Opinion | The Tragic Link Between Pregnancy and Homicide

In Louisiana, where Markitha Sinegal lived, homicide is the second leading cause of death for pregnant and postpartum women. Only drug overdoses take more lives.

This data comes from Louisiana’s Pregnancy-Associated Mortality Review Committee, one of many created in the United States in recent years to study the causes of maternal mortality, which has ticked upward over the past two decades. Though the rise in the statistics is most likely because of a change in recordkeeping — with the gradual rollout of a pregnancy checkbox on death certificates making the reported maternal mortality rate increase — the deaths are real. We simply weren’t seeing them this way before.

Homicide deaths are usually omitted from maternal mortality statistics because they aren’t considered sufficiently related to the pregnancy itself. But homicide isn’t a rare anomaly for pregnant and postpartum women — it’s one of their leading causes of death. This makes pregnancy-associated homicides, as they’re called by epidemiologists and health researchers, a real public health concern.

A young woman’s elevated risk of homicide during and after pregnancy holds true whether she is white, Black or Hispanic, but young Black mothers are afflicted by much higher rates of lethal violence.

National-level data on the phenomenon is difficult to find, as it’s often buried in individual state reports on maternal mortality or in databases inaccessible to the public. Dr. Maeve Wallace, an epidemiologist at the University of Arizona, has put a special focus on the analysis and publication of data on pregnancy-associated homicides and provided some of the data for this story. According to Dr. Wallace, from 2018 through 2022, at least 837 women were killed during pregnancy or within the following year, although because the pregnancy checkbox is new and not always consistently used, that number is most likely an undercount. “There’s tons of funding and attention at the federal level for maternal mortality,” Dr. Wallace said, referring to obstetric causes of death. “My goal in looking at homicide is that it’s happening just as often.”

And though homicides aren’t generally classified as pregnancy-related, the pregnancy often has played a part. In these cases, more often than not, a husband or boyfriend is the killer.

The stress and emotional turmoil of a pregnancy — especially an unexpected one — can exacerbate an already abusive relationship. According to experts on intimate partner violence, the abuse almost always precedes the pregnancy.

Domestic violence is rooted in power and control, and pregnancy is a tether that can shift a relationship’s dynamic. Once partners are tied together by a child on the horizon, abusers can feel a greater degree of impunity to escalate their behavior. Suddenly, there are not just emotional ties, but legal and financial ones as well. And just as suddenly, as a pregnant woman, it becomes much harder to leave.

Like the stories of the other mothers who died at the hands of their partners, the story of Ms. Sinegal’s death began long before her boyfriend pulled the trigger. To understand how she died — and how to prevent more deaths of young mothers like her — we have to understand how she came to be in that bedroom in the first place.

It’s much more comfortable to grapple with America’s maternal mortality rates by staring down the faceless threats of hypertension and hemorrhage. The killings of young mothers are far uglier deaths. But that is precisely why we must not look away.

There are ways Ms. Sinegal’s story could have ended differently.

Some of the potential interventions are broad — they address the problem of homicides in America writ large. Around three-quarters of pregnancy-associated homicides are committed with a firearm, and given that gun access increases the risk of intimate partner homicide, policies that keep guns out of abusers’ hands could help prevent some of these deaths. Louisiana has such a law, which applies to people convicted of certain domestic violence crimes or with a domestic violence restraining order in place. Laws like this have been shown to reduce homicides by intimate partners.

Others are focused on the pregnancy. According to her mother, Ms. Sinegal was excited about her pregnancy and thrilled about becoming a mom. But for other women, increasing access to contraception and to safe and affordable abortions could enable them to be in control of when and with whom they get pregnant, which can help them avoid becoming trapped in abusive relationships.

But most suggestions for preventing pregnancy-associated homicides are related to domestic violence of one kind or another.

One key intervention would be to conduct more robust screening for intimate partner violence during routine obstetric visits. These screenings are recommended by the American College of Obstetricians and Gynecologists, but interviews with public health officials and victims’ advocates suggest that they are not practiced widely and with sufficient vigilance and follow-through. Proper coordination of care between doctors and trauma specialists is also both lacking and necessary to get women the help they need to escape from relationships poisoned by domestic violence.

When the cops are called, police departments should also be more proactive about connecting young women to dedicated victims’ advocates. Trained advocates can be a critical link between law enforcement and victims of domestic violence, many of whom may not be inclined to trust police officers with details of abuse that can be deeply personal or embarrassing.

Preventing the abuse in the first place is more complicated and depends on teaching young people what dangerous relationships look like. The red flags of a relationship trending toward abuse can be difficult to see if you don’t know what to look for. Learning what’s healthy may begin in the classroom with young children, or it may begin with a court-mandated course for perpetrators of domestic violence designed to teach them how to have healthier partnerships.

These educational approaches are harder to recommend because they’re more nebulous, but they’re also some of the most consistent recommendations from doctors, advocates and other experts in pregnancy-associated homicides. Although only one person is ultimately responsible for Ms. Sinegal’s death — the man who pulled the trigger — it’s still worth considering what might have been, to better understand how to prevent tragedies like hers.

Ms. Sinegal’s boyfriend did not respond to repeated attempts to contact him through his lawyer or to a letter sent to him through the Orleans Parish Sheriff’s Office, which held him in jail for more than three years while he awaited trial. At the trial, his lawyer argued that he could have pulled the trigger accidentally that night. But the jury was not convinced.

On Oct. 3, 2024, he was convicted of second-degree murder. He will spend the rest of his life in prison without the option of parole, as Louisiana law requires. But her parents still lost a child. Her children still lost their mother. There is no real justice in this story.