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There is no code for: my boyfriend has a gun in the home.

DR. YAMICIA CONNOR, MD, PHD, MPH

I can take a blood pressure. I can send a preeclampsia panel, count platelets, read a fetal tracing, stock the hemorrhage meds. Every dangerous thing I screen for at a prenatal visit has a number attached to it, a threshold, a protocol I have been trained to execute in my sleep.

The condition most likely to kill the woman sitting on my exam table has none of that. It does not appear on the flowsheet. There is no box for it, no structured field in the chart to type it into.

And yet for a great many women, the most relevant question I could ask in that room is whether the person who drove her to the appointment is going to kill her. As her physician I will never know unless I learn how to ask.

The leading killer of pregnant women in this country is not hemorrhage. Not preeclampsia. Not infection. It is homicide.

In the most careful national analysis we have, a woman who was pregnant or newly postpartum was murdered at a rate exceeding every leading obstetric cause of maternal death by more than twofold. That risk fell hardest on Black women and on women under twenty-five. In roughly three out of four of those deaths, a gun was implicated.

We run codes for shoulder dystocia. We run codes for hemorrhage. There is no code for: my boyfriend has a gun in the home.

I want to be precise, because people hear this and assume it is anti-men, or anti-partner. It is not. Most pregnant women will not be killed by their partners. Most pregnant women have supportive partners. I have no ability to predict the difference and I am not claiming one.

My claim is narrower and harder to argue with: for how much death this causes, the time we dedicate to understanding it is remarkably limited. The leading cause of death in my patient population is not a disease. It is a person — a person unconstrained in a system.

What determines whether she survives him is almost never medical. It is economic.

We like to frame domestic violence as a private misfortune that happened to a woman who chose badly. That framing does not let us see the structure underneath. Financial abuse — draining the account, wrecking her credit, sabotaging the job so she cannot hold one — is not peripheral to the violence. It is the machinery. It is how a man makes leaving impossible.

So whether she gets out is not a question of courage. It is a question of money, and of the public scaffolding that stands in for money when she has none: a shelter bed, a lawyer, a month's rent, a door with a lock she controls.

Part One is the economics of leaving, what the state actually owes her when she calls, and what it does to a pregnant body.

Part Two is what the state owes her, which in reality is nothing. The restraining order no one is required to enforce. The gun no one comes to get. The shelter bed that is not there the night she calls. The lawyer she cannot afford. The money that pays for all of it, moved a little every year without anyone having to repeal a thing.

When the Supreme Court was asked this question, this was the answer. Three children were killed because the state did not act, and the Court said their mother had no right to its protection, because that protection "would have no ascertainable monetary value." That was not a ruling about one family. It was a statement to all of us about what the state protects. It protects property. It does not protect us, not in any way that changes a day in the life of a woman with an order in her hand and a man who has decided to ignore it. These are some of the most vulnerable people in this country, and the state has decided it owes them nothing.

Part Three is in the clinic. Our duty to care, inside a system that has abandoned women. What we can still give her.

None of the numbers in these sends come from me. We built a database called Labora Rounds to hold them. Every figure over the next four weeks was pulled from its original source, the CDC, the FBI, a Supreme Court opinion, a state statute, a campaign finance filing, and we keep a screenshot of the page it came from next to the number. When I say twenty-eight states never wrote the step, you can see the page. That is the difference between an argument and a receipt.

IN THE NEWS

Netflix has a three-part documentary called Death of the Pastor's Wife. Mica Miller was found dead in a state park in North Carolina in April 2024, and within days the file said suicide. A month before she died she told police she was afraid for her life. Her husband, the pastor she was leaving, is now under federal indictment for stalking her across state lines.

Watch it alongside this series, because everything in the next eleven sends is in it. The warning that was already on the record. The order. Nobody coming. And then the one word on a file that closes the case and ends the questions.

THREE PARTS  ·  ON NETFLIX

RESEARCH DEEP DIVE

The number in the chapter comes from one study, and it is worth knowing what is inside it. Wallace and colleagues took every death in the national records for 2018 and 2019 of a woman who was pregnant or within a year of a pregnancy, and asked what killed her. Homicide came to 3.62 per 100,000 live births. Every obstetric cause we drill for, hemorrhage, hypertensive disorders, infection, sits below 1.81. Homicide is not first by a little. It is more than double each of them.

Two hundred seventy-three women in those two years. A gun in 189 of them, sixty-nine percent. And here is the part that makes it an obstetric finding and not a crime statistic: her risk of being murdered was sixteen percent higher than a woman of the same age who was not pregnant. Pregnancy did not shelter her. It raised the odds.

Now the part that explains why you have never seen this number on a maternal mortality chart. The CDC's pregnancy-related count is built to capture deaths caused by the pregnancy itself, so homicide is left out of it by definition. The leading killer of pregnant women in this country is the one the official count does not count.

One more, from our own review of the record. In more than half of the violent deaths reviewed, obstetric providers already knew of or suspected intimate partner violence before the patient died. The gap was not detection. It was what followed detection.

The counts above are Wallace et al., from the national vital records for 2018 and 2019. Every figure in this series is held in Labora Rounds with a screenshot of the page it came from, so you can check any of it against the source.

TAKE THIS WITH YOU

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WHAT YOU ARE A PART OF  ·  1

When I chose OB/GYN as an MD/PhD, the response was almost uniform: I was wasting the credentials. Go to oncology. Go to cardiology. Pick something serious. Women's health was treated as a soft specialty — too narrow, too underfunded, too thinly studied to deserve the training I had.

That response is the diagnosis. Women's health is not narrow. It is the foundation of public health, family health, and global stability. The reason it looks small is that it has been kept small — by a century of exclusion, underfunding, and clinical incuriosity. The reason it looks soft is that the people most often harmed by it have been taught to absorb the harm quietly.

I went into it because that's where the work was. What I found was worse than I expected.

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Every step of the picture people carry is wrong. The Supreme Court has said so three times, and it said so in cases with names and children in them.

Thank you for being here. Forward this to one person who needs the spine.

— YC
Dr. Yamicia Connor, MD, PhD, MPH · Founder & CEO, Diosa Ara | Creator & Editor-in-Chief, The Labora Collective