WS MoreOrLess: Pregnancy and Homicide

Summary

More or Less: Pregnancy and Homicide

BBC Radio 4 | Host: Ruth Alexander | Date: November 15, 2014
Exploring the Truth Behind Shocking Statistics in the News and Popular Culture

---

Episode Overview

In this episode of “More or Less,” Ruth Alexander investigates a striking claim featured in the film “Gone Girl”: that homicide is the third most common cause of death among pregnant women. Backed by expert interviews and data analysis, the episode dives into how pregnancy-associated deaths are defined and counted, exposing reporting pitfalls and statistical ambiguities. The episode also shifts gears in its latter half to evaluate the reliability of global country rankings—like the much-circulated lists for quality of life and the Global Slavery Index—with insight from The Economist’s Helen Joyce.

---

Segment 1: Investigating Homicide as a Cause of Death in Pregnancy

(00:19–04:31)

The “Gone Girl” Statistic

• Ruth Alexander introduces the episode by referencing the movie "Gone Girl," which claims homicide is the third most common cause of death for pregnant women. The team sees this as an opportunity to verify how accurate this claim is.

Defining Pregnancy-associated Deaths

• Dr. Catherine Gold, Assistant Professor at University of Michigan, explains the ambiguities in defining such deaths:
  • World Health Organization (WHO) defines maternal mortality: Deaths during pregnancy or up to 42 days (six weeks) postpartum.
  • US definition: Broader, includes deaths up to one year after childbirth.
  • "In the United States, we look at both pregnancy and the first full year after a woman delivers as a pregnancy associated death, because it's thought that a lot of the things that may cause women to die long after they've delivered are actually associated to the pregnancy." — Dr. Catherine Gold (01:30)

Data Collection and Its Flaws

• US death certificates include a checkbox for pregnancy/recent birth, but this isn’t always marked, especially if the death isn't directly related to childbirth.
  • "If something happens like she is killed by her partner a few months after she delivers, often people don't check that little box. Most of the data that's out there doesn't look at violent deaths." — Dr. Catherine Gold (02:13)

The Real Numbers

• Dr. Gold describes her own research methods:
  • Linking birth and death records, not just relying on certificates, uncovers more homicides.
  • "When you do that kind of data and you look at other data sources, you see that there are a lot more homicides of women that weren't actually counted the first time around just from the death certificates." (02:51)
• In her study:
  • Close to three homicides per 100,000 live births—a higher rate than many other pregnancy-related causes.
  • Still, figures are underreported due to missed pregnancies and unnoticed cases.
  • "In some very small studies, it does look like it's the number one cause. If it is not the number one cause, it certainly is up there in the top two or three." (03:27)

The Real Risk Profile

• Popular media, like "Gone Girl," often misrepresents the typical victim:
  • "Absolutely not. The women who are most at risk in the United States are African American women. It typically is women at the extremes of age—so less than 24 or older than 40—typically as unmarried women, those are the ones who really have two to three times the risk of being killed in pregnancy." — Dr. Catherine Gold (04:13)

---

Segment 2: The Reliability of Country Rankings

(04:31–08:59)

Proliferation of Rankings

• Ruth Alexander introduces Helen Joyce, International Editor at The Economist, to discuss the explosion of global indices: from life expectancy to education to slavery rates.
• Helen Joyce discusses the reasons:
  • Growth of data availability (Internet).
  • Such rankings draw social media attention.
  • Think tanks and NGOs use them as branding tools, or “soft power.”
  • "If you have a policy that you want to get taken seriously, one great thing you can do is create an index. It'll get picked up, it'll get reported, it'll get shared, it'll get your name out there." — Helen Joyce (05:47)

Are These Rankings Reliable?

• Some rankings, like the OECD’s PISA test (educational standards), are done meticulously and with transparency.
  • "The PISA study by the OECD is pretty good... There's a margin of error around each country that it's not fair to make a lot of one or two points of difference." — Helen Joyce (07:00)
• Others, like the Global Slavery Index, are problematic:
  • Relies on small, uneven, or nonexistent country-level data points.
  • For missing data, it sometimes borrows numbers from “similar” countries—highly questionable.
  • Still, these indices “name and shame” countries at the bottom of the list.
  • "When you think how poor the data were, that's really totally unfair." — Helen Joyce (07:39)
  • Suggests the practice of ranking countries into four or five broad categories, not detailed lists.

