Native American women tackle high rate of maternal mortality
WINDOW ROCK, Ariz. — As the sun begins to set on a blustery fall day, the rugged buttes of Navajoland glow red in the soft light and swift gusts spiral dust through the air.
About 40 women, most draped in traditional dress, stand in a circle as Melissa Brown, an indigenous midwife, asks the group to reflect on the day just ending — and the mission still ahead.
“We have talked about being safe here. That is our goal,” she tells them. “We’re going to cry, and we’re going to laugh. And that’s OK.”
One by one, the women share a word that best captures how they feel: Happy. Safe. Joyful. Supported. Sovereign. Brave. Then one sings a hymn in her native tongue.
These women have come to the Navajo reservation to be trained as doulas, aides who have no formal medical background but provide guidance for pregnant women up to and through labor, and sometimes beyond.
They’re here in Window Rock, capital of the Navajo Nation, to learn how to help their own, but also to help confront a tragedy plaguing women in Indian Country and across the United States.
Too many women are dying due to complications from pregnancy and childbirth — deaths that should be preventable with the right intervention and care.
“My first birth that I had when I was a teenage mother was very traumatic,” said Brown, who trains indigenous women as midwives and doulas across the United States and Canada. “I didn’t understand how my body worked … how labor and delivery worked. I was very scared, and I didn’t have much support.”
Now, she said, “people are recognizing that we are our own experts in our community. We can help ourselves. We can empower ourselves. We can educate ourselves.” ___ An American crisis It’s a grim statistic, and one that’s often recounted: American women are more likely to die of childbirth or pregnancy-related causes than other women in the developed world.
And although recent investigations have drawn the attention of Congress and put a national spotlight on the issue — especially among black women — Native Americans often are left out of the conversation.
American Indian women are more than twice as likely to die from pregnancyrelated causes than white women and lag behind only black women as those most at risk, according to federal statistics.
From 2011 through 2016, according to the Centers for Disease Control and Prevention, the ratio of pregnancy-related deaths among American Indian and Alaska Native women was 30.4 deaths per 100,000 births, compared with 13 deaths per 100,000 births for white women and 42.4 deaths for black women.
In Arizona, maternal death rates are highest among Native American women: 70.8 deaths per 100,000 births.
Overall, the U.S. maternal mortality rate jumped to 16.7 deaths per 100,000 births in 2016 from 7.2 deaths per 100,000 births in 1987.
As many as 60% of these deaths are preventable. Nevertheless, about 700 women in America die each year due to complications of pregnancy — and for every death, there are many more women at risk.
For American Indian women, hemorrhage and hypertensive disorders of pregnancy are among the biggest contributors to these deaths, according to the CDC. In addition, lack of access to proper health care particularly affects American Indian and Alaska Native women.
Ramona Antone-Nez, senior epidemiologist at the Navajo Epidemiology Center in Window Rock, specializes in data collection and works to identify health priorities and concerns within the Navajo Nation.
She notes that the reservation — the nation’s largest, spanning more than 25,000 square miles across Arizona, Utah and New Mexico — typifies some of those accessibility issues that can hamper a woman’s care.
“For the majority of our population, the hospital isn’t just around the corner, just around the block. … A lot of our care takes probably an hour or so just to get to,” Antone-Nez said, adding that a lack of access to specialized care for highrisk pregnancies is another problem.
As a result, many women may miss screenings, prenatal checkups and other appointments at which early problems might be identified.
Nicolle Gonzales is a nurse midwife and the founder and executive director of Changing Woman Initiative in Santa Fe, New Mexico.
Gonzales, who is Navajo, said women should have 10 to 12 prenatal visits before delivery, but indigenous women are lucky to have half that many.
“That makes it difficult to identify health problems like diabetes and hypertension and obesity, or a baby that’s not growing well in the uterus,” she said. “So there’s a lot of missed opportunities to screen for things that could come up in pregnancy.”
Congress and numerous state legislatures have taken steps recently to address these deaths.
In December 2018, President Donald Trump signed the Preventing Maternal Deaths Act, authorizing the CDC to help support maternal mortality review committees established by states and tribes to collect more data about what’s happening and identify possible solutions. A first round of grant money was awarded in August to 25 states, including more than $2 million over five years to the Arizona Department of Health Services.
Also this fall, U.S. Rep. Xochitl Torres Small, DN.M., introduced legislation meant to specifically help women in rural America by expanding federal telehealth programs to include birth and postnatal services and further identifying gaps in care.
“For pregnant women in rural districts … they often have to spend hours on the road and cross state lines to attend the necessary prenatal appointments,” Torres Small said in announcing the bill. “Expectant mothers should have the peace of mind that no matter where they choose to start a family, they will have access to the resources they need to bring healthy babies into the world.”
Reconnecting, revitalizing
Although some of the women gathered in Window Rock had left the reservation long ago, all shared at least one thing: Navajo roots.
Pam Malone was there to learn how to be an emotional support aide for women throughout their pregnancies. She was inspired after helping her sister during labor — a duty she took on after her mother died.
“That kind of put me in this place of wanting to give back,” said Malone, a program manager at Northern Arizona University in Flagstaff who has no medical training.
“We might hear from our elders that we’re not supposed to talk about death,” Gonzales said. “And so to have a really frank conversation about death and miscarriage and abortion and pregnancy was really the heart of the issue.”
Most importantly, she said, the women felt “held and heard” by one another.