Addressing Maternal Health Disparities in American Indian and Alaska Native Communities

In the United States, maternal mortality has been on the rise over the past two decades. This crisis has had a disproportionate impact on Native American populations. American Indian and Alaska Native (AIAN) women are two to three times more likely to face maternal morbidity or mortality compared to their white counterparts. According to the Centers for Disease Control and Prevention, mental health conditions and hemorrhage were the most common underlying causes of pregnancy-related death among AIAN people between 2017 and 2019. More than 90 percent of these deaths were deemed preventable.

Health Disparities Driven by Multiple Factors and Obscured by a Lack of Data

Maternal health disparities in AIAN communities are deeply rooted and multifaceted. Many factors contribute to this including: generational trauma from centuries of displacement, systemic discrimination, geographic isolation with inadequate health care infrastructure and limited access to perinatal care, socioeconomic disadvantage, and insufficient insurance coverage. Relatedly, AIAN women also have a high prevalence of prepregnancy risk factors, including diabetes and mental distress, which can heighten the potential for maternal complications.

Further, limited data can obscure the needs for services and support in AIAN populations. They are often racially categorized as “other,” which conceals their needs and health outcomes and makes it difficult to guide appropriate interventions and resources.

A legacy of health system abuses against AIAN people and a lack of culturally competent health care services have led to mistrust and further deterred Native American women from seeking prenatal care. In 2020, 24 percent of AIAN women did not receive adequate prenatal care, compared to just 10 percent of white women. Furthermore, discrimination within the health care system and language barriers hinder access to essential maternal care services.

Limited economic development, declining infrastructure, geographic isolation, and challenges finding reliable transportation also act as structural barriers to seeking care, especially prenatal care, and increase risk for poor maternal health outcomes.

Solutions Designed to Tackle Maternal Health Disparities

Collaborative efforts and partnerships among tribal governments, health care providers, policymakers, and community organizations are imperative to optimizing maternal outcomes and implementing effective solutions. These solutions will require:

• Research and data collection. Strengthening data collection efforts and conducting research on maternal health disparities with Native populations are essential for developing evidence-based interventions. Maternal deaths in AIAN populations can become invisible, obscured by the racial category of “other,” due to small sample sizes. With better data and community-led research, policymakers and health care providers can identify key challenges and implement targeted strategies to improve maternal health disparities.
• Culturally safe and congruent care. Nineteen percent of Native American births in 2020 were attended by midwives, but only a very small fraction (0.4%) of midwives are AIAN. It is therefore important to diversify the midwifery workforce to include more Native Americans. Training Indigenous doulas and lactation consultants to provide in-home postpartum maternal care could also be beneficial. Medical and nursing schools situated on tribal lands like the Grow Our Own nursing program at Aaniiih Nakoda College in Montana, or the Oklahoma State University College of Osteopathic Medicine in Cherokee Nation, which graduated its first class of physicians in 2024, can provide opportunities for diversity. A representative workforce would enhance access to culturally aligned care, foster trust, and ultimately improve maternal outcomes. Increased funding targeting the pipeline could mitigate maternity deserts and workforce shortages.
• Community-based programs and infrastructure. Establishing community-based maternal health programs led by Native American people is key. This can allow integration of cultural values and customs of AIAN populations — such as adapting initiatives to engage elders during the birth process. Programs that integrate Navajo community health representatives within health systems have worked for diabetes care; this model can be leveraged for maternal health.
• Telehealth services. Telehealth can broaden access to maternal care in remote and underserved areas. Through telehealth consultations, remote monitoring, and telemedicine services, pregnant women can access medical advice and support, regardless of where they live.

Addressing maternal health disparities in American Indian and Alaska Native communities is a complex and urgent public health challenge that requires a multifaceted approach. This involves identifying data gaps, centering cultures and traditions, and implementing policy and structural reforms that address workforce shortages and improve access to quality care.