Overview: American Indian and Alaska Native Maternal Health
American Indian and Alaska Native (AI/AN) populations continue to experience maternal health disparities at alarming rates. In 2021, the pregnancy related mortality ratio was 118.7 maternal deaths for every 100,000 live births—making them 4.9 times more likely to die from pregnancy-related complications than non-Hispanic white women. Underlying causes include infection, mental health conditions, cardiovascular conditions, and hypertensive disorders of pregnancy. Maternal health challenges are closely linked to higher infant mortality rates within AI/AN communities. In 2022, the infant mortality rate for AI/AN populations increased to 9.06 deaths per 1,000 live births (up from 7.46 per 1,000 in 2021), which is twice the infant mortality rate of non-Hispanic whites. For information on contributing factors to AI/AN infant and maternal health disparities, see NCUIH’s Factsheet here.
NCUIH is dedicated to improving maternal and infant health outcomes among AI/AN communities by working to ensure that UIOs are equipped to address these disparities and support Native maternal and infant health.
118.7
maternal deaths per 100,000 live births
4.9
times more likely to die from pregnancy-related complications than non-Hispanic white women
Figure 1: Pregnancy related mortality ratio by race-ethnicity, 2021. Chart from the CDC.
Maternal Health Work at NCUIH
Engaging Urban Indian Organizations in Maternal Mortality Review Committees
By fostering collaboration between Urban Indian Organizations (UIOs) and Maternal Mortality Review Committees (MMRCs), NCUIH aims to strengthen partnerships and increase the capacity of UIOs to engage with MMRC processes and data related to their patient populations and areas of services.
About MMRCs
MMRCs are multidisciplinary groups that convene at the state or local level to comprehensively review maternal deaths that occur during or within one year of the end of pregnancy. They include representatives from public health, obstetrics and gynecology, maternal-fetal medicine, nursing, midwifery, forensic pathology, mental and behavioral health, patient advocacy groups, and community-based organizations. MMRCs contribute to reducing maternal mortality by generating data on causes of maternal death, developing recommendations to prevent maternal deaths, and disseminating findings to policy makers to support implementation of recommendations. Of all AI/AN cases reviewed in 2020, MMRCs determined that 92% of AI/AN maternal deaths were preventable.
Examples of recommendation reports by MMRCs at the state level:
NCUIH and CDC: Working to Expand Access to Maternal Health Resources for Urban AI/AN Communities
Through our partnership with the Centers for Disease Control and Prevention (CDC) and the CDC Foundation, NCUIH is actively working to expand UIO involvement in MMRC processes to address maternal mortality disparities in AI/AN populations.
Through these efforts, NCUIH aims to enhance the role of UIOs in addressing maternal health disparities, ensuring that AI/AN voices are heard in critical policy discussions.
Goals:
- Increase Awareness — Educate UIOs on the importance of engaging with MMRCs.
- Strengthen Partnerships — Facilitate connections between UIOs and state-led MMRCs.
- Improve Data & Insights — Gather and analyze data to identify barriers and opportunities for UIO participation.
- Support AI/AN Maternal Health — Ensure that MMRCs incorporate culturally relevant perspectives and recommendations.
Key Activities:
- Virtual Engagement & Outreach — Hosting informational sessions, recruitment meetings, and peer-to-peer Community of Learning (CoL) events for UIOs.
- Partnership Building — Supporting up to two UIOs annually to establish direct relationships with MMRCs.
- UIOs connected with MMRCs thus far (as of 2025): Bakersfield American Indian Health Project, Kansas City Indian Center, South Dakota Urban Indian Health, Oklahoma City Indian Clinic
- Research & Reporting — Conducting surveys and compiling reports to assess UIO involvement, barriers, and policy recommendations impacting AI/AN people.
- National Representation — Participating in key maternal health convenings and discussions with federal and tribal partners.
Improving Native Maternal Health Policy
NCUIH Policy Priorities
NCUIH’s policy priorities are created after collaborating with UIOs to determine issue areas most important and impactful for the upcoming year. These priorities include recommendations to be made when engaging with the federal government. NCUIH has three policy priorities that align with improving Native maternal health and infant health.
- Strengthen the Ability of the Advisory Committee on Infant and Maternal Mortality to Address Native Maternal and Infant Health.