The Takeaway

• Rankings are everywhere and can shape policies and reputations, but many are built on shaky foundations. Transparency and integrity are essential.
• "If you're going to do that, you have to be doing it with the most incredible integrity. And you also have to be completely transparent about what you're doing." — Helen Joyce (08:47)

---

Notable Quotes & Memorable Moments

• On maternal death classification:
  "In the United States, we look at both pregnancy and the first full year after a woman delivers as a pregnancy associated death..." — Dr. Catherine Gold, (01:30)
• On underreporting of homicide:
  "There are a lot more homicides of women that weren't actually counted the first time around just from the death certificates." — Dr. Catherine Gold, (02:51)
• Media portrayal vs reality:
  "Absolutely not. The women who are most at risk in the United States are African American women..." — Dr. Catherine Gold, (04:13)
• On the index explosion:
  "They're catnip for the sorts of things that get shared on social media." — Helen Joyce, (05:47)
• On unreliable indices:
  "If you're then going to rank countries and then the worst thing they did was they actually named and shamed the bottom countries... that's really totally unfair." — Helen Joyce, (07:39)

---

Timestamps for Key Segments

• 00:19 – Ruth Alexander introduces the episode and the “Gone Girl” statistic.
• 01:30 – Dr. Catherine Gold explains international differences in defining maternal deaths.
• 02:13 – Discussion of flaws in death certificate data and undercounting violence.
• 02:51 – Dr. Gold describes more comprehensive methods for identifying pregnancy-related homicides.
• 03:27 – Findings about homicide as a top cause of death among pregnant women.
• 04:13 – Demographic realities of homicide risk during pregnancy.
• 05:02 – Helen Joyce on the rise of global indices.
• 05:46 – Why country rankings proliferate.
• 07:00 – Good versus bad indices, with examples.
• 07:39 – The flaw in data for the Global Slavery Index.

---

Conclusion

This episode of More or Less deftly unpacks a shocking claim from pop culture with rigorous data analysis, exposing how both media and official records can misrepresent or undercount uncomfortable truths—especially when it comes to violence against pregnant women. The second half broadens to critically examine the foundations and impact of country rankings, urging listeners to look beyond headlines and question the data behind the stories.

Listeners are encouraged to be cautious consumers of “statistical facts”—and to send in any dubious numbers for future investigation.

Transcript

[Ruth Alexander]

This is the short edition of More or Less, first broadcast on the BBC World Service.

[BBC Announcer]

Thank you for downloading from the BBC. For details of our complete range of podcasts and our terms of use, go to bbcworldservice.com podcasts

[Ruth Alexander]

hello, this is More or Less on the BBC World Service, and I'm Ruth Alexander. The team at More or Less love going to the cinema and watching a new film. And the one that's got everyone in the office excited recently is the film based on the book by Gillian Flynn. Gone Girl, Beautiful wife, handsome husband, Wife goes missing on her anniversary.

[Dr. Catherine Gold]

You talk like a man who believes his wife is still alive.

[Ruth Alexander]

Being the professionals that we are, even on our downtime, we on the More or Less team still keep our eyes open for statistical claims that we haven't heard before. And there was one in Gone Girl that did catch our attention. Now, for those of you who haven't seen it, don't worry, we don't think it'll spoil the plot. To tell you that during the film, there's the claim that the third most common cause of death for pregnant women is homicide. But can that really be true? I've been speaking to Dr. Catherine Gold, an assistant professor at the University of Michigan in the United States who's done research on homicide in pregnant women. She told me the first thing to figure out when looking at the data is how pregnancy associated deaths are defined. And, and it isn't as clear cut as you might think.

[Dr. Catherine Gold]

The World Health Organization defines maternal mortality as women who die during pregnancy or within the first 42 days, which is about six weeks after they deliver. In the United States, we look at both pregnancy and the first full year after a woman delivers as a pregnancy associated death, because it's thought that a lot of the things that may cause women to die long after they've delivered are actually associated to the pregnancy.

[Ruth Alexander]

In the US where the film's based on death certificates, there's a box which is ticked if a woman's pregnant or had given birth in the previous year. And Catherine Gold said many researchers have used that method when looking at causes of death in pregnant women. But it's not foolproof.

[Dr. Catherine Gold]

What's happened is when a woman dies from something like a hemorrhage when she delivers, the baby loses a lot of blood and subsequently dies. Then people are very likely to check that box saying that she was pregnant. But if something happens like she is killed by her her partner a few months after she delivers, often people don't check that little box. Most of the Data that's out there doesn't look at violent deaths. So most of the data that's out there, both in the US and the uk, says that cardiovascular disease is the number one cause of death.

[Ruth Alexander]

But two studies, one of which Katherine Gold did herself, tried a different approach and got a different result.

[Dr. Catherine Gold]

They not only looked at death certificates, but they looked at women who delivered a live birth over the last 12 months and then matched that up with people who had died and were able to identify women who had been pregnant. And when you do that kind of data and you look at other data sources, you see that there are a lot more homicides of women that weren't actually counted the first time around just from the death certificates.

[Ruth Alexander]

So they found that more pregnant women had died from homicide than previously realized. But how about the claim in Gone Girl that homicide is the third most common cause of death in pregnant women?

[Dr. Catherine Gold]

In some very small studies, it does look like it's the number one cause. If it is not the number one cause, it certainly is up there in the top two or three. In our study, it looked like there were almost three homicides for every 100,000 live births, which is higher than many of the causes of death in pregnant women. Most of the studies suggest that it's probably hundreds of women per year. But the problem is it's under reported. So there are homicides where women are pregnant and we don't know that. Maybe they were in their first trimester and they haven't told many people. Maybe the special box on the desk certificate was not checked.

[Ruth Alexander]

It seems that the claim in Gone Girl then could be true. In the film, the victim being referred to is white, middle class and in her 30s. I asked Catherine Gold if she fitted the normal profile.

