Gun Violence and Safety

The impact of gun violence on the health and safety of the people and communities that obstetricians-gynecologists serve is of great concern. Obstetricians and gynecologists see and treat a patient population that disproportionately experiences intimate partner violence,ⁱ and fatality rates associated with intimate partner violence are increased when there is access to guns.ⁱⁱ More than 50% of homicides perpetrated by an intimate partner involved a gun and over 59% of mass shootings have a domestic violence component.ⁱⁱⁱ

Pregnant patients are at higher risk for intimate partner violence. Up to 20% of pregnant patients report experiencing interpersonal violence, with a domestic partner the aggressor in the majority of cases.^iv Homicide and suicide are the second and fourth leading cause of injury-related deaths among pregnant and postpartum women,^v and the majority of these homicides are carried out with firearms.^vi

Gun violence disproportionately affects communities of color, people with low income, and other historically marginalized patients.^vii It also has a demonstrably harmful effect on the mental health of those exposed to it.^viii

The annual cost to our health system to treat firearms-related injuries is reported to be $2.8 billion.^ix The availability of research about gun violence has been affected by legislation limiting funding for gun violence research.^x In addition, some states have adopted rules and regulations that limit a physician’s ability to discuss gun safety with their patients.^xi The American College of Obstetricians and Gynecologists (ACOG) joins many professional organizations to strongly oppose legislative interference in the physician-patient relationship, including legislative requirements or restrictions dictating the contents of physician-patient conversations that are not grounded in medicine or science.^xii

The evidence shows that few physicians routinely discuss the issue of gun violence with their patients.^xiii The development and implementation of gun violence prevention training for clinicians has been shown to increase clinician knowledge of available gun-safety resources and comfort discussing the topic.^xiv

ACOG supports an evidence-based, public health approach to gun violence that emphasizes prevention, education and safety. To this end, ACOG:

1. Recommends clinicians engage in routine screening of patients for intimate partner violence^xv
2. Recommends clinicians perform periodic injury prevention evaluations and counseling regarding firearms^xvi
3. Opposes governmental restrictions or requirements dictating the content of physician/patient counseling regarding firearms^xvii
4. Encourages the appropriate federal and state agencies to support and fund research, surveillance activities, public education, and anti-violence initiatives that recognize and address the role of intimate partner violence and firearms in the health and safety of all people seeking obstetric and gynecological care, their families and communities
5. Encourages the training of clinicians on gun and domestic violence prevention
6. Supports laws or regulations limiting the purchase and ownership of firearms by individuals with emergency, temporary, or permanent protective or restraining orders or those with intimate partner violence and/or stalking convictions
7. Encourages improved access to mental health care and services

References

ⁱ Chang J, Berg CJ, Saltzman LE, Herndon J. Homicide: a leading cause of injury deaths among pregnant and postpartum women in the United States, 1991-1999. Am J Public Health 2005;95:471-7. doi: 10.2105/AJPH.2003.029868; Petrone P, Jiménez-Morillas P, Axelrad A, Marini CP. Traumatic injuries to the pregnant patient: a critical literature review. Eur J Trauma Emerg Surg 2019;45:383-92. doi: 10.1007/s00068-017-0839-x; Velopulos CG, Carmichael H, Zakrison TL, Crandall M. Comparison of male and female victims of intimate partner homicide and bidirectionality-an analysis of the national violent death reporting system. J Trauma Acute Care Surg 2019;87:331-6. doi: 10.1097/TA.0000000000002276; Rothman EF, Hemenway D, Miller M, Azrael D. Batterers' use of guns to threaten intimate partners. J Am Med Womens Assoc (1972) 2005;60:62-8.

ⁱⁱ Edmund M. Guns and violence against women: key challenges and solutions. Center for American Progress; 2022. Accessed February 15, 2023. https://www.americanprogress.org/article/guns-and-violence-against-women/; Cai Z, Junus A, Chang Q, Yip PS. The lethality of suicide methods: a systematic review and meta-analysis. J Affect Disord 2022;300:121-9. doi: 10.1016/j.jad.2021.12.054Z; Miller M, Zhang Y, Prince L, Swanson SA, Wintemute GJ, Holsinger EE, et al. Suicide deaths among women in California living with handgun owners vs those living with other adults in handgun-free homes, 2004-2016. JAMA Psychiatry 2022;79:582-8. doi: 10.1001/jamapsychiatry.2022.0793; Geller LB, Booty M, Crifasi CK. The role of domestic violence in fatal mass shootings in the United States, 2014-2019. Inj Epidemiol 2021;8:38-0. doi: 10.1186/s40621-021-00330-0; Kafka JM, Moracco KBE, Taheri C, Young B, Graham LM, Macy RJ, et al. Intimate partner violence victimization and perpetration as precursors to suicide. SSM Popul Health 2022;18:101079. doi: 10.1016/j.ssmph.2022.101079; Campbell JC, Webster D, Koziol-McLain J, Block C, Campbell D, Curry MA, et al. Risk factors for femicide in abusive relationships: results from a multisite case control study. Am J Public Health 2003;93:1089-97. doi: 10.2105/ajph.93.7.1089.

