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Eventually, physicians determined the condition occurred in utero and asked Chong if she'd had any accidents during the pregnancy. The mother considered the question carefully — no, none. But there had been kicking and stomping.

Chong, now 38, survived her husbands' beatings, but many women do not.

Black and Blue Before Birth

According to a new study in the Journal of Midwifery and Women's Health, homicide is the leading cause of death among pregnant women in the United States. Because of the way deaths are reported in this country, however, the link between homicide and pregnancy often goes unremarked, prompting the American College of Nurse-Midwives to call violent death during pregnancy, "a hidden epidemic."

"What pregnant women do not know," says the organization's director Deanne Williams, "is that instead of facing joyful celebration at the announcement of pregnancy, too many face violent death. We have got to do a better job of identifying this problem and helping the women and their partners not end up with such a horrific outcome."

Researchers reviewed 651 women's autopsy charts from the Office of the Chief Medical Examiner in the District of Columbia between 1988 and 1996, and found 13 pregnancies among the homicides. During that same period, the D.C. State Center for Health Statistics reported only 21 maternal deaths, all from medical causes, such as hemorrhaging and infection.

But 13 homicides of pregnant women were not reported as maternal deaths. When included in the maternal death data, pregnancy-associated homicides account for 38 percent of the total, according to the study's authors.

"It's not routine for evidence of pregnancy to be recorded on death certificates," says Dr. Clara Krulewitch, a nurse/midwife and epidimiologist at the University of Maryland in Baltimore and the lead author of the study. Because of death coding standards, collecting accurate data on homicide as a cause of maternal mortality is very difficult, she explains.

In addition, FBI statistics don't note if a woman was pregnant at the time of a homicide, allowing many violent deaths associated with pregnancy to escape scrutiny. "We need to rethink how we measure and collect the data," says Krulewitch.

Building a Body of Evidence

In fact, Washington D.C. and Maryland, have recently adopted policies of recording pregnancy on death certificates. The World Health Organization has also begun collecting data on the link between homicide and pregnancy.

Krulewitch and her team hope that on the basis of their data and others' now being collected, routine screening for domestic violence during pregnancy will soon be implemented. Without a body of evidence, however, it is impossible to get funding for screening, support and prevention programs. "Once we quantify the problem, we can start to deal with contextual issues," she says.

The study also found that younger women were at greater risk of death during pregnancy, with teenagers in the highest risk category. Chong — a former federal police officer who killed her husband in a violent struggle after he closed a car door on her stomach during a third pregnancy in 1993 — is now devoting her life to teaching those young women about the violence they may encounter.

She points to her own life story and the shooting of former NFL player Rae Carruth's pregnant girlfriend as examples, saying some men believe it's easier to get rid of the baby and the woman than to deal with child support.

Like Krulewitch, Chong thinks screening for domestic violence during pregnancy is critical. Her daughter, now a teenager, has had difficulties learning and her right arm is set at a permanent ninety degree angle. "Everyone believes in human rights and there's a lot of talk about the rights of the unborn child, but what are we doing to protect her," she asks.


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