Authors: National Indian Health Board

Publication Year: 2024

Keywords: Culturally Informed Care, Health Care Access, Maternal Mortality and Morbidity, Mental and Behavioral Health, Missing and Murdered Indigenous People (MMIP), Social Determinants of Health (SDOH), Substance Use, Traditional Healing, Pregnancy and Postpartum

Abstract:
Maternal mortality remains an urgent crisis in Indian Country. It is critical to start at the root causes of these deaths and address urgent maternal health needs. Accessing quality healthcare services, developing culturally congruent workforces, increasing community needs assessment efforts, and addressing maternal mental and behavioral health were all mentioned as priority areas for improving maternal health outcomes. Fostering partnerships between Tribal, Federal, and state entities is crucial for implementing policy changes and resource allocation that address the broader social determinants of health, such as poverty, education, and housing, impacting maternal health outcomes.

Maternal Mortality Review (MMR) is a promising method for further investigating the current challenges and successes Tribes and Tribal-serving organizations face when addressing maternal health. Recognizing and including AI/AN perspectives in current maternal mortality review processes is essential for developing effective healthcare policies and recommendations to improve maternal health outcomes, for all.

In general, it is necessary to increase Tribal representation and raise Tribal perspectives at all levels of existing review processes. Additionally, there are opportunities to integrate traditional practices that protect and safeguard Native committee members serving on MMRCs, ensuring they are equipped to conduct effective reviews.

Beyond the existing MMRCs run by state or local governments, Tribal MMRs offer the opportunity to develop models rooted in Tribal sovereignty and data sovereignty with the health and well-being of AI/AN communities at the heart of the review process. Participants of the convening voiced the

need to move toward a more holistic, resilience-based process; this is the opportunity of Tribal MMR. Based on the insight shared in this convening, there is likely no “one size fits all” model of Tribal MMR. Rather, different models or components of different models may best suit the needs of

Tribes in different places and different circumstances, and so flexibility is key. To develop successful Tribal MMR processes, CDC, Tribes, and Tribal-serving organizations will need to carefully consider potential challenges around data access, data quality, fragmented healthcare systems, and privacy concerns in small communities. In addition, fractured relationships and historical mistrust between Tribal, state, and federal governmental entities can make MMRC more difficult, and these relationships must be navigated with care.

While the convening demonstrated notable momentum in efforts to develop Tribal MMR processes, further work is needed. Moving forward will require dedicated, sustained funding directly to Tribes and Tribal organizations. Additionally, time and space are needed for exploration and planning, as

capacity in this area builds. NIHB and CDC Maternal Mortality Prevention Team learned they need to continue to engage partners in strategic planning and expand outreach to collaborate with Tribal leaders and Tribal

Epidemiology Centers, in particular. These outreach efforts will build on the work done in the convening, which continued conversations to advance the development of Tribal MMR, and strengthen them, by bringing partners together to collaborate on what would work best in and for Tribal communities.

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Source: Link to Original Article.

Type of Resource: Reports