Restoration Magazine

Concern grows for maternal health disparities in Native American communities as Native women face higher rates of maternal morbidity and mortality compared to other racial and ethnic groups in the United States.

For instance, American Indian/Alaska Native (AI/AN) women are 2.3 times more likely to die from pregnancy-related causes. According to one scoping review of research, the top three leading causes of pregnancy-related death for AI/AN women are hemorrhage, cardiomyopathies, and hypertensive disorders. The majority of these are preventable. In addressing these issues, it is essential to recognize how medical and social determinants of health and cultural, historical, and systemic factors contribute to these disparities.

The intersectionality between maternal health, violence against Native women, and the work of health justice advocates presents a critical pathway to improving outcomes in Indian Country.

Social determinants of health, such as access to healthcare, discrimination, poverty, homelessness, historical trauma, and a lack of cultural connection, are all social determinants of health and prenatal outcomes. Remote and rural areas are also challenging for AI/AN women who need prenatal care. A lack of insurance coverage, underfunded healthcare systems, racial biases in medical care, and mistrust of the healthcare system also determine negative maternal health outcomes. The reason health disparities vary is unclear due to the lack of research into the population. Parallel to historical trauma in AI/AN communities, many emerging issues surround maternal mortality and morbidity.

Underrepresentation in the Data

The lack of representation in research and data collection is a barrier that affects quality individualized maternal healthcare. Data on maternal mortality and morbidity often classifies AI/AN birthing people as “Other” and typically uses an insufficient sample size to deliver quality data. Furthermore, no research specific to Alaska Native populations exists. Representation of specific communities must be prioritized, preferably with researchers from those communities.

Maternal Health “Deserts”

Areas where access to prenatal, labor, and postpartum care is limited or nonexistent present significant challenges for Native American communities. These “deserts,” often located in rural and remote reservations, result from decades of underinvestment in Indigenous healthcare infrastructure, transportation, and trained healthcare professionals. Many Native people must travel long distances to receive essential maternal healthcare services, often facing logistical, financial, and cultural barriers along the way. Compounding these geographic and resource challenges is the high rate of chronic conditions among Native American populations, increasing the risk of pregnancy complications. 

With these emerging and ongoing challenges for the AI/AN communities, responses and solutions created by people with lived experiences are increasing. One promising approach is the revitalization of traditional Indigenous birth workers, also known as midwives or doulas. Often deeply rooted in their communities, these birth workers deliver care grounded in Indigenous practices and beliefs. Their knowledge is passed down through generations and emphasizes a holistic approach to pregnancy, labor, and delivery. This includes incorporating ceremony, family support, and Indigenous spirituality. Traditional birth workers can provide individualized care by helping Native birthing people navigate the healthcare system and advocating for their needs. Integrating traditional knowledge with modern healthcare practices is crucial to reducing maternal morbidity and mortality rates among AI/AN people.

The maternal health crisis in Native American communities is multifaceted, requiring holistic and culturally-informed responses. Adopting holistic care, revitalizing traditional Indigenous birth workers, and linking maternal health to the broader issue of violence against Native women, we can build a more just and equitable healthcare system.

This project was made possible by Grant Number 90-EV0533-04 from the Administration on Children, Youth and Families, Family and Youth Services Bureau, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services.