Maternal death due to domestic violence: an unrecognized critical component of maternal mortality.

The last two decades have seen progress in the comprehension of and approaches to both domestic violence and maternal mortality. Governments' commitments to women's initiatives at the international and national level, such as the Convention on the Elimination of All Forms of Discrimination against Women and the Safe Motherhood Initiative, are testimonies to this progress. The Beijing Platform for Action, adopted in 1995 by most countries, is a strong model of a direct call for governments to generate statistics on and make appropriate responses to the consequences of violence against women (1). High rates of domestic violence and disproportionately high maternal mortality ratios in developing countries are recognized as global public health problems. (The maternal mortality ratio is a measure of the risk of death of women when pregnant. It is usually measured in terms of maternal deaths per 100 000 live births.) Domestic violence and maternal mortality are linked because some women die from domestic violence while pregnant or during the period following the end of pregnancy. However, it is not yet known what proportion of maternal mortality is due to domestic violence , whether there are differences between countries in that proportion, and what factors could explain any such differences. It may be challenging to generate data on the concurrence of domestic violence and maternal mortality, but such information could be used to develop a joint strategic framework on safe motherhood and on gender health that comprehensively addresses this issue. Acting now against domestic violence is essential for all pregnant women, whether their childbearing is desired or not. A definition of " maternal death due to domestic violence " should take into account several components, including violent death, violence against women, and the current international definition of maternal death. There are various questions that need to be answered when working out the definition of maternal death due to domestic violence. These questions include: Which maternal deaths are caused by domestic violence? Would it only be deaths caused by direct lethal trauma, or should deaths due to obstetric complications that are initially caused by physical injuries also be included (for example, a placental abruption secondary to an abdominal trauma)? Can psychological violence be included as a cause of maternal death? Would these