机翻的《自然》11月12号的新闻，错误难免，不喜勿读。原文附在后面。

读后第一感：难过的无以言表，恶之花绽放的土地，愿真相早日到来，告慰无辜的亡灵……

又：nature在文末附的note也是超级魔幻。

凶杀是美国产妇死亡的首要原因

对国家数据库中的死亡证明的评估描绘了孕妇的严峻情况。

一名妇女发言，其他人举着标语抗议针对妇女的暴力。

一名妇女在抗议活动中发言，要求制定防止暴力侵害妇女的标准。

根据上个月发表在《妇产科学》(Obstetrics & Gynecology)上的一项研究，美国的孕妇死于凶杀的情况比死于与怀孕有关的原因的情况更多--而且她们经常被伴侣杀害。研究人员通过使用死亡证明来比较整个国家的凶杀案和与怀孕有关的死亡，首次揭示了这一严峻的统计数字。

位于安阿伯的密歇根大学医学院的医生维贾伊-辛格说，尽管较小的研究在州和地方一级跟踪了怀孕期间的凶杀案，但在全国范围内确认这一现象的范围是有价值的，他研究了保健工作者如何监测当前和以前的浪漫伴侣的虐待行为。"除非你能测量它，否则你无法理解一个问题。"

他补充说，研究结果是 "惊人的"。

研究人员发现，怀孕或在过去42天内（产后）怀孕的美国妇女死于凶杀的比例是死于出血或胎盘疾病的两倍以上--这是通常被列为与怀孕有关的死亡的主要原因。此外，怀孕也会增加被杀死亡的风险：在10至44岁之间，怀孕或在过去一年中结束怀孕的妇女被杀的比率比没有怀孕的妇女高16%。

"马里兰州巴尔的摩约翰霍普金斯大学护理学院的护士科学家菲利斯-夏普斯说："20多年来，研究人员一直在讨论与怀孕有关的妇女死亡和被杀问题。她说，人们的共识是，这种情况的发生在很大程度上是由于亲密伴侣的暴力。

一个年龄和种族的故事

为了得出一个全国性的快照，路易斯安那州新奥尔良市杜兰大学的生殖流行病学家Maeve Wallace和她的合著者分析了2018年和2019年美国所有50个州的死亡数据，使用国家卫生统计中心数据库的信息，该数据库由美国疾病控制和预防中心（CDC）托管。

2003年，美国开始要求在死亡证书上注明一个人是否在怀孕期间死亡，或在怀孕结束后42天或1年内死亡。到2010年，约有37个州的证书上包括了这样的选项；到2018年，所有50个州都要求提供这一信息。今年，华莱士和同事们分析了由此产生的记录。根据他们的统计，在整个2018年和2019年，共有273名妇女在怀孕期间或在怀孕结束后的一年内死于凶杀。

在追踪美国孕妇的死亡情况时，CDC并没有将凶杀、事故或自杀归入 "产妇死亡 "的原因。华莱士和其他人说，凶杀案应该被计算在内，因为凶杀和怀孕之间确实存在联系。

美国的总体产妇死亡率正在上升。而且对于一个富裕的国家来说，这个数字特别高。造成这种情况的因素包括：获得医疗保健的机会不足，工作人员在产科急诊方面的训练不足，以及由于临床实践中的种族主义而给予黑人妇女的护理不合格。

根据多年的研究，亲密伴侣暴力方面的专家预计，如果已经处于虐待关系中的妇女怀孕，她们被杀的风险会增加。华莱士和她的合著者说，在他们的数据中记录的凶杀案中，约有三分之二发生在当事人的家中，这表明该妇女是被其伴侣杀害的。华莱士说，这不是一个完美的指标，"但这是我们在这些数据中得到的全部"。

研究小组发现，在美国，怀孕或最近怀孕的黑人妇女死于凶杀的风险比没有怀孕的妇女高近三倍，这是所有种族或族裔群体中报告的最高增幅。(该小组只报告了黑人、西班牙裔和白人妇女的比率，因为其他群体--如亚裔美国妇女或美国土著妇女--的样本量太小，无法公布）。

黑人妇女因产科原因而死亡的风险同样很高。根据CDC的数据，总体而言，怀孕或最近怀孕的黑人妇女死于与怀孕有关的原因的频率是非西班牙裔白人妇女的2.5倍。

研究小组发现，年龄也是与怀孕有关的凶杀案的一个因素：根据该研究，10至24岁的年轻妇女在怀孕期间发生凶杀的风险高于那些年龄较大的妇女。"这是一个年龄和种族的故事，"华莱士说。

印第安纳州印第安纳波利斯大学研究家庭暴力和自杀预防的临床心理学家亚伦-基维斯托（Aaron Kivisto）说，华莱士和同事们 "利用现有数据所做的工作使人们对问题的范围和之前的工作更有信心"。在今年2月发表的一项研究中2，他和他的同事显示，与白人或西班牙裔孕妇相比，黑人孕妇的被杀风险增加。

Sharps说，黑人妇女风险较高的部分原因可能是，种族主义的经历导致她们对执法机构更加不信任，不太可能提出关于家庭暴力的投诉。

辛格说，像华莱士这样的研究可以被政策制定者或医院管理者用来改善对孕妇和刚分娩的人的监测。它还可以建立公众对怀孕期间的危害和风险的理解。"Sharps说："在我们的社会中，有一种观念认为怀孕是一个快乐的时刻。"但是对很多妇女来说，这不是真的，很多妇女在家里就是不安全。"

编者注：《自然》杂志承认，变性人和非二元人可以怀孕。我们在这个故事中使用'女性'来反映研究中使用的语言，该研究是基于只确定人们为男性或女性的死亡证明。

原文地址：https://www.nature.com/articles/d41586-021-03392-8

Homicide is a top cause of maternal death in the United States

Evaluation of death certificates from national database paints grim picture for pregnant women.

