Homicide Mortality Among Female Adolescents and Women Aged 15 to 44 Years and US State Abortion Policies

Importance: Homicide is a leading cause of death among female adolescents and women aged 15 to 44 years (hereinafter, women of reproductive age) in the US. Whether homicide trajectories differed across state abortion policy environments after the COVID-19 surge and the Dobbs v Jackson Women's Health Organization (hereinafter, Dobbs) decision is unclear. Objectives: To characterize national homicide trends among women of reproductive age and assess whether post-2022 trajectories in homicide mortality among women of reproductive age diverged between states with and without sustained abortion bans. Design, Setting, and Participants: This quasi-experimental study used national interrupted time series and comparative interrupted time series analyses of homicide mortality from January 1, 2016, through December 31, 2024, among women of reproductive age. Exposure: The COVID-19 pandemic and sustained state abortion bans after Dobbs. Main Outcomes and Measures: The main outcome was monthly homicide deaths. The population-offset Poisson model estimated differential post-Dobbs changes in homicide rates. Absolute rate differences, excess deaths, and years of life lost were estimated from fitted and counterfactual Poisson models. States with sustained total or near-total abortion bans after Dobbs were compared with states without such bans; states with partial or legally fluid restrictions were excluded. A triple-difference analysis comparing those aged 15 to 29 years with those aged 45 to 59 years served as a negative-control analysis. Results: The analysis included 19 118 homicide deaths among women of reproductive age. Nationally, homicide increased sharply during the COVID-19 surge and subsequently decreased, with no clear national level or slope change beginning in July 2022. In policy-stratified analyses, however, homicide trajectories diverged. After July 2022, the exposed states (those with total or near-total abortion bans) vs unexposed states homicide monthly rate ratio (RR) was 1.006 (95% CI, 1.000-1.011; P = .03). Across calendar years 2023 and 2024, the fitted homicide rate in exposed states was higher than the modeled counterfactual (2023: RR, 1.07; 95% bootstrap interval, 1.01-1.13; and 2024: RR, 1.15; 95% bootstrap interval, 1.03-1.29). This corresponded to an estimated 48 excess deaths (95% bootstrap interval, 11-81) in 2023 and 87 excess deaths (95% bootstrap interval, 20-149) in 2024. A triple-difference model indicated greater post-Dobbs divergence among those aged 15 to 29 years than those aged 45 to 59 years (monthly ratio of RRs, 1.017; 95% CI, 1.000-1.034; P = .046); placebo Dobbs dates yielded nonsignificant results. Conclusions and Relevance: In this study, national homicide mortality rates among women of reproductive age returned toward prepandemic levels after COVID-19, but post-2022 trajectories diverged across state abortion policy environments. The findings suggest that national improvements in homicide mortality rates among women of reproductive age may mask less-favorable homicide trends among women of reproductive age in states with sustained abortion bans.