[Dr. Catherine Gold]

Absolutely not. The women who are most at risk in the United States are African American women. It typically is women at the extremes of age. So less than 24 or older than 40, typically as unmarried women, those are the ones who really have two to three times the risk of being killed in pregnancy.

[Ruth Alexander]

Katherine Gold from the University of Michigan. Now, if you're the kind of person who normally gets their news from the Internet, you'll be used to seeing headlines

[Helen Joyce]

like these revealed the best and worst countries in the world to grow old.

[Ruth Alexander]

India tops NEW Global Slavery Index it seems that these rankings of countries performance are everywhere. But how reliable are they? This is a question that was tackled recently by the Economist magazine and I asked there in international editor Helen Joyce why they looked into these performance indices.

[Helen Joyce]

As soon as you talk about anything Say it's corruption, education, women's status, someone has done a country ranking of it. And we started to think, how well are these done and has there really been an explosion in them or are we just noticing now and what are the policy implications for countries that are trying to tackle these issues?

[Ruth Alexander]

So what did you find? Is the increase real and do they stand up to scrutiny?

[Helen Joyce]

When you look closely, the increase is certainly real. So we cited in the article this pair of academics, Kelly and Simmons, who had done an extraordinary Internet search of rankings and they had found that from say pre1974, when there was basically nothing like this, to now, it's multiplied by many, many, many times the number of country rankings.

[Ruth Alexander]

Why do you think that is?

[Helen Joyce]

Mixture of reasons. One is just the Internet, the data is available. These things used to just be on shelves. And then the second reason is also to do with the Internet. And that's a pol. They're catnip for the sorts of things that get shared on social media. People love rankings. If you see something about, you know, which country is the best place to live as a woman or something like that, you look to see where your country is or any other countries that you maybe lived and, you know, people make headlines of them. The odder the comparison, the better. And then this feeds back into people who create indices. That's why they do it. If you have a policy that you want to get taken seriously, one great thing you can do is create an index. It'll get picked up, it'll get reported, it'll get shared, it'll get your name out there. It's a branding tool as well. For organizations like think tanks or for NGOs, it's an incredibly powerful tool. So all of these things feed into each other and mean that this new tool of soft power has become ubiquitous.

[Ruth Alexander]

So we love them. But should we be looking so excitedly at the top 10 of this and the top 10 of that, or when you look closely, do they really not make that much sense?

[Helen Joyce]

I would say that there are the good and the bad.

[Ruth Alexander]

So which are the good ones?

[Helen Joyce]

Well, I do think that, for example, the PISA study by the OECD is pretty good.

[Ruth Alexander]

That's a study which looks at education, internationally, educational standards.

[Helen Joyce]

It looks at 15 year olds standards in their own language, in mathematics and in science. And I mean, it's meticulous. They go to an enormous amount of trouble and they don't produce a ranking from the results, although they do score countries. They try to explain to journalists and everyone else who uses it that, you know, there's a margin of error around each country that it's not fair to make a lot of one or two points of difference. Of course, people do produce a ranking from it. We did pick out one index, perhaps unfairly, as a particularly egregious example of index sins. And, you know, I think we were fair to do that. So let's go again. So it's called the Global Slavery Index and it's produced by an NGO called Walk Free. You know, it's titling a very important subject which is modern day slavery, including things like child marriage, forced trafficking of people, forced labor. These are not things that people have good figures on. So they made some, shall we say, heroic assumptions based on very tiny surveys and so on. And then the most shocking thing that they did is there are some countries for which there are literally no estimates whatsoever, not one single figure you can use. So they go beyond the using small figures, out of date figures, incomparable figures. And they actually used figures for some countries for other countries on the grounds that they were vaguely similar. If you were trying to get some ballpark figure for the total number of slaves in the world today, this is just about something that you could imagine doing to come to a headline figure. I think already it's a bit shoddy, but anyway. But if you're then going to rank countries and then the worst thing they did was they actually named and shamed the bottom countries. And when you think how poor the data were, that's really totally unfair. I do think there's a place for rankings and for categorizing countries in say four or five categories because I think it's really clear and it's hard for politicians to wriggle out of a clear cut judgment. It's just that if you're going to do that, you have to be doing it with the most incredible integrity. And you also have to be completely transparent about what you're doing.

[Ruth Alexander]

Helen Joyce from the Economist. That's all we've got time for this week. But if you've got any numbers you're suspicious about, please do email us at more or lessbc.co.uk. you can also listen to more editions of More or Less at our website, bbcworldservice.com more or less.

[Neil Rozell]

Ruth Alexander there. I'm Neil Rozell with a cheeky plug for a new program we're excited about. It's called the Inquiry. Each week we take one pressing question from the news and look in depth at possible answers. It's topical analysis, but with a polished sound you won't find in a daily program. It's different, so give us a spin. It's the Inquiry. It's broadcast Tuesdays on the BBC World Service and available always as a podcast.

[BBC Announcer]

There are dozens of different podcasts now available from the BBC, including news, documentaries, science, business, arts and sports. For details of them all, go to BBC service.com podcasts.