Jazmin Orozco Rodriguez and Oona Zenda
Illustration by Oona Zenda
Just hours after Rhonda Swaney left a prenatal appointment for her first being pregnant, she felt extreme ache in her abdomen and began vomiting.
Then 25 years previous and 6 months pregnant, she drove herself to the emergency room in Ronan, Montana, on the Flathead Indian Reservation, the place an ambulance transferred her to a bigger hospital 60 miles away in Missoula. Once she arrived, the workers couldn’t detect her child’s heartbeat. Swaney started to bleed closely. She delivered a stillborn child and was hospitalized for a number of days. At one level, medical doctors instructed her to name her household. They didn’t anticipate her to outlive.
“It certainly changed my life — the experience — but my life has not been a bad life,” she instructed KFF Health News.
Though her experiences had been practically 50 years in the past, Swaney, a member of the Confederated Salish and Kootenai Tribes, stated Native Americans proceed to obtain insufficient maternal care. The knowledge seems to help that perception.
In 2024, the latest 12 months for which knowledge for the inhabitants is out there, Native American and Alaska Native folks had the highest pregnancy-related mortality ratio amongst main demographic teams, in line with the Centers for Disease Control and Prevention.
In response to this disparity, Native organizations, the CDC, and a few states are working to spice up tribal participation in state maternal mortality evaluation committees to higher monitor and deal with pregnancy-related deaths of their communities. Native organizations are additionally contemplating methods tribes might create their very own committees.
State maternal mortality evaluation committees examine deaths that happen throughout being pregnant or inside a 12 months after being pregnant, analyze knowledge, and concern coverage suggestions to decrease demise charges.
According to 2021 CDC data, compiled from 46 maternal mortality review committees, 87% of maternal deaths in the U.S. were deemed preventable. Committees reported that most, if not all, deaths amongst Native American and Alaska Native folks had been thought of preventable.
Our matriarchs, our mothers, are what carries a nation ahead.
Kim Moore-Salas
State committees have obtained federal cash via the Preventing Maternal Deaths Act, which President Donald Trump signed in 2018.
But the cash is scheduled to dry up on Jan. 31, when the short-term spending invoice that ended the federal government shutdown expires.
Funding for the committees is included within the Labor, Health and Human Services, Education, and Related Agencies appropriations bill for fiscal 12 months 2026. That invoice have to be permitted by the House, Senate, and president to take impact.
Native American leaders stated together with members of their communities in maternal mortality evaluation committee actions is a crucial step in addressing mortality disparities.
In 2023, tribal leaders and federal officers met to debate 4 fashions: a mortality evaluation committee for every tribe, a committee for every of the 12 Indian Health Service administrative areas, a nationwide committee to evaluation all Native American maternal deaths, and the addition of Native American subcommittees to state committees.
Whatever the mannequin, tribal sovereignty, expertise, and conventional data are vital components, stated Kim Moore-Salas, a co-chair of the Arizona Maternal Mortality Review Committee. She’s additionally the chairperson of the panel’s American Indian/Alaska Native mortality evaluation subcommittee and a member of the Navajo Nation.
“Our matriarchs, our moms, are what carries a nation forward,” she stated.
Mental well being situations and an infection had been the main underlying causes of pregnancy-related demise amongst Native American and Alaska Native ladies as of 2021, in line with the CDC report analyzing knowledge from 46 states.
The CDC discovered an estimated 68% of pregnancy-related deaths amongst Native American and Alaska Native folks occurred inside every week of supply to a 12 months postpartum. The majority of these occurred between 43 days and a 12 months after delivery.
The federal authorities has a duty beneath signed treaties to offer well being care to the 575 federally acknowledged tribes within the U.S. via the Indian Health Service. Tribal members can obtain restricted providers for free of charge, however the company is underfunded and understaffed.
A study published in 2024 that analyzed knowledge from 2016 to 2020 discovered that roughly 75% of Native American and Alaska Native pregnant folks didn’t have entry to care via the Indian Health Service across the time of giving delivery, that means many probably sought care elsewhere. More than 90% of Native American and Alaska Native births happen exterior of IHS services, according to the agency. For those that did ship at IHS services, a 2020 report from the Department of Health and Human Services’ Office of Inspector General discovered that 56% of labor and supply sufferers obtained care that didn’t comply with nationwide medical tips.
The 2024 research’s authors additionally discovered that members of the inhabitants had been much less more likely to have steady insurance coverage protection and extra more likely to have a lapse in protection throughout the interval near delivery than non-Hispanic white folks.
Cindy Gamble, who’s Tlingit and a tribal neighborhood well being advisor for the American Indian Health Commission in Washington, has been a member of the state’s maternal mortality evaluation panel for about eight years. In the time she’s been on the state panel, she stated, its composition has broadened to incorporate extra folks of shade and neighborhood members.
The panel additionally started to incorporate suicide, overdose, and murder deaths in its knowledge evaluation and added racism and discrimination to the danger components thought of throughout its case evaluation course of.
Solutions have to be tailor-made to the tribe’s identification and wishes, Gamble stated.
“It’s not a one-size-fits-all,” Gamble stated, “because of all the beliefs and different cultures and languages that different tribes have.”
Gamble’s tenure on the state committee is distinctive. Few states have tribal illustration on maternal mortality evaluation committees, in line with the National Indian Health Board, a nonprofit group that advocates for tribal well being.
The National Council of Urban Indian Health can be working to increase the participation of Urban Indian well being organizations, which give look after Native American individuals who dwell exterior of reservations, in state maternal mortality evaluation processes. As of 2025, the council had linked Urban Indian well being organizations to state evaluation committees in California, Kansas, Oklahoma, and South Dakota.
Native leaders similar to Moore-Salas discover the present efforts encouraging.
“It shows that state and tribes can work together,” she stated.
In March 2024, Moore-Salas grew to become the primary Native American co-chair of Arizona’s Maternal Mortality Review Committee. In 2025 she and different Native American members of the committee developed tips for the American Indian/Alaska Native subcommittee and reviewed the group’s first instances.
The subcommittee is exploring methods to make the info assortment and evaluation course of extra culturally related to their inhabitants, Moore-Salas stated.
But it takes time for coverage modifications to create widespread change within the well being of a inhabitants, Gamble stated. Despite efforts across the nation, different components could hinder the tempo of progress. For instance, maternity care deserts are rising nationally, attributable to speedy hospital and labor and supply unit closures. Health specialists have raised concerns that upcoming cuts to Medicaid will hasten these closures.
Despite her expertise and the continuing disaster amongst Native American and Alaska Native folks, Swaney hopes for change.
She had a second difficult being pregnant quickly after her stillbirth. She went into labor about three months early, and the medical doctors stated her son wouldn’t dwell to the subsequent morning. But he did, and he was transferred about 525 miles away from Missoula to the closest superior neonatal unit, in Salt Lake City.
Her son, Kelly Camel, is now 48. He has extreme cerebral palsy and profound deafness. He lives alone however has caregivers to assist with cooking and different duties, stated Swaney, 73.
He “has a good sense of humor. He’s kind to other people. We couldn’t ask for a more complete child.”
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working applications at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
USE OUR CONTENT
This story could be republished free of charge (details).
