Violence against women can include a range of behaviors such as hitting, pushing, kicking, sexually assaulting, using a weapon, and threatening violence. Violence sometimes includes verbal or psychological abuse, stalking, or enforced social isolation. Victims are often subjected to repeated physical or psychological abuse. The federal public health agencies that address violence against women include CDC, NIH, HRSA, and the Substance Abuse and Mental Health Services Administration (SAMHSA). They focus on activities such as defining and measuring the magnitude of violence, identifying causes of violence, and evaluating and disseminating promising prevention, intervention, and treatment strategies. CDC’s National Center for Injury Prevention and Control and National Center for Chronic Disease Prevention and Health Promotion have funded efforts to document the prevalence of violence against women, improve maternal health, and prevent intimate partner violence. CDC’s National Center for Health Statistics operates the National Vital Statistics System, which maintains a national database of death certificate information. The National Center for Health Statistics has a contract with each state to support routine production of annual vital statistics data, generally covering from one- fourth to one-third of state vital statistics operating costs. NIH has funded research to study violence against women through several of its institutes—the National Institute on Alcohol Abuse and Alcoholism, National Institute of Child Health and Human Development, National Institute on Drug Abuse, National Institute of Nursing Research, and National Institute of Mental Health—and the National Center for Research Resources. HRSA’s Maternal and Child Health Bureau, as part of its mission to promote and improve the health of mothers and children, funds demonstration grant programs that focus on violence against women during the prenatal period. SAMHSA funds efforts focused on the mental health and substance abuse treatment of women who have been victims of violence. The federal criminal justice agencies that address violence against women are OJP’s Violence Against Women Office (VAWO), National Institute of Justice (NIJ), and Bureau of Justice Statistics (BJS). Using VAWA funds, VAWO administers grants to help states, tribes, and local communities improve the way criminal justice systems respond to intimate partner violence, sexual assault, and stalking. VAWO also works with victims’ advocates and law enforcement agencies to develop grant programs that support a range of services for victims, including advocacy, emergency shelters, law enforcement protection, and legal aid. VAWO administers these funds through both formula and discretionary grant programs. NIJ conducts and funds research on a variety of topics, including violence, drug abuse, criminal behavior, and victimization. BJS collects, analyzes, publishes, and disseminates information on crime, criminal offenders, victims of crime, and the operation of justice systems at all levels of government. The FBI administers the Uniform Crime Reporting Program (UCR). Under this program, city, county, and state law enforcement agencies voluntarily provide information on eight crimes occurring in their jurisdictions: criminal homicide, forcible rape, robbery, aggravated assault, burglary, larceny-theft, motor vehicle theft, and arson. The FBI assembles and publishes the data and distributes them to contributing local agencies, state UCR programs, and others interested in the nation’s crime problems. CDC homicide data indicate that from 1995 through 1999, homicide was the second leading cause of death for women aged 15 to 24, after accidents. CDC data also show that almost 2,600 women of childbearing age (15 through 44) were homicide victims in 1999. BJS reported that intimate partner homicides accounted for about 11 percent of all murders nationwide in that year. Seventy-four percent of these murders (1,218 of 1,642) were of women. About 32 percent of all female homicide victims were murdered by an intimate partner, in comparison to about 4 percent of all male homicide victims. There is no current national estimate of the prevalence of violence against pregnant women. Estimates that are currently available cannot be generalized or projected to all pregnant women. CDC’s PRAMS develops statewide estimates of the prevalence of violence for women whose pregnancies resulted in live births; 1998 estimates for 15 participating states ranged from 2.4 percent to 6.6 percent. Research on whether women are at increased risk for violence during pregnancy is inconclusive. However, CDC reported that study findings suggest that, for most abused women, physical violence does not seem to be initiated or to increase during pregnancy. National data are also not available on the number of pregnant homicide victims, and such data at the state level are limited. The two federal agencies collecting homicide data, the FBI and CDC, do not identify the pregnancy status of homicide victims. CDC is exploring initiatives that could result in better data on homicides of pregnant women. There is no current national estimate measuring the prevalence of violence during pregnancy—that is, the proportion of pregnant women who experience violence. Some state- and community-specific estimates are available, but they cannot be generalized or projected to all pregnant women. CDC developed PRAMS, an ongoing population-based surveillance system that