A woman speaks while others hold signs to protest against violence against women.

A woman speaks at a protest to demand standards to prevent violence against women.Credit:

Pregnant women in the United States die by homicide more often than they die of pregnancy-related causes — and they’re frequently killed by a partner, according to a study published last month in Obstetrics & Gynecology1. Researchers revealed this grim statistic by using death certificates to compare homicides and pregnancy-related deaths across the entire country for the first time.

Although smaller studies have tracked homicides during pregnancy at the state and local level, confirming the scope of the phenomenon on a national scale is valuable, says Vijay Singh, a physician at the University of Michigan Medical School in Ann Arbor, who studies how health-care workers can monitor abuse by current and former romantic partners. “You can’t understand a problem unless you can measure it.”

The study results, he adds, are “stunning”.

The researchers found that US women who are pregnant or were pregnant in the past 42 days (the post-partum period) die by homicide at more than twice the rate that they die of bleeding or placental disorders — the leading causes of what are usually classified as pregnancy-related deaths. Also, becoming pregnant increases the risk of death by homicide: between the ages of 10 and 44 years, women who are pregnant or had their pregnancy end in the past year are killed at a rate 16% higher than are women who are not pregnant.

“For more than 20 years, researchers have been talking about pregnancy-associated death and homicide of women,” says Phyllis Sharps, a nurse-scientist at the Johns Hopkins School of Nursing in Baltimore, Maryland. The consensus, she says, is that this is happening in large part because of violence by intimate partners.

‘An age and race story’

To arrive at a national snapshot, reproductive epidemiologist Maeve Wallace at Tulane University in New Orleans, Louisiana, and her co-authors analysed data for deaths in all 50 US states from 2018 and 2019, using information in the National Center for Health Statistics database, which is hosted by the US Centers for Disease Control and Prevention (CDC).

In 2003, the United States began requiring that death certificates indicate whether a person had died while pregnant, or within either 42 days or 1 year of the end of a pregnancy. By 2010, about 37 states included such an option on their certificates; by 2018, all 50 states required this information. This year, Wallace and coworkers analysed the resulting records. According to their count, across 2018 and 2019, a total of 273 women died by homicide either while pregnant or within a year of the end of their pregnancy.

When tracking deaths among pregnant women in the United States, the CDC doesn’t classify homicide, accidents or suicides as causes of ‘maternal mortality’. Wallace and others say homicides should be counted, because there is indeed a connection between homicide and pregnancy.

The overall rate of maternal mortality in the United States is on the rise. And it is particularly high for a wealthy country. Contributing factors include inadequate access to health care, staff who are poorly trained for obstetric emergencies, and subpar care given to Black women because of racism in clinical practice.

On the basis of years of study, specialists in intimate-partner violence expect women who are already in abusive relationships to be at increased risk of homicide if they become pregnant. Wallace and her co-authors say that about two-thirds of the homicides recorded in their data occurred in the person’s home, suggesting that the woman was killed by her partner. It’s not a perfect indicator, Wallace says, “but it’s all we’ve got in these data”.

The team found that Black women in the United States who are pregnant or were recently pregnant have up to nearly three-fold higher risk of dying by homicide than those who are not pregnant — the highest increase reported among any racial or ethnic group. (The team reported rates only among Black, Hispanic and white women, because the sample sizes for other groups — such as Asian American women or Native American women — were too small to publish.)

Black women are similarly at heightened risk of death from obstetric causes. Overall, Black women who are pregnant or were recently pregnant die of pregnancy-related causes 2.5 times as often as non-Hispanic white women, according to the CDC.

Age is also a factor in pregnancy-related homicide, the team found: young women between the ages of 10 and 24 are at higher risk of homicide while pregnant than are those who are older, according to the study. “It’s an age and race story,” Wallace says.

What Wallace and coworkers “have done with the data available gives more confidence to the scope of the problem and the work that came before”, says Aaron Kivisto, a clinical psychologist at the University of Indianapolis in Indiana who studies domestic violence and suicide prevention. In a study published in February this year2, he and his colleagues showed increased risk of homicide for Black pregnant women, compared with white or Hispanic pregnant women.

Sharps says part of the reason that Black women are at higher risk could be that experiences of racism have led them to be more distrustful of law-enforcement agencies and less likely to bring forward complaints about domestic violence.

Studies such as Wallace’s could be used by policymakers or hospital administrators to improve monitoring of pregnant people and those who have recently given birth, Singh says. It could also build public understanding of harms and risks during pregnancy. “There’s an idea in our society that pregnancy is a happy time,” Sharps says. “But for a lot of women, that’s just not true, and a lot of women are just not safe in their homes.”

Editor’s note: Nature recognizes that transgender men and non-binary people can become pregnant. We use ‘women’ in this story to reflect the language used in the study, which is based on death certificates that identify people only as men or women.