States prohibiting divorce during pregnancy have significantly higher rates of pregnancy-associated intimate partner homicide compared with states without such restrictions.

In a cross-sectional study analyzing data from 2018 to 2021 published in JAMA Network Open, investigators examined 181 state-years of data from the National Violent Death Reporting System (NVDRS), which included more than 600 data elements from law enforcement, medical examiners/coroners, and death certificates. The analysis began with 40 states in 2018, added 3 states in 2019, and reached 49 states by 2020 to 2021, excluding Florida and Hawaii.

During the study period, more than 350 state restrictions on abortion services were in place. Mandatory waiting periods ranged from 18 to 72 hours in states with such requirements. The data showed that approximately 18% of rape-related pregnancies were perpetrated by the female's father, stepfather, or other family member.

The study represents the first examination of correlations between state divorce laws and pregnancy-associated homicide rates, while expanding previous research on associations between pregnancy-associated homicide rates and state-level reproductive health care policies.

States prohibiting divorce finalization during pregnancy (Arkansas, Missouri, and Texas) demonstrated notably higher rates across categories per 100,000 reproductive-aged females:

• Mean intimate partner homicide rate: 0.26 vs 0.10
• Mean nonintimate partner homicide rate: 0.04 vs 0.03
• Mean rate among younger Black females: 1.36 vs 0.39
• Mean rate among younger Hispanic females: 0.21 vs 0.10
• Mean rate among younger White females: 0.11 vs 0.03.

States with greater reproductive health care access showed significantly lower rates of:

• Nonintimate partner homicide (IRR = 0.92) 
• Homicide among younger Black females (IRR = 0.91)
• Homicide among younger Hispanic females (IRR = 0.87).

Regional analysis revealed higher rates in the Southern United States for younger Black and White females.

Study limitations included missing data on pregnancy status in the NVDRS, underreporting of pregnancies on death certificates, and inability to calculate pregnancy-associated homicide rates for some states because of small numbers resulting in unstable rates.

The authors declared having no competing interests.