I will never forget the day I heard about the heinous murder of Dr. Tamara O’Neal—an emergency physician in Chicago—and her colleagues by her former partner on hospital grounds.1 Her death was a shocking reminder of the reality women face in this country, especially minoritized and transgender women.2,3 Intimate partner violence (IPV) affects nearly one in four women in this country, and three to nine percent experience IPV during their pregnancy.4,5
Any conversation about IPV must include a discussion about firearms. An average of 70 women every month are shot and killed by an intimate partner, and the majority of mass shootings in this country involve the perpetrator shooting a current or former intimate partner or family member.6 An abuser’s access to and prior use of firearms to threaten partners are strongly predictive of future homicide.7 Given that firearm ownership appears to be increasing, as have firearm-related homicides during the pandemic, we can expect that rates of IPV-related homicides will similarly increase.8,9
As emergency physicians, we are no strangers to the impact of firearms and IPV. The patients whose memories have stayed with me the longest are those who were slain by guns. They are often women and children, for whom no number of thoracotomies, transfusions, or chest tubes will save.10 It can never ease the heartache of the family to whom I must say, “Despite our best efforts, your loved one has died.” Each reset of the trauma room after the death of a patient is an acknowledgement that another victim is to be expected, that another life will hang in the balance thanks to firearm-related violence. This endlessly repeating cycle of secondhand violence takes its toll on us as physicians, adding to the burnout that we face from so many different directions.
The solution to these intersecting epidemics—gun violence, intimate partner violence, and burnout—is systemic. We must advocate for legislation to decrease access to firearms. Data have already shown that restricting access to firearms decreases deaths, and, on the other hand, increasing access leads to increased mortality.11,12 Decreasing firearm ownership among people who have been convicted of domestic violence charges or are under IPVrelated restraint orders can similarly protect those at high risk of death—including pregnant women.13
While we cannot bring back the lives of Dr. O’Neal or the countless others who have been murdered, common sense policies could save others just like them. Rome wasn’t built in a day and neither will comprehensive gun control reform. In the meantime, by preventing access to deadly weapons by people who are known to be at high risk of harming others, we can at least begin by protecting those in this highly vulnerable group.
Diana Halloran, MD, Analyzes New Study
Pregnant people and those within one year postpartum are at an elevated risk of homicide—in fact, homicide is one of the leading causes of death among this group.14 Some states have enacted policy changes by passing laws banning the possession of firearms by people convicted of domestic violence misdemeanors or who are under domestic violence restraining orders.15 Occasionally this law is paired with a second law requiring people banned from possessing firearms, such as the groups above, to turn in their firearms to law enforcement or gun dealers.15
What The Research Shows
A recent study, published in October of 2021 in Health Affairs, assessed data from 2011–2019 from the National Center for Health Statistics on pregnancy-associated homicides throughout the United States to determine if the implementation of domestic violence related firearm possession bans and relinquishment laws had an effect on the rates of pregnancy-associated homicide.13
During 2010–2018, 16 states did not have the possession ban nor a relinquishment law in effect, while 23 states had at least one of these laws. Eleven states implemented either the possession ban (with or without a relinquishment law) or a relinquishment law to support an already present possession ban during the study period. States that both prohibited firearm possession and required firearm relinquishment by people convicted of a domestic violence misdemeanor experienced 3.74 fewer deaths per 100,000 live births than would have been expected in the absence of either law. Additionally, the authors found that the presence of a relinquishment law in addition to a prohibition ban was associated with 1.17 fewer deaths per 100,000 live births compared to a prohibition ban alone.
Public Health, Health Care Provision, and Policy Making
This analysis and the state laws discussed suggest that the policy regarding prohibition and relinquishment laws are effective interventions in the reduction and prevention of pregnancy-associated homicide. However, the effectiveness of these laws are most apparent when these laws are coupled together. Some states passed prohibition laws without an associated enforcement or relinquishment strategy and these states showed no significant reduction in pregnancy—associated homicide. This is in line with previous research, which revealed that prohibiting firearms without a relinquishment strategy may be ineffective in reducing the risk of intimate partner homicide.15,16 This study emphasizes the strong intersection between public health, health care provision, and policy making, and the importance of firearm-related research to inform safe and effective public policy.
Dr. Eswaran is an emergency physician and managing editor for PolicyRx.
Dr. Halloran is an emergency medicine resident in Chicago, Illinois.
- Jeltsen M. Tamara O’Neal was almost erased from the story of her own murder. HuffPost. Available at: https://www.huffpost.com/entry/tamara-onealchicago-shooting-domestic-violence_n_5bf576a6e4b0771fb6b4ceef. Accessed Aug. 1, 2022.
- Petrosky E, Blair JM, Betz CJ, et al. Racial and ethnic differences in homicides of adult women and the role of intimate partner violence—United States, 2003–2014.
MMWR Morb Mortal Wkly Rep. 2017;66(7):741–746.
- Peitzmeier SM, Mannat M, Kattari SK, et al. Intimate partner violence in transgender populations: systematic review and meta-analysis of prevalence and correlates. Am J Public Health. 2020;110(9):e1–e14.
- Fast facts: preventing intimate partner violence. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html. Accessed Aug. 1, 2022.
- Alhusen JL, Ray E, Sharps P, et al. Intimate partner violence during pregnancy: maternal and neonatal outcomes. J Womens Health (Larchmt). 2015;24(1):100–106.
- Guns and violence against women: America’s uniquely lethal intimate partner violence problem. Everytown Research. Available at: https://everytownresearch.org/report/guns-and-violence-against-women-americas-uniquely-lethal-intimate-partner-violence-problem/. Accessed Aug. 1, 2022.
- Gold LH. domestic violence, firearms, and mass shootings. J Am Acad Psychiatry Law. 2020;48(3):35–42.
- Norton A. 5 million more Americans became gun owners during pandemic. US News. Available at: https://www.usnews.com/news/health-news/articles/2021-12-21/5-million-more-americans-became-gun-owners-during-pandemic. Accessed Aug. 1, 2022.
- Kegler SR, Simon TR, Zwald ML, et al. Vital signs: Changes in firearm homicide and suicide rates – United States, 2019-2020. MMWR Morb Mortal Wkly Rep. 2022;71(5):656–663.
- Goldstick JE, Cunningham RM, Carter PM. Current Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2022;386(5):1955–1956.
- Huang DD, Manley NR, Lewis RH, et al. The sustained effect of a temporary measure: Urban firearm mortality following expiration of the Federal Assault Weapons Ban. Am J Surg. 2022;224(7):111–115.
- Goldstein EV, Prater LC. Examining the policy effects of Arizona’s 2016 preemption law on firearm suicide rates in the greater Tucson area: An observational study. BMJ Open. 2022;12(5):e058196.
- Wallace ME, Vilda D, Theall KP, et al. Firearm relinquishment laws associated with substantial reduction in homicide of pregnant and postpartum women. Health Aff (Millwood). 2021;40(10):1654–1662.
- Fildes J, Reed L, Jones N, et al. Trauma: The leading cause of maternal death. J Trauma. 1992;32(5):643–5.
- Zeoli AM, Frattaroli S, Roskam K, et al. Removing firearms from those prohibited from possession by domestic violence restraining orders: A survey and analysis of state laws. Trauma Violence Abuse. 2019;20(1):114–125.
- Zeoli AM, Malinski R, Turchan B. Risks and targeted interventions: Firearms in intimate partner violence. Epidemiol Rev. 2016;38(1):125–39.