Native Americans die of pregnancy. They want a voice to stop the trend.

Just hours after Rhonda Swaney left a prenatal appointment for her first pregnancy, she felt intense pain in her stomach and began vomiting.

Then 25 and six months pregnant, she went to the emergency room in Ronan, Mont., on the Flathead Indian Reservation, where an ambulance transferred her to a larger hospital 60 miles away in Missoula. Once she arrived, staff couldn’t detect her baby’s heartbeat. Swaney began bleeding profusely. She delivered a stillborn baby and was hospitalized for several days. At one point, doctors told him to call his family. They didn’t expect her to survive.

“It’s definitely been life-changing — the experience — but my life hasn’t been a bad life,” she told KFF Health News.

Although his experiences date back nearly 50 years, Swaney, a member of the Confederated Salish and Kootenai Tribes, said Native Americans continue to receive inadequate maternal care. The data seems to support this belief.

In 2024, the most recent year for which population data is available, American Indians and Alaska Natives had the highest pregnancy-related mortality rate among major demographic groups, according to the Centers for Disease Control and Prevention.

In response to this disparity, Native organizations, the CDC, and some states are working to increase tribal participation on national maternal mortality review committees to better track and address pregnancy-related deaths in their communities. Native organizations are also considering how tribes could create their own committees.

National Maternal Mortality Review Committees investigate deaths occurring during pregnancy or in the year following pregnancy, analyze the data, and make policy recommendations aimed at reducing mortality rates.

According to 2021 CDC data, compiled from 46 maternal mortality review panels, 87% of maternal deaths in the United States were deemed preventable. The committees reported that most, if not all, deaths among American Indians and Alaska Natives were considered preventable.

Our matriarchs, our mothers, are what move a nation forward.

Kim Moore Salas

State committees received federal money as part of the Preventing Maternal Deaths Act, signed by President Donald Trump in 2018.

But the money is expected to dry up on Jan. 31, when the short-term spending bill that ended the government shutdown expires.

Funding for the committees is included in the Labor, Health and Human Services, Education, and Related Agencies appropriations bill for Fiscal Year 2026. This bill must be approved by the House, Senate, and President to take effect.

Native American leaders said including members of their communities in the Maternal Mortality Review Committee’s activities was an important step in addressing mortality disparities.

In 2023, tribal leaders and federal officials met to discuss four models: a mortality review committee for each tribe, a committee for each of the Indian Health Service’s 12 administrative regions, a national committee to review all Native American maternal deaths, and the addition of Native American subcommittees to state committees.

Regardless of the model, tribal sovereignty, experience and traditional knowledge are important factors, said Kim Moore-Salas, co-chair of the Arizona Maternal Mortality Review Committee. She is also chair of the American Indian and Alaska Native Mortality Review Subcommittee and a member of the Navajo Nation.

“Our matriarchs, our mothers, are what move a nation forward,” she said.

Mental health issues and infections were the leading underlying causes of pregnancy-related deaths among American Indian and Alaska Native women in 2021, according to the CDC report analyzing data from 46 states.

The CDC found that about 68% of pregnancy-related deaths among American Indians and Alaska Natives occurred within a week of giving birth to up to a year after giving birth. The majority of them occurred between 43 days and a year after birth.

The federal government has the responsibility under signed treaties to provide health care to the 575 federally recognized tribes in the United States through the Indian Health Service. Tribal members can receive limited services free of charge, but the agency is underfunded and understaffed.

A study published in 2024 analyzing data from 2016 to 2020 found that about 75% of American Indian and Alaska Native pregnant women did not have access to Indian Health Service care at the time of delivery, meaning many likely sought care elsewhere. More than 90% of American Indian and Alaska Native births take place outside of IHS facilities, according to the agency. For those who gave birth in IHS facilities, a 2020 report from the Department of Health and Human Services Office of Inspector General found that 56% of labor and delivery patients received care that did not follow national clinical guidelines.

The 2024 study authors also found that members of the 2024 population were less likely to have stable insurance coverage and more likely to experience a lapse in coverage in the period near birth than non-Hispanic white people.

Cindy Gamble, a Tlingit and tribal community health consultant for the American Indian Health Commission in Washington, has been a member of the state’s maternal mortality review committee for about eight years. Since serving on the state panel, she said, its membership has expanded to include more people of color and community members.

The committee also began including deaths by suicide, overdose and homicide in its data analysis and added racism and discrimination to the risk factors considered during its case review process.

Solutions must be tailored to the identity and needs of the tribe, Gamble said.

“It’s not a one-size-fits-all solution,” Gamble said, “because of all the beliefs, different cultures and languages ​​that different tribes have.”

Gamble’s tenure on the state committee is distinctive. Few states have tribal representation on maternal mortality review boards, according to the National Indian Health Board, a nonprofit organization that advocates for tribal health.

The National Council on Urban Indian Health also works to increase the participation of urban Indian health organizations, which provide care to Native Americans living off reservations, in state maternal mortality review processes. Since 2025, the council had connected urban Indian health organizations with state review boards in California, Kansas, Oklahoma and South Dakota.

Indigenous leaders such as Moore-Salas find the current efforts encouraging.

“It shows that the state and tribes can work together,” she said.

In March 2024, Moore-Salas became the first Native American co-chair of Arizona’s Maternal Mortality Review Committee. In 2025, she and other Native American members of the committee developed guidelines for the American Indian and Alaska Native subcommittee and reviewed the group’s first cases.

The subcommittee is exploring ways to make the data collection and analysis process more culturally relevant to their population, Moore-Salas said.

But it takes time for policy changes to lead to widespread changes in a population’s health, Gamble said. Despite efforts across the country, other factors could slow the pace of progress. For example, maternity care deserts are growing nationwide, due to the rapid closure of hospitals and labor and delivery units. Health experts have expressed concerns that upcoming cuts to Medicaid would accelerate these shutdowns.

Despite his experience and the current crisis among American Indians and Alaska Natives, Swaney is hopeful for change.

She had a complicated second pregnancy shortly after her stillbirth. She went into labor about three months early and doctors said her son would not live until the next morning. But he did, and he was transferred about 525 miles from Missoula to the nearest advanced neonatal unit in Salt Lake City.

His son, Kelly Camel, is now 48 years old. He suffers from severe cerebral palsy and profound deafness. He lives alone but has caregivers to help him with cooking and other tasks, Swaney, 73, said.

He “has a good sense of humor. He is kind to others. We couldn’t ask for a more well-rounded child.”

Related topics

Contact Us Submit a Story Tip