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California Pregnancy-Associated Mortality Review (CA-PAMR): Pregnancy-Associated Suicide from 2002 to 2012


Released by the California Department of Public Health’s Maternal, Child and Adolescent Health Division, the California Maternal Quality Care Collaborative (CMQCC) and the Public Health Institute (PHI), California Pregnancy-Associated Mortality Review (CA-PAMR): Pregnancy-Associated Suicide from 2002 to 2012 offers an in-depth review of maternal deaths offers key insights to improve care and reduce preventable maternal suicide.

Read the full report or executive summary, or scroll down to watch a video overview. 

Suicide during pregnancy or within a year after pregnancy is a tragic event that has a profound impact on the children and families left behind. Maternal suicide, while rare, is a sentinel event that serves as a call to action for public health professionals and maternity care clinicians. Between 2002 and 2012, suicide accounted for 4.3% of all deaths among California women who were pregnant within the prior year.

In-depth reviews of suicide among women while pregnant or within a year after pregnancy ended revealed that suicide preventability is high, regardless of maternal mental health history.

Key findings from the CA-PAMR report on pregnancy-associated suicide include:

  • 51% of suicide cases had a good to strong chance of preventability with missed opportunities to intervene.
  • The majority of women (83%) died in the late postpartum period, 43-365 days following the end of pregnancy: 36% died between 43 days and 6 months and 47% died more than 6 months postpartum.
  • Mental health conditions were highly prevalent: 62% of women had reported mental health conditions before becoming pregnant and 25% had new onset conditions noted during or after pregnancy. Nearly a quarter of women (23%) had a reported family history of mental health conditions.
  • Depression (54%), psychosis (24%), and bipolar disorder (17%) were the most prevalent conditions identified. Substance use, including alcohol and tobacco, was a common co-occurring condition with all mental health disorders.
  • Nearly one-third (32%) of women used illicit drugs (i.e. methamphetamine, cocaine, heroin) or abused prescription opioids during or after pregnancy; heavy alcohol use was noted in 17% of women. Substance abuse was identified as a precipitating factor to the suicide in 29% of women.
  • Approximately 85% of women had one or more psychosocial stressors documented (e.g., interpersonal conflict with partner, financial hardship, exposure to violence as a child or adult).

Read the full report.


Amina Foda; Paula Krakowiak; Dan Sun; Diana Ramos; David Reynen; Christine Morton; Elliott Main; Delphina Alvarez; Sue Holtby
PHI PI/PD:, Christy McCain

Produced through PHI's:

California Pregnancy-Associated Mortality Review