How does crime against expectant mothers affect their children’s health?

Crime is known to have wide-ranging economic and social consequences. It can even affect the health of the next generation when pregnant women become victims of theft, robbery or violence.

Exposure to crime and fear of victimisation has been shown to have detrimental effects both on people’s mental health (Dustmann and Fasani, 2014) and on their physical health by restricting physical activity (Janke et al, 2016). These negative effects are amplified for women.

A new strand of research explores the potential negative effects of a variety of stressful events during pregnancy, which can then affect the health of children early in life (Currie and Rossin-Slater, 2013; Black et al, 2016).

This raises the question of how exposure to crime among pregnant women, or just the fear of it, may negatively affect unborn children. Any such effects on the health of children are very concerning given the potential life-long negative impact on both health and socio-economic outcomes.

Poor health at birth has been shown to have long-term consequences, including effects on educational attainment, earnings and even mortality (Oreopoulos et al, 2008; Almond and Currie, 2011).

How does indirect exposure to crime affect the health of newborns?

Indirect exposure to serious violent crimes – for example, by witnessing homicides and assaults during pregnancy – has been shown to have negative effects on the health of newborns in a variety of settings.

One study has shown the negative effect of exposure to violent crime from the escalation of the Mexican ‘war on drugs’ on birthweight, a proxy for the health of children at the time of their birth (Brown, 2018).

Other research documents a similarly negative effect of day-to-day violence in Brazil on gestational length and birthweight (Foureaux Koppensteiner and Manacorda, 2016).

In addition to these two studies for middle-income countries, researchers have shown similar outcomes in Detroit in the United States (Grossman and Khalil, 2022).

This work documents the negative intergenerational effect of crime exposure. But it leaves the question of the underlying mechanism largely unanswered. Focusing on exposure to the most severe violent crimes is likely to underestimate the overall effect of crime, and fail to establish whether these effects extend to more common crimes, such as theft and robbery.

How does mothers’ experience of being a victim of crime during pregnancy affect their children’s health at birth?

Answering this question requires access to much more precise datasets, namely those linking crime records with birth records.

Using such linked records, one recent study shows that in utero exposure to assault from intimate partner violence significantly increases the incidence of adverse birth outcomes (Currie et al, 2022). The overall social costs from those assaults based on the negative health consequences of the children are estimated to exceed $3.5 billion annually in the United States.

Focusing on assault during pregnancy makes it difficult to distinguish the physical effects of injury to the mother from other effects (including psychological effects) that may affect the unborn child.

In contrast to looking at victimisation from intimate partner violence, a recent study explores the more general effect of being a victim of crime on birth outcomes (Menezes and Foureaux Koppensteiner, 2023). Using data from Brazil, this focuses on the two most frequent crimes involving a victim – theft and robbery – to provide new insights into the detrimental effects of crime on unborn children.

One common issue with these studies is that becoming a victim of crime might not be random. This can be influenced by neighbourhood characteristics, or characteristics of the victim, among other traits.

To get around this, the researchers control for residential and individual characteristics, and take account of seasonality and time trends.

This is important as, for example, poorer neighbourhoods tend to be more violent and women residing there might have worse birth outcomes for other reasons. By comparing birth outcomes for women residing in the same neighbourhood, it is possible for researchers to estimate causal effects.

Being a victim of crime during pregnancy negatively affects birthweight by, on average, 15 grams (see Figure 1). Despite this relatively small average effect on birthweight (equal to about 0.5% of mean birthweight), the magnitude of the effect is large compared with those found in other studies. For example, it is about seven times the (positive) effect of receiving nutritional support during pregnancy in the form of food stamps (Almondet al, 2011).

The effect is particularly strong at the lower end of the birthweight distribution, with an increase in the propensity of children to be born with low, very low or extremely low birthweight (less than 2,500, 2,000 and 1,500 grams respectively) of 10%, 14% and 38% relative to the baseline incidence.

This increase in children born with low birthweight is particularly worrying given the considerable negative consequences of low birthweight for short- and long-term outcomes in health, education and the labour market (Fletcher, 2011, Almond et al, 2005).

Figure 1: Estimated effects of being a victim of crime during pregnancy on birthweight (BW) and low BW indicators

Source: Menezes and Foureaux Koppensteiner, 2023

To understand the long-term effects of being a victim of crime during pregnancy better, the study looks at hospitalisations of children after birth. Figure 2 shows an increased risk, of around 6%, of hospitalisation due to victimisation, compared with the average.

The authors also find that children of mothers who are victims of crime during pregnancy are more likely to attend neonatal intensive care units (ICUs). This is important for two reasons. First, the increase in ICU attendance indicates more severe cases of hospitalisation. Second, neonatal ICUs are among the most expensive components of a hospital. This means that there is also a substantial increase in the direct cost of hospitalisation.

Figure 2: Estimated effects of being a victim of crime during pregnancy on hospitalisation risk, log cost of hospitalisations and hospitalisation in neonatal and regular ICUs

Source: Menezes and Foureaux Koppensteiner, 2023

Who is affected most by being a victim of crime?

The effect of crime is not the same across individuals, with children of some mothers suffering particularly strongly. Figure 3 reports the effect of victimisation separately by indicators of socio-economic status.

Across the different outcomes of birthweight, the effects for mothers with lower socio-economic status are more pronounced. This may indicate that the economic loss from being a victim of robbery and theft plays a key role in explaining the negative effect.

In addition, the effects are driven by being a crime victim late in pregnancy (during the third trimester). With foetuses putting on most weight in utero in the last trimester, this suggests that nutrition may play a role in the reductions in birthweight, for example, due to the economic impact of victimisation.

Figure 3: Estimated effects of being a victim of crime during pregnancy on birthweight (BW) and low BW indicators by socio-economic background

Source: Menezes and Foureaux Koppensteiner, 2023

Taken together, this evidence indicates that being a victim of crime during pregnancy is a contributor to the intergenerational transmission of inequality by affecting the health of the next generation.

Previous research on the cost of crime has focused mainly on the consequences of direct and indirect exposure for adults, including estimates of the effects on mental health (Dustmann and Fasani, 2014) and earnings (Bindler and Ketel, 2022). The potential consequences for children have been less studied.

Some studies have documented the negative effects of exposure to crime on educational outcomes of children (Brown and Velasquez, 2017; Foureaux Koppensteiner and Menezes, 2021). Now research provides evidence on the consequences for children if their mothers are victims of crime during pregnancy (Menezes and Foureaux Koppensteiner, 2023).

Where can I find out more?

Victimization and birth outcomes: Study of the effect of victimisation during pregnancy on birth outcomes, highlighting the negative effect on birthweight and an increase in subsequent hospitalisations.
Violence while in utero: the impact of assaults during pregnancy on birth outcomes: Study of the effect of assault from a violent partner on birth outcomes, demonstrating the adverse consequences for infant health of violence during pregnancy.
Violence and birth outcomes: evidence from homicides in Brazil: Study of the effect of indirect exposure to violent events on the health of unborn children, indicating how violence compounds the disadvantage of children in households with lower socio-economic status.