generates state-specific data on a number of maternal behaviors, such as use of alcohol and tobacco, and experiences—including physical abuse—before, during, and immediately following a woman’s pregnancy. CDC awards grants to states to help them collect these data. The number of states that participate in PRAMS has increased since its inception. Five states and the District of Columbia participated in fiscal year 1987 and 32 states and New York City participated in fiscal year 2001. CDC officials reported that lack of funds has prevented additional states from being added; six states were approved for participation in PRAMS but were not funded in 2002. CDC’s goal is to fund all states that want the surveillance system. The estimated 1998 PRAMS prevalence rates of physical abuse by husband or partner during pregnancy, which CDC reported for 15 states, ranged from 2.4 percent to 6.6 percent. (See app. II for PRAMS prevalence estimates for the 15 participating states and a description of PRAMS’s methodology.) States participating in PRAMS use a consistent data collection methodology that allows for comparisons among states, but it does not allow for development of national estimates because states participating in PRAMS were not selected to be representative of the nation. In addition, PRAMS data cannot be generalized to all pregnant women because they represent only those women whose pregnancies resulted in live births; the data do not include women whose pregnancies ended with fetal deaths or abortions or women who were victims of homicide. PRAMS is based on self-reported data and, because some women are unwilling to disclose violence, the findings may underestimate abuse. Studies have also estimated the prevalence of violence within certain states and communities and among narrowly defined study populations. These estimates lack comparability and cannot be generalized or projected to all pregnant women. Many of the studies do not employ random samples and are disproportionately weighted toward specific demographic or socioeconomic populations. Most of the 11 such studies we reviewed, which were published from 1998 through 2001, found prevalence rates of violence during pregnancy ranging from 5.2 percent to 14.0 percent. In a CDC-sponsored 1996 review of the literature, the majority of studies reported prevalence levels of 3.9 percent to 8.3 percent. The variability in estimates could reflect differences in study populations and methodologies, such as differences in how violence is defined, the time period used to measure violence, and the method used to collect the data. Research on whether being pregnant places women at increased risk for violence is inconclusive. CDC reported that additional research is needed in this area, but that current study findings suggest that for most abused women, physical violence does not seem to be initiated or to increase during pregnancy. Although some women experience violence for the first time during pregnancy, the majority of abused pregnant women experienced violence before pregnancy. In one study we reviewed, only 2 percent of women who reported not being abused before pregnancy reported abuse during pregnancy. The same study also found that, for some women, the period of pregnancy may be less risky, with violence abating during pregnancy; 41 percent of the women who reported abuse in the year before pregnancy did not experience abuse during pregnancy. Studies have found other factors to be associated with violence during pregnancy, including younger age of the woman, lower socioeconomic status, abuse of alcohol and other drugs by victims and perpetrators of violence, and unintended pregnancy. To increase the generalizability of research on the prevalence and risk of violence to women during pregnancy, researchers have reported the need for more population-based studies that would allow for comparisons of pregnant and nonpregnant women. These studies would draw their samples from all pregnant women, not just those receiving health care or giving birth, as well as nonpregnant women. Such research could indicate whether pregnant women are at increased risk for violence compared to their nonpregnant counterparts. Researchers have also suggested using methodologies that consistently define and measure the prevalence of violence. A recent report by the Institute of Medicine on family violence recommended that the Secretary of HHS establish new, multidisciplinary education and research centers to, among other things, conduct research on the magnitude of family violence and the lack of comparability in current research. There is also little information available on violence against pregnant women that results in homicide. The FBI and CDC are the two federal agencies that collect and report information on homicides nationwide; however, neither agency collects data on whether female homicide victims were pregnant or recently pregnant. According to CDC, 17 states, New York City, and Puerto Rico collect data related to pregnancy status on their death certificates, but the data collected are not comparable. Included in these data are victims who may not have been pregnant at the time of death but had been “recently” pregnant; in addition, states’ criteria for recent pregnancy ranged from 42 days to 1 year after birth. (See app. III for a list of the questions on pregnancy status that states include on their death certificates.) The ability to identify pregnant homicide victims from death certificates is limited.