Native American and Alaska Native women continue to face high rates of pregnancy-related deaths, according to recent data from the Centers for Disease Control and Prevention (CDC). In 2024, these groups had the highest pregnancy-related mortality ratio among major demographic groups.
Rhonda Swaney, a member of the Confederated Salish and Kootenai Tribes, shared her experience with inadequate maternal care nearly 50 years ago. After complications during her first pregnancy led to a stillbirth and life-threatening health issues, she reflected on the ongoing challenges Native Americans face in accessing quality maternal care. "It certainly changed my life — the experience — but my life has not been a bad life," she told KFF Health News.
Efforts are underway to address these disparities. Native organizations, the CDC, and some states are working to increase tribal participation in state maternal mortality review committees. These committees investigate deaths related to pregnancy, analyze data, and recommend policies aimed at reducing death rates.
According to CDC data from 2021 based on information from 46 maternal mortality review committees, 87% of maternal deaths in the U.S. were considered preventable. The committees found that most or all deaths among Native American and Alaska Native people could have been prevented.
Federal funding for these state committees comes from the Preventing Maternal Deaths Act signed in 2018. However, this funding is set to expire on January 31 unless Congress approves new appropriations as part of the Labor, Health and Human Services, Education, and Related Agencies bill for fiscal year 2026.
Tribal leaders emphasize that including members of their communities in these reviews is essential for addressing mortality disparities. In 2023, tribal leaders and federal officials discussed several models for improving oversight: creating separate review committees for each tribe or Indian Health Service region; establishing a national committee; or adding Native American subcommittees to existing state panels.
Kim Moore-Salas, co-chair of Arizona's Maternal Mortality Review Committee and chairperson of its American Indian/Alaska Native subcommittee, highlighted the importance of cultural knowledge in these efforts. "Our matriarchs, our moms, are what carries a nation forward," she said.
Mental health conditions and infections were leading causes of pregnancy-related deaths among Native American and Alaska Native women as of 2021. The CDC reported that about two-thirds of these deaths occurred between one week after delivery up to a year postpartum.
The federal government is responsible for providing health care to federally recognized tribes through the Indian Health Service (IHS), but this agency faces chronic underfunding and staffing shortages. A study published in 2024 found that about three-quarters of pregnant people from these populations did not have access to IHS care around childbirth; more than 90% gave birth outside IHS facilities. For those who delivered at IHS facilities, over half received care that did not meet national clinical guidelines according to a report by the Department of Health and Human Services' Office of Inspector General in 2020.
The same study noted that Native American and Alaska Native individuals were less likely than non-Hispanic white people to have stable insurance coverage near childbirth.
Cindy Gamble, Tlingit tribal community health consultant for the American Indian Health Commission in Washington State, has served on her state's maternal mortality review panel for eight years. She observed changes during her tenure: broader representation on panels—including more people of color—and expanded analysis criteria such as suicide, overdose, homicide deaths, racism, and discrimination as risk factors.
"It's not a one-size-fits-all," Gamble said regarding solutions tailored for different tribes due to diverse beliefs and cultures.
Few states include tribal representation on their review committees according to the National Indian Health Board. The National Council of Urban Indian Health is also working with Urban Indian health organizations—serving those living off reservations—to participate in state reviews across several states including California, Kansas, Oklahoma, and South Dakota as of 2025.
Moore-Salas expressed optimism about collaboration between states and tribes: "It shows that state and tribes can work together," she said.
In March 2024 Moore-Salas became Arizona's first Native American co-chair for its Maternal Mortality Review Committee; by 2025 she helped develop guidelines specific for reviewing cases involving American Indian/Alaska Native individuals.
Despite ongoing efforts nationwide—and positive steps like increased representation—progress may be slow due to broader issues such as growing maternity care deserts caused by hospital closures. Experts warn that potential Medicaid cuts could worsen access problems further.
Swaney remains hopeful despite personal loss and continued challenges facing her community. After losing her first child she endured another difficult pregnancy resulting in her son Kelly Camel being born prematurely with severe disabilities; now aged 48 he lives independently with caregiver support.
He "has a good sense of humor. He's kind to other people. We couldn't ask for a more complete child."
