Violent deaths: The hidden face of maternal mortality

Objective: To review pregnancy-related deaths due to injuries, to identify the characteristics of these women and to compare the magnitude of injury-related maternal deaths to that of other causes of maternal death. Design: A retrospective study was performed during a five-year period (1991-1995), covering deaths from injuries, including suicide, homicide and accidents in Maputo, Mozambique. Setting: Department of Forensic Medicine at the Maputo Central Hospital, Mozambique. Population: The pregnant or recently pregnant (post-abortion and postpartum) population of Maputo city, the national capital of Mozambique. Twenty-seven cases of pregnancy-related deaths caused by injuries were identified. Main outcome measures: Proportion of deaths due to homicide, suicide, and accidents in pregnant women or within 42 days after termination of pregnancy. Results: Ten cases were due to alleged homicide, nine to alleged suicide and six to alleged accident. Fifty-nine percent (16/27) of women suffering an injury-related maternal death were younger than 25 years of age. Eighty-five percent of pregnancies were less than 28 weeks of gestational age. The magnitude of the problem of violence-related maternal deaths compares with the magnitude of pregnancy-induced hypertension as the fourth cause of maternal death at Maputo Central Hospital. Conclusion: The contribution of violence-related deaths to maternal mortality is significant and must not be neglected.