- Increase the Federal Engagement with Urban Indian Organizations through Urban Confer on the Provision of Health Care to Native Mothers and Infants.
- Ensure Critical Investments in Native Maternal Health.
Policy Work to Improve Native Maternal and Infant Health
- NCUIH Endorses Bicameral Bill to Secure Funding for Native Mothers and Infants (1/10/2024)
- NCUIH Director of Congressional Relations Presented before the AAP CONACH to Highlight NCUIH Policy Priorities and Efforts within the Native Child Health Space (2/28/2023)
- NCUIH Recommendations Included in Report on Improving the Health and Safety of American Indian and Alaska Native Mothers and Infants (1/31/2023)
- NCUIH Endorses Bipartisan Bicameral Bill that Extends Grants to Address Maternal Mental Health and Substance Use Disorders to Urban Indian Organizations (5/17/2022)
- NCUIH Testified before the HRSA Advisory Committee on Infant and Maternal Mortality (ACIMM) (9/14/2022)
- NCUIH-Endorsed Protecting Moms Who Served Act Enacted (12/13/2021)
Engagement with Federal Agencies
- 2025
- 1/10/2025 – Comment to CDC regarding Maternal Health and Tribal Maternal Mortality Review
- In response to the December 4, 2024, listening session, NCUIH requested that the CDC continue to engage in listening sessions on maternal health and Tribal maternal mortality review.
- 1/10/2025 – Comment to CDC regarding Maternal Health and Tribal Maternal Mortality Review
- 2023
- 1/27/2023 – Comment to Administration for Children and Families regarding Tribal Maternal, Infant, Early Childhood Home Visiting Program
- NCUIH requested that ACF host an Urban Confer with UIO leaders to discuss the Tribal MIECHV final report guidance.
- 1/27/2023 – Comment to Administration for Children and Families regarding Tribal Maternal, Infant, Early Childhood Home Visiting Program
- 2022
- 3/9/2022 – Comments to HRSA on Advisory Committee on Infant and Maternal Mortality
- NCUIH made several recommendations to HRSA including establishing an HHS Urban Confer policy; advising HHS Secretary to collaborate with UIOs to gather accurate data; include a tribal and UIO health provider representative on the ACIMM; and create an ACIMM subcommittee dedicated to addressing AI/AN infant and maternal health.
- 8/31/2022 – Comment to HRSA regarding HRSA’s Pediatric Mental Health Care Access Program
- NCUIH requested that HRSA assist in facilitating UIO participation in the PMHCA Program and recommended that HRSA continue to engage with UIOs and develop an Urban Confer policy.
- 3/9/2022 – Comments to HRSA on Advisory Committee on Infant and Maternal Mortality
Recorded Trainings
Expanding Maternal Health Services at Urban Indian Organizations
NCUIH hosted a presentation on starting or expanding maternal health services at Urban Indian Organizations (UIOs). Dr. Tyler Freeman, physician and Director of Family Practice and Specialty Services at the Oklahoma City Indian Clinic (OKCIC), shared his experience developing a full-spectrum OBGYN clinic and provided best practices for building a labor and delivery program at the UIO.
One is Too Many: Together We Can Prevent American Indian and Alaska Native Maternal Deaths
This virtual dialogue addressed American Indian and Alaska Native (AI/AN) maternal mortality, its impact on UIO communities, and introduced Maternal Mortality Review Committees (MMRCs) as a potential maternal mortality prevention mechanism. The event provided a space for open discussion and participant collaboration, where attendees explored the benefits and barriers to UIO participation in MMRCs.
Resources
- NCUIH Knowledge Resource Center
- RSV and Flu Vaccine Toolkit
- AI/AN Infant and Maternal Health Disparities Data
- Pregnancy-Related Deaths Among American Indian or Alaska Native Persons: Data from Maternal Mortality Review Committees in 36 US States, 2017–2019
- HEAR HER Campaign for AI/AN Women who are Pregnant and Postpartum
- MMRC Guides and Tools from CDC
- NCUIH’s Five-Year Public Health Journey: A Summary of Achievements
This webpage is supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $175,000.00 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS, the U.S. Government, or the CDC Foundation.
