A Deadly Disparity: Exploring Structural and Interpersonal Drivers of Homicide Among Pregnant and Postpartum Black Women

Background and Purpose: Maternal homicide is a leading cause of pregnancy-associated death in the United States, yet remains underexamined within maternal health research. Black women face disproportionately higher rates of both maternal mortality and intimate partner violence (IPV), yet few studies have centered their experiences to identify factors driving maternal homicide risk at the intersection of pregnancy and race. Existing research often compiles findings across racial groups, obscuring the unique risk profiles and structural vulnerabilities shaping Black women's experiences. This mixed-methods study addresses these gaps by examining demographic characteristics and precipitating circumstances associated with maternal homicide among Black women, and analyzing medical examiner narratives to contextualize these homicides. Two research questions guided the study: (1) What characteristics and circumstances are associated with maternal homicide among pregnant, recently pregnant, or recently postpartum Black women? (2) What qualitative themes were found from medical examiner narratives regarding the contexts surrounding these homicides?

Methods: This study utilized data from the National Violent Death Reporting System (NVDRS), a CDC-funded population-based surveillance system that links death certificates, medical examiner reports, and law enforcement records. The sample included 9,160 deaths among Black women who were pregnant or recently pregnant, of whom 705 died by homicide. Bivariate analyses using chi-square tests and F-tests compared maternal homicide and non-homicide deaths across demographic and circumstance variables. Multivariate logistic regression identified independent predictors of maternal homicide. Qualitative thematic analysis of the medical examiner narratives was conducted to examine the contexts surrounding the homicides.

Results: Black maternal homicide victims were significantly younger (M = 25.7 vs. 37.2 years), more likely to be single/never married (86.5% vs. 64.5%), and more likely to have IPV documented (45.5% vs. 14.2%). In the multivariate model, IPV was the strongest predictor (OR = 5.25, p < .01), followed by homelessness (OR = 3.14, p < .01) and single/never married status (OR = 2.00, p < .05). Qualitative analysis yielded eight themes: separation-related lethality risk, environmental vulnerabilities, reproductive coercion, perpetrator possession and control, calculated violence, accumulated socioeconomic stressors, intergenerational trauma through children witnessing homicide, and cohabitation as a risk context.

Conclusions and Implications: Findings reveal that maternal homicide among Black women is driven by the intersection of intimate partner violence, structural vulnerability, and reproductive coercion. IPV emerged as the strongest predictor and qualitative findings illuminated how coercive control, possessive jealousy, and conflict over pregnancy decisions created pathways to lethal violence. These findings carry direct implications for social work practice and policy, including the integration of IPV and reproductive coercion screening into routine prenatal care, the development of culturally responsive safety planning for pregnant Black women, housing-based interventions for those fleeing violence, and trauma-informed services for children who witness maternal homicide. This research advances racial and social justice by centering the experiences of the population most disproportionately affected and informing prevention strategies that address both interpersonal violence and the structural conditions that sustain it.