Tuesday, October 6, 2009

Pregnant and Scared, But Should You Be?

Yair Anthony Carillo is back home with his mother tonight, after a first two weeks of life with more drama than most adults can even dream of.  Carillo was kidnapped last Tuesday at the age of 4 days.  His mother was stabbed and left to bleed to death by a woman who, apparently, was intent on passing him off as her son, adopted from a "friend" who was "going to jail."  He was found on Saturday, but after a brief visit with his mother both he and his three siblings were placed in foster care while child welfare personnel investigated an allegation that someone in the family had tried to sell the children.  Yair's parents have now been cleared.

Every so often, one of these stories grabs our attention.  A woman late in pregnancy or having just given birth is attacked and often killed. The baby is stolen.  Often, we later learn that the kidnapper has been telling friends she is pregnant or, less frequently, about to adopt a baby.  The stories make news because they are sensational, and America loves anything having to do with a baby.  From time to time we get word of a missing pregnant woman, and those stories also get a fair amount of attention.  Most commonly, those women are white and relatively affluent.  They are frequently found dead or never found at all.  And, most commonly, their husbands or boyfriends are charged with the crime.

The fact of the matter is, homicide is the second most common cause of non-health-related death for pregnant women.  It is more common than suicide and somewhere behind car accidents.  Headlines on this topic say things like "Homicide:  A Leading Cause of Death Among Pregnant Women."  The stories then go on to tell us that one third of pregnant women who are murdered are murdered by their intimate partner.

All of this is enough to whip you into a frenzy, but as with most statistics it's a good idea to look a little deeper.  First of all, the leading cause of death among pregnant women is not homicide.  It is pregnancy.  About 7.5 pregnant women die per 100,000 live births in the United States right now (down, I should point out, from about 850 per 100,000 in 1900) due to pregnancy-related complications.

Second, the homicide rate among pregnant women is actually lower than in the population at large.  While the homicide rate in the United States in 2008 was 5.4 per 100,000, the rate among pregnant women is somewhere around 1.7 per 100,000.  So how can homicide be both at a lower rate for pregnant women and a leading cause of death?  It's all in how you look at the data.

Pregnant women are less likely to die from some other causes of death than the general population.  Their suicide rate is somewhat lower, as is their rate of auto accidents.  The fact that homicide appears higher in the list of causes of death, however, does not mean that pregnant women are more likely to be murdered than other women.  They're not.  They're just more likely to have been murdered if they die at all, if their death was not caused by the pregnancy, than they are to have died by some other means.  That's a lot of ifs.

What's more, the typical homicide of a pregnant woman, furthermore, is not a kidnapping attack, nor is it the murder of a white, affluent woman.  It is very disproportionately the murder of an African-American woman who is poor and has not received adequate prenatal care and who is murdered by her spouse or boyfriend.  It is a sad commentary that those cases almost never make the news at all.

So before we all get into a panic about the safety of pregnant women and their babies, it might be a good idea to take a deep breath and realize that what we're really reacting to isn't really the rate of homicide.  It's the fact that pregnant women are murdered at all, which offends our sense of motherhood and pregnancy as being sacrosanct.  We imagine that someone who would kill a pregnant woman would kill anyone, which makes us all feel unsafe.  In the end, however, while any homicide is a traumatic tragedy, the murder of a pregnant woman isn't really that different than the murders we ignore in this country every day.


Colleen said...

Your stat of 850 deaths per 100,000 in 1900 is interesting. When one reads about pregnancy and midwifery, it appears that the death rate was lower in the 18th C, and went up during the 19th C, declining rapidly after the advent of penicillin.

But one could really wish for better stats pre-1800...didn't they know that we would want them?

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