The Hidden Cost of Firearm Violence on Infants in Utero

Firearm violence is a critical public health crisis in the U.S., marked by a significant number of homicides involving firearms, including indiscriminate shootings in public spaces. This study investigates the largely unexplored impact of such violence on newborn health. We adopt two approaches. First, we analyze the 2002 'beltway sniper' attacks in the Washington DC metropolitan area, using administrative birth records with maternal residential addresses in Virginia. The beltway sniper attacks, a series of random shootings in the Washington DC metropolitan area, caused widespread terror and disruption over three weeks. Leveraging both spatial and temporal variation, we compare outcomes of children exposed to the attacks in utero due to timing or having a residential address near a shooting location to those who were not exposed. Second, we investigate the impact of in-utero exposure to mass shootings on infant health using restricted-access U.S. Vital Statistics Natality records between 2006 and 2019 and leveraging variation in the timing of mass shootings in counties with at least one shooting. We document substantial, previously overlooked costs on pregnant women and infants. Exposure to the beltway sniper attacks during pregnancy increased the likelihood of very low birthweight and very premature birth by 25%. The analysis of national mass shootings confirms these findings with slightly smaller effect sizes. These results emphasize the need to consider the broader impact of violence on vulnerable populations when assessing the cost of firearm violence. The estimates suggest additional costs of $155 million (2023 dollars) for the beltway sniper attacks and $75 million annually for mass shootings.