This research is a case study of 309 pregnancy-associated deaths that occurred in Virginia from 1999-2005. Pregnancy-associated deaths due to homicide, suicide, or accidental overdose were compared with natural deaths. Violent deaths accounted for almost 30% of the cases. Homicides accounted for 13% of all the deaths in the sample, larger than any single natural cause of death. Homicide was the leading manner of death for Black women and was 4.5 times the rate of White decedents. Recommendations include expanding maternal death surveillance, committing to ending violence against women, and promoting universal screenings for domestic or interpersonal violence.