to fear when she's pregnant -- the "What to Expect When You're Expecting" books gingerly spell out the many medical hazards in chapters too frightening for some women to read: preeclampsia, miscarriage, stillbirth, stroke and hemorrhage are complications that American women, many of whom enjoy some of the best prenatal care in the world, are familiar with.

But what the pregnancy manuals don't mention is a chilling fact that has been buried in death statistics for many years: Murder is now believed to be responsible for more pregnancy-associated deaths in this country than any other single cause, including medical complications such as embolism or hemorrhaging.

For decades, the medical community has limited its definition of "pregnancy-related death" to fatal medical complications, and law enforcement has followed suit, failing to collect separate data on whether female homicide victims were pregnant. The absence of murder as a category of pregnancy-related -- or more accurately, pregnancy-associated death -- left a void where a significant medical and social concern had been brewing for years.

"We aren't doing a good job yet of surveillance of pregnancy-associated deaths," says Dr. Cara Krulewitch, an epidemiologist at the University of Maryland in Baltimore, who was among the first researchers to find a link between pregnancy and homicide. "The system isn't in place because pregnant women are supposed to be healthy.

"We don't expect them to die -- or be killed," she says, "but it's beginning to change -- there's a sense that the number of deaths may be significantly higher -- with a frightening number caused by homicide."

And as the numbers of pregnant women murdered every year are revealed, so, too, are their murderers. Homicide is the fourth leading cause of death among all American women of childbearing age; and one-third of all female murder victims each year are killed by an intimate partner. As pioneering medical researchers reexamine death reports of murdered women, looking for signs that the victim was pregnant, they are concluding that often, the killer of a pregnant woman is the partner or spouse of the mother-to-be.

"Why are pregnant women dying?" asks Rebecca Whiteman of the Family Violence Protection Fund in San Francisco. "Their partners are killing them."

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Historically, deaths defined as "pregnancy-related" were deaths caused by a medical complication of pregnancy, or deaths that occurred when pregnancy aggravated an existing health problem. Traumatic deaths of pregnant women -- deaths due to injury, accident or violence -- have generally not been systematically collected or examined. The result is an almost complete lack of accurate national statistics about the number of pregnant women murdered or the circumstances of their deaths. In the absence of those numbers, researchers have begun to compile data, often on a state-by-state basis, by recovering and then scrutinizing old death records and murder reports.

Cara Krulewitch, who is also a nurse and midwife, suspected for years that pregnancy-associated deaths -- a phrase that, unlike "pregnancy-related," includes deaths associated not just with medical complications in pregnancy but with trauma, including murder -- were underreported. In an initial study in the Journal of Midwifery and Women's Health, she took a look at death records in Washington, D.C., over an eight-year span. She was shocked by her discovery that 14 of 35, or 38 percent, of pregnant women who died in Washington from 1988 to 1996 were victims of homicide.

She also found that, during that same period, the Washington Center for Health Statistics reported only 21 of those pregnancy-related deaths, those who died from medical causes. The 13 homicide victims that Krulewitch found were reported simply as murder victims. Their pregnancy status wasn't noted on their death certificates.

"I was stunned by what I saw," says Krulewitch.

Next Page: Krulewitch found that female homicide victims were disproportionately pregnant

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