Indigenous Maternal Health—A Crisis Demanding Attention

Many Americans know very little about the people who are Indigenous to the lands they inhabit.A recent survey reported that 40% of Americans believed that Native American/Alaska Native (Indigenous) people no longer existed.In reality, there are 574 federally recognized tribes and more than 5.2 million people who identify as Indigenous in the United States.I am one of them.Indigenous women, like me, face disproportionate risks across the life span, including around the time of childbirth.Giving birth in the US is more deadly now than it was a generation ago.Deaths that occur during pregnancy, childbirth, or in the postpartum year are increasingly common.Approximately 60% of US maternal deaths are preventable.Maternal morbidity and mortality rates in the US highlight the fault lines of geography and race: people of color and rural residents face higher risks than their non-Hispanic white and urban counterparts.These inequities are the inevitable and tragic result of health insurance and health care systems shaped by structural racism 1 and structural urbanism 2 or the unequal allocation of opportunities and resources based on race and geography.Some aspects of maternal health equity are starting to receive the policy attention they deserve, including crises in black maternal health and rural maternity care.Yet there is little attention to the intersection of race and geography and to the safety and vitality of Indigenous mothers, who are dying at a rate 2 to 3 times higher than non-Hispanic white mothers nationally.