Revealing the hidden toll of violent deaths during pregnancy

A new study led by LCDS researcher Dr Ursula Gazeley has uncovered the substantial but largely invisible burden of violent deaths during pregnancy and the postpartum period in Mexico, showing how definitions of maternal mortality shape which women’s deaths are counted, and which are left out of official statistics.

Published in BMJ Public Health, the study analysed nationwide Mexican death records from 1998 to 2024 and identified 1,855 violent deaths among pregnant and postpartum women, including suicides and homicides. Violent deaths exceeded several major obstetric causes of maternal mortality, including pregnancy-related infections, and approached the number of deaths linked to abortive outcomes.

The authors argue that current international monitoring frameworks fail to adequately capture these deaths. Under existing maternal mortality definitions, suicides during pregnancy and the postpartum period should be counted as maternal deaths but are frequently underreported, while homicides are excluded from maternal mortality statistics altogether.

Using Mexico as a case study — where both violence levels and death registration systems are comparatively robust — the researchers show that including violent deaths would significantly alter maternal mortality estimates. In 2024 alone, incorporating suicides and homicides would have increased Mexico’s maternal mortality ratio by around 31%.

The study further argues that decisions about which deaths are included or excluded from maternal mortality statistics shape surveillance systems, accountability and the allocation of resources within maternal health policy. The authors suggest these boundaries also reflect wider fragmentation between maternal health, mental health and gender-based violence research, policy and monitoring systems.

Dr Ursula Gazeley said:
“Violent deaths during and after pregnancy remain largely invisible in global maternal health statistics. Our findings underscore the need for better reporting of maternal suicides and for a dedicated global indicator to track homicides during pregnancy and the postpartum period. Without these changes, many of these deaths will remain excluded from existing maternal surveillance systems.”

The study, “Hidden toll of violent deaths during pregnancy and the postpartum period: a nationwide analysis of Mexican death records”, was co-authored by researchers from the Leverhulme Centre for Demographic Science, the London School of Hygiene & Tropical Medicine, Johns Hopkins University, El Colegio de México, and the Centre for Impact on Violence and Health.