Health Policy Journal Club, Health Policy, Social EM, OB/GYN

Health Policy Journal Club: Bullet on Board

Firearm Regulations Protect Pregnant People

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. 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. 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.

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.

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.

This study analysis and the state laws discussed above 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 researchwhich revealed that prohibiting firearms without a relinquishment strategy may be ineffective in reducing the risk of intimate partner homicide.

EM TAKE-AWAY
This study emphasizes the strong intersection of public health, health care provision, and policy-making, and the importance of firearm-related research to inform safe and effective public policy.


Abstract

ARTICLE: Wallace ME, Vilda D, Theall KP, Stoecker C. Firearm Relinquishment Laws Associated With Substantial Reduction In Homicide Of Pregnant And Postpartum Women. Health Aff (Millwood). 2021;40(10):1654-1662.

Abstract: 
Homicide is a leading cause of death among women who are pregnant and up to 1 year postpartum in the United States. Most incidents are perpetrated by an intimate partner with a firearm. Some states have implemented laws that prohibit firearm possession by perpetrators of domestic violence and, in some instances, include explicit statutory language mandating relinquishment of firearms once a person has become prohibited from possessing them.

We examined the impact of these policies on state-level rates of homicide among pregnant and postpartum women during the period 2011-19. We found that state laws prohibiting possession of firearms and requiring relinquishment of firearms by people convicted of domestic violence-related misdemeanors were associated with substantial reductions in the homicide of pregnant and postpartum women.

State policymakers should consider further strengthening domestic violence-related firearm regulations and their enforcement to prevent the homicide of pregnant and postpartum women.


EMRA + PolicyRx Health Policy Journal Club: A collaboration between Policy Prescriptions and EMRA

As emergency physicians, we care for all members of society, and as such have a unique vantage point on the state of health care. What we find frustrating in our EDs - such as inadequate social services, the dearth of primary care providers, and the lack of mental health services - are universal problems. As EM residents and fellows,  we learn the management of myocardial infarctions and traumas, and how to intubate, but we are not taught how health policy affects all aspects of our experience in the ED. Furthermore, given our unique position in the health care system, we have an incredible opportunity to advocate for our patients, for society, and for physicians. Yet, with so many competing interests vying for our conference education time, advocacy is often not included in the curricula. This is the gap this initiative aims to fill.  Each month, you will see a review of a new health policy article and how it is applicable to emergency physicians.  

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