JAMA Forum: A Global Epidemic in Plain Sight

Joshua M. Sharfstein, MD

Joshua M. Sharfstein, MD

The leading cause of death in Maryland among women during pregnancy and the first year after delivery is not hemorrhage, eclampsia, heart disease, cancer, or even motor vehicle accidents.

It’s homicide.

Lethal violence against pregnant and postpartum women is shocking, but in one sense not surprising. The recent mass shooting in California has shed light on a dark corner of our society, in which misogyny poses a real threat to the health of women. Intimate partner violence is a global epidemic, affecting women of every race, ethnicity, culture, age, educational level, and socioeconomic strata. In the United States, about one in four women sustain severe physical violence from a partner in their lifetime.

Such injuries, such as fractures, bruises, and lacerations are the most obvious health effects. Other consequences include depression, anxiety, posttraumatic stress disorder, asthma, chronic pain, smoking, and substance use disorders.

Both public safety and health professionals have a critical role to play in addressing this crisis.

Police Departments can assign domestic violence experts to police units, improve victims access to information, implement a standardized lethality assessment to guide response, and provide free and confidential mail forwarding for victims. Maryland has taken all these steps and has made women who are forced to leave a job because of intimate partner violence eligible for unemployment insurance. Judges and police departments must protect victims of abuse in order to keep them from becoming victims of homicide.

Health professionals at all levels, in every subspecialty, have an equally vital role. We can also save lives by identifying those at risk and helping them take action to protect themselves. Our health department in Maryland has developed a screening tool for use in emergency departments and medical offices across the state. In the last year, we have given more than 100 training sessions to health professionals and more than 1000 clinicians have pledged to use it every day.

Maryland is seeing progress, with homicides of women down from an average of 81 from 2006 to 2008 to an average of 66 from 2011 to 2013. It has helped immeasurably to have Gov Martin O’Malley make further reductions in homicides one of his top strategic goals for the state.

But there is so much more to do, in our state and every other. Just this week, in suburban Baltimore, another pregnant woman’s death is under investigation as a homicide.

The 24/7 national domestic violence hotline is 1-800-799-SAFE. It should be as integral to medical care as a stethoscope.


About the author: Joshua M. Sharfstein, MD, is Secretary of the Maryland Department of Health and Mental Hygiene. He has previously served as the Principal Deputy Commissioner of the US Food and Drug Administration and as Commissioner of Health for Baltimore. A pediatrician, he lives with his family in Baltimore.

About The JAMA Forum: JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.



Categories: Health Policy, Public Health, The JAMA Forum, Violence and Human Rights

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