Reflections on the Indigenous maternal health crisis

Senan Ebrahim
Chief Executive Officer
at Delfina
min read

On Indigenous Peoples’ Day, I am reflecting on both the impact of the maternal health crisis on Indigenous communities and our goal of creating pregnancy care technology to best serve Indigenous pregnant patients and their families. The worsening Indigenous maternal health crisis has received minimal public attention and relatively little funding in the United States (Kozhimannil 2020). Pregnancy-related mortality in Native American pregnant patients is now 2.3 times higher than in white patients (Heck et al. 2021). Superimposed on this crisis is the COVID-19 pandemic, which significantly widened health disparities for Native American communities throughout the United States in 2020-21 (Goldman et al. 2022).

Inequitable access to care in part underlies the disparities in Native American maternal health outcomes. Once a robust network of rural healthcare resources, most Indigenous midwifery practices have been lost due to colonial health policies banning traditional birthing practices. Approximately 40% of the Native American population now lives in rural areas, limiting access to in-person care (Kozhimannil 2020). High rates of poverty and lack of insurance coverage stemming from structural racism exacerbate challenges for these patients in accessing care. Remote monitoring and telehealth options are becoming critical elements of comprehensive pregnancy care in order to overcome this geographic hurdle, while additional funding to directly cover all pregnancy-related care is imperative to reduce the financial burden on patients.

Due to centuries of neglect, mistreatment, and complicity with colonization by the medical establishment, Indigenous patients often report high levels of mistrust of medical professionals (Guadagnolo et al. 2009). Our goal is to deliver culturally competent care that works in collaboration with, rather than at the expense of, Indigenous healing modalities to promote self-determination in healthcare decision-making. In my past work with Quechua Indigenous communities in Peru, I observed midwifery practice by parteras who cared for hundreds of pregnant patients in their community with culturally competent, holistic midwife practices. As one experienced partera demonstrated external cephalic version to her apprentices, she narrated the technique in the context of longstanding healing traditions of Andean communities. This culturally competent obstetric care program in the Peruvian Andes demonstrated efficacy in improving engagement by high-risk pregnant patients (Gabrysch et al. 2009). Midwifery practices like the Changing Woman Initiative, serving pregnant patients in Navajo Nation, have similarly revitalized Native American cultural practices to the benefit of their patients.

We look forward to learning from researchers like Abigail Echo-Hawk, who advocates for sharing de-identified data on Indigenous health with Indigenous public health leaders. Analysis of this data has the potential to show efficacy of culturally competent obstetrics practices, as published data from Inuit midwifery centers in Canada have previously demonstrated (Van Wagner et al. 2012). Analyses of these data can also help identify mitigable root causes of health inequities with a rigorous and unbiased approach.

We aim to build on these learnings with Delfina Care. We also aim to openly share insights on the Indigenous maternal health crisis as we continue our research on health disparities. If you work with Indigenous pregnant patients, we would love to learn from your experience.

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