The Silent Crisis: Why Native American Maternal Mortality Remains a National Emergency
Rhonda Swaney’s harrowing experience nearly five decades ago – a near-fatal pregnancy complication on the Flathead Indian Reservation in Montana – isn’t a relic of the past. It’s a stark echo of a continuing crisis. Today, Native American and Alaska Native women face disproportionately high rates of pregnancy-related death, a disparity that demands urgent attention and systemic change.
A Deepening Divide: The Numbers Tell a Troubling Story
The Centers for Disease Control and Prevention (CDC) data consistently reveals a grim reality: Native American and Alaska Native women experience the highest pregnancy-related mortality ratio among major demographic groups in the United States. In 2024, the latest year with available data, the gap widened, highlighting a failure to adequately address the unique challenges faced by these communities. Approximately 68% of these deaths occur within a year postpartum, often between 43 days and a year after giving birth, indicating a critical need for extended care and support.
Did you know? 87% of maternal deaths in the U.S. are considered preventable, according to data from 46 maternal mortality review committees. Among Native American and Alaska Native women, that preventability rate is even higher – approaching 100%.
The Role of Maternal Mortality Review Committees – and Their Uncertain Future
State maternal mortality review committees (MMRCs) are crucial for investigating these deaths, analyzing data, and recommending policy changes. These committees, bolstered by funding from the Preventing Maternal Deaths Act of 2018, have begun to identify key risk factors and potential interventions. However, the future of this funding is precarious. The short-term spending bill that averted a government shutdown is set to expire, potentially cutting off vital resources to these committees.
The push for increased tribal participation in MMRCs is gaining momentum. Currently, few states have meaningful tribal representation. The National Indian Health Board advocates for greater inclusion, recognizing that culturally informed perspectives are essential for effective solutions. Arizona, under the leadership of Kim Moore-Salas (Navajo Nation), is a leading example, having established a dedicated American Indian/Alaska Native subcommittee within its MMRC.
Beyond Funding: Addressing Systemic Barriers to Care
The crisis isn’t solely about funding. It’s deeply rooted in systemic barriers to healthcare access. The Indian Health Service (IHS), responsible for providing healthcare to federally recognized tribes, is chronically underfunded and understaffed. A 2024 study revealed that approximately 75% of Native American and Alaska Native pregnant individuals didn’t have consistent access to IHS care around the time of delivery, forcing them to seek care elsewhere.
Even when care *is* received within the IHS system, quality concerns persist. A 2020 report from the Department of Health and Human Services’ Office of Inspector General found that over half of labor and delivery patients at IHS facilities didn’t receive care aligned with national clinical guidelines. Insurance coverage instability further exacerbates the problem, with Native American and Alaska Native individuals being less likely to have continuous coverage compared to their non-Hispanic white counterparts.
The Importance of Culturally Competent Care and Tribal Sovereignty
Cindy Gamble (Tlingit), a tribal community health consultant, emphasizes the need for tailored solutions. “It’s not a one-size-fits-all,” she explains. “Because of all the beliefs and different cultures and languages that different tribes have.” This underscores the importance of respecting tribal sovereignty and incorporating traditional knowledge into healthcare practices.
Pro Tip: When advocating for maternal health improvements, prioritize culturally sensitive approaches. Engage tribal elders, community health workers, and traditional healers to ensure interventions are respectful and effective.
Emerging Trends and Future Directions
Several promising trends are emerging. The National Council of Urban Indian Health is actively connecting Urban Indian health organizations with state MMRC processes. States are beginning to broaden the scope of their reviews to include deaths from suicide, overdose, and homicide, recognizing the interconnectedness of maternal health and overall well-being. Furthermore, the inclusion of racism and discrimination as risk factors in case reviews is a critical step towards addressing the root causes of disparities.
Looking ahead, several models for improving maternal health outcomes are being considered: tribe-specific MMRC’s, regional committees aligned with the 12 IHS administrative regions, a national committee, or the integration of Native American subcommittees into existing state committees. The key is to prioritize tribal leadership and ensure that data collection and analysis are culturally relevant.
FAQ: Addressing Common Questions
- What is a maternal mortality review committee? A group that investigates deaths related to pregnancy and childbirth to identify preventable factors and recommend improvements.
- Why are Native American women at higher risk? Systemic barriers to healthcare, underfunding of the IHS, lack of culturally competent care, and social determinants of health all contribute.
- What can be done to improve maternal health outcomes? Increased funding for MMRCs, greater tribal participation in review processes, culturally sensitive care, and addressing social determinants of health are crucial steps.
- Is the IHS adequately funded? No. The IHS is chronically underfunded, leading to limited access to care and staffing shortages.
The fight for equitable maternal health for Native American and Alaska Native women is far from over. It requires sustained commitment, collaborative partnerships, and a willingness to address the systemic injustices that have perpetuated this crisis for far too long. The health of mothers is inextricably linked to the health of nations, and ensuring the well-being of these communities is a moral and societal imperative.
Want to learn more? Explore the resources available at the Indian Health Service and the CDC’s Maternal Mortality website.
Share your thoughts and experiences in the comments below. Let’s continue the conversation and work towards a future where all mothers have access to the care they deserve.