ⁱⁱⁱ Geller LB, Booty M, Crifasi CK. The role of domestic violence in fatal mass shootings in the United States, 2014-2019. Inj Epidemiol 2021;8:38-0. doi: 10.1186/s40621-021-00330-0.

^iv Petrone P, Jiménez-Morillas P, Axelrad A, Marini CP. Traumatic injuries to the pregnant patient: a critical literature review. Eur J Trauma Emerg Surg 2019;45:383-92. doi: 10.1007/s00068-017-0839-x.

^v Chang J, Berg CJ, Saltzman LE, Herndon J. Homicide: a leading cause of injury deaths among pregnant and postpartum women in the United States, 1991-1999. Am J Public Health 2005;95:471-7. doi: 10.2105/AJPH.2003.029868. The American College of Obstetricians and Gynecologists recognizes and supports the gender diversity of all patients who seek obstetric and gynecologic care. In original portions of this document, authors seek to use gender-inclusive language or gender-neutral language. When describing research findings, this document uses gender terminology reported by investigators.

^vi Chang J, Berg CJ, Saltzman LE, Herndon J. Homicide: a leading cause of injury deaths among pregnant and postpartum women in the United States, 1991-1999. Am J Public Health 2005;95:471-7. doi: 10.2105/AJPH.2003.029868

^vii Kravitz-Wirtz N, Bruns A, Aubel AJ, Zhang X, Buggs SA. Inequities in community exposure to deadly gun violence by race/ethnicity, poverty, and neighborhood disadvantage among youth in large US cities. J Urban Health 2022;99:610-25. doi: 10.1007/s11524-022-00656-0-; Youngson N, Saxton M, Jaffe PG, Chiodo D, Dawson M, Straatman A. Challenges in risk assessment with rural domestic violence victims: implications for practice. J Fam Violence 2021;36:537-50. doi: 10.1007/s10896-021-00248-7.

^viii Smith ME, Sharpe TL, Richardson J, Pahwa R, Smith D, DeVylder J. The impact of exposure to gun violence fatality on mental health outcomes in four urban U.S. settings. Soc Sci Med 2020;246:112587. doi: 10.1016/j.socscimed.2019.112587.

^ix Frisby JC, Kim TW, Schultz EM, Adeyemo A, Lo KW, Hazelton JP, et al. Novel policing techniques decrease gun-violence and the cost to the healthcare system [published erratum appears in Prev Med Rep 2020;20:101283]. Prev Med Rep 2019;16:100995. doi: 10.1016/j.pmedr.2019.100995

^x Chien L, Gakh M, Coughenour C, Lin R. Temporal trend of research related to gun violence from 1981 to 2018 in the United States: a bibliometric analysis [published erratum appears in Inj Epidemiol 2020;7:43]. Inj Epidemiol 2020;7:9-6; Rostron A. The Dickey Amendment on federal funding for research on gun violence: a legal dissection. Am J Public Health 2018;108:865-7. doi: 10.2105/AJPH.2018.304450.

^xi McCourt AD, Vernick JS. Law, ethics, and conversations between physicians and patients about firearms in the home. AMA J Ethics 2018;20:69-76. doi: 10.1001/journalofethics.2018.20.1.hlaw1-1801.

^xii Legislative interference with patient care, medical decisions, and the patient-physician relationship. Statement of Policy, American College of Obstetricians and Gynecologists; 2021. Accessed February 1, 2023. https://www.acog.org/clinical-information/policy-and-position-statements/statements-of-policy/2019/legislative-interference-with-patient-care-medical-decisions-and-the-patient-physician-relationship.

^xiii Simonetti JA, Azrael D, Zhang W, Miller M. Perspectives on clinician-delivered firearm safety counseling during routine care: results of a national survey. Prev Med 2022;158:107039. doi: 10.1016/j.ypmed.2022.107039.

^xiv Rickert CG, Felopulos G, Shoults B, Hathi S, Scott-Vernaglia SE, Currier P, et al. Development and implementation of a novel case-based gun violence prevention training program for first-year residents. Acad Med 2022;97:1479-83. doi: 10.1097/ACM.0000000000004656

^xv Intimate partner violence. Committee Opinion No. 518. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012;119:412-7. doi: 10.1097/AOG.0b013e318249ff74.

xvi American College of Obstetricians and Gynecologists. Well-woman health care. Accessed February 1, 2023. https://www.acog.org/topics/well-woman-health-care

^xvii Legislative interference with patient care, medical decisions, and the patient-physician relationship. Statement of Policy, American College of Obstetricians and Gynecologists; 2021. Accessed February 1, 2023. https://www.acog.org/clinical-information/policy-and-position-statements/statements-of-policy/2019/legislative-interference-with-patient-care-medical-decisions-and-the-patient-physician-relationship

Approved February 2014
Reaffirmed July 2017
Amended and Reaffirmed February 2019
Revised and Approved February 2023