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The Sexual Abuse to Maternal Mortality Pipeline: Executive Summary

The national sexual assault, reproductive health and maternal mortality crises in the United States are inextricably interlinked. This plainly calls for gender-violence prevention and reproductive justice fields to work together to prevent victimization or retraumatization in women’s healthcare settings. Yet, we are falling far short of an integrated approach. All the while survivors of color, whether subject to ever more visible sexual harassment and abuse, the shutdown of women’s health clinics in rural areas and/or the increase in maternal deaths, continue to be left out of local and state strategies for recourse.

There are over 32,000 pregnancies resulting from rape each year in the United States according to the Bureau of Justice Statistics.[1] Furthermore a survey completed by Black Women's Blueprint as part of the Truth and Reconciliation Commission on Sexual Assault, found that close to seventy percent of Black girls surveyed experienced sexual violence before reaching their 18th birthday.[2] A local doula services agency -- among a growing number of doulas and doula services who find it imperative to inquire into pregnant women’s sexual abuse history -- reported that almost 20 percent (50 of 275) of pregnant women served, report having experienced some form of sexual abuse across their lifespan.[3] Women in labor and women in their childbearing years also report a variety of retraumatizing experiences in obstetrics and gynecological settings that exacerbate pre-existing post-traumatic-stress from past sexual abuse.[4]

Sexual violence survivors report lasting impact throughout their reproductive life-span and where maternal health is concerned, the long-term effects of trauma experienced by women is directly proportional to the lack of gender-responsive care and intervention.[5] Yet, as Penny Simkin’s book When Survivors Give Birth documents by drawing on case studies to surface the challenges between clients and caregivers, the lack of attention drawn to sexual trauma and the lack of trauma-informed care for pregnant and laboring women is pervasive.[6]

To date, there are few local efforts to address what has been dubbed the “Sexual Abuse to Maternal Mortality Pipeline” or “Abuse to Maternal Mortality Pipeline.” Even where some fragmented efforts are emerging, there is a dearth of research on the impact of sexual abuse on women’s long-term reproductive health and morbidity outcomes. Consequently, sexual assault and reproductive justice advocates do not yet have the appropriate framework, models and tools to address sexualized violence in reproductive healthcare. We lack the adequate strategies for gender-responsive interventions to prevent what survivors of color have reported as “negative sexualized experiences” in women-and-maternal healthcare.

Black Women's Blueprint is offering a special training on the subject in July, Register for the session here.

This report will examine the “Sexual Abuse to Maternal Mortality Pipeline” and its markers from: sexual abuse, to unaddressed trauma, to superimposed social/structural stressors like racism and sexism, retraumatization within OBGYN experiences, distrust and avoidance of health care professionals, obstetrics violence and finally, maternal mortality. It will also:

  • Lay out recommendations for research to determine how pervasive this issue may be in maternal health and gynecological service settings across the nation.

  • Expose the ways in which we neglect the sexual trauma histories — especially of Black women — who receive OB/GYN services and/or are at risk for pregnancy complications and maternal morbidity; and

  • Offers policy recommendations to dismantle the-abuse-to-maternal-mortality-pipeline

The report illustrates the pipeline with examples, including pregnant women who do not seek gynecological and prenatal care due to childhood trauma of abuse, rape and incest, pregnant women who report experiences of virginity testing as girls with vaginal penetration practiced with parental consent by OB/GYN professionals, and stories of young women and girls who experience non-consensual vaginal exams, non-consensual pelvic exams, or who report what they experience as “obstetrics violence.” It will also include incidents reported by women who disclose non-consensual gynecological procedures, violation and stressors during labor, like “disrespect and abuse”[7] and sexualized language used in communicating with young women who won’t open their legs or refuse to push during labor.

By illuminating both the problem and potential solutions, we hope to take the first step toward addressing the pattern of sexual-abuse-to-negative-maternal-outcomes for marginalized women. The link between race and maternal health outcomes has been repeatedly identified in government reports by state and local entities We hope this report deepens the understanding of the healthcare community, sexual assault prevention advocates and reproductive justice fields of the gendered nature of the race discrimination so many women of color suffer and how to break the larger pervasive and toxic cycle in which specific incidents manifest.[8]

To obtain a hard copy of this report, please contact:

Black Women’s Blueprint | Institute for Gender and Cultural Competence

279 Empire Blvd. | Brooklyn, New York, 11225 | 347-533-9102 | |

Download available at:


[1] Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women. Holmes MM1, Resnick HS, Kilpatrick DG, Best CL. Am J Obstet Gynecol. 1996 Aug;175(2):320-4; discussion 324-5.

[2] Constellations of Struggle: the importance of “individual” experiences, the silenced stories of violence and the collective construction of memory through a non-capitalist concept of time. Written for Black Women’s Blueprint, by Alan Enriquez, Liberatory Psychologist, El Salvador

[3] Ancient Song Doula Services is an international doula certifying organization with the goal to offer quality Doula services to women of color and low income families who otherwise would not be able to afford Doula Care and training a workforce of full spectrum doulas to address health inequities within the communities they want to serve.

[4] The American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women in collaboration with committee members Serina Floyd, MD, MPH, and Joy Anderson, MD.

[5] Trauma and Recovery: The Aftermath of Violence--From Domestic Abuse to Political Terror. Herman, Judith Lewis, M.D.

[6]When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on the Childbearing Woman. Penny Simkin and Phyllis H. Klaus

[7] CDC: Meeting the Challenges of Measuring and Preventing Maternal Mortality in the United States

[8] Recommendations to the Governor to Reduce Maternal Mortality and Racial Disparities March 2019; New York State Task Force on Maternal Mortality and Disparate Racial Outcomes

#sexualabuse #sexualviolence #sexabuse #maternalmortality #bwb #nationalwomenshealthweek #nwhw

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