Each year, 700 women in the United States die as a result of pregnancy-related complications. In fact, the United States has the highest maternal mortality ratio of all high-income countries—16.7 maternal deaths per 100,000 live births. For Indigenous/Alaskan Native women, that number is even higher: Indigenous/Alaska Natives are 2.3 times more likely to die from pregnancy-related complications than their white counterparts. While recent years have seen growing national attention to the U.S. maternal mortality crisis, research and advocacy for Indigenous peoples’ maternal health in the United States has been limited. This research gap includes the Alaskan Native peoples—Iñupiat, Yupik, Aleut, Eyak, Tlingit, Haida, Tsimshian, and multiple Diné tribes.

Significant disparities in socioeconomic status, access to health services, and other health conditions contribute to worse maternal health outcomes for Alaska Native women. Due to the scarcity of hospitals, safe and accessible roads, and the unreliability of other forms of travel like planes and snowmobiles, Alaska Native women are less likely to have access to health services. The lasting legacy of colonialism and ongoing systemic racism that Alaska Native peoples face also impacts their social determinants of health—including socio-economic status, social norms, quality of education, and access to economic opportunities. The acceleration of unmitigated climate change effects, like permafrost thaw, will likely widen existing disparities in health and socio-economic status. Together, these challenges create several obstacles to community health and prosperity. Solutions to address poor maternal health outcomes and health disparities in Alaska must take a holistic and interdisciplinary approach.

Drivers of Disparities in Maternal Health for Alaska Native People

At 8.3 maternal deaths per 100,000 live births maternal mortality ratio is lower than the national average, yet this does not hold true for Alaska Native women. The maternal mortality ratio for Alaska Native women is 19.2 deaths per 100,000 live births, which is higher than the national average. This disparity persists in infant mortality, with an Alaska Native infant being four times more likely to die in their first year than a white infant in Alaska. In addition, Indigenous and Alaskan Native women’s race is often misclassified on medical records, suggesting that rates of Alaskan Natives’ maternal and infant deaths are likely underestimated.

Trauma caused by systemic racism, forced migration, reproductive coercion, and cultural erasure of Indigenous peoples’ history and culture contributes to “weathering“—the deterioration of communal health outcomes caused by persistent socio-economic disadvantages. Research shows that weathering contributes to many poor maternal and infant health outcomes for Alaskan Native people. A history of colonization and ongoing discrimination also contribute to gender-based violence, substance abuse, and mental health risks, which widen gaps in maternal health outcomes.

A lack of access to health services is another prominent barrier to improving maternal health disparities in Alaska. Indigenous and Alaskan Native women are less likely to live near maternity care facilities and are less likely to have health insurance than their white counterparts across the United States—21 percent of Indigenous women are uninsured compared to 8 percent of white women. Limited access to health services can lead to higher rates of non-communicable diseases, which have been shown to worsen maternal health outcomes. Even when health services and infrastructure are available, many Indigenous women have negative experiences with health care providers due to implicit biases, racism, and a lack of respectful maternity care.

Melting Permafrost Threatens Health Services in Rural Alaska

The growing burden of climate change threatens to worsen these health disparities and contributes to the weathering experienced by Alaska Natives, who face imminent risks from climate change. Relocation and migration due to sea-level rise and coastal erosion exacerbate the impact of weathering, further undermining maternal and child health and development.

Climate change also threatens the very ground on which critical physical infrastructure, like hospitals and roads to those hospitals, is built. Currently, 80 percent of Alaska rests on groundcover that overlays permafrost (ground that has been completely frozen for at least two years). In recent years, climate change has led to permafrost thawing at increased levels, undermining the integrity of a vast amount of infrastructure in the Arctic.

Moreover, Alaska Native women from rural areas often live far from hospitals and maternal health services. For example, the town of Bethel, Alaska provides medical services to people who live in villages and communities in a 350-mile radius. The unreliability of roads and other forms of travel like planes or snowmobiles—due to permafrost thaw and increasingly variable winter weather—requires many women to meet their “be in Bethel” date at least 30 days before their due date. Women often must leave their families and communities weeks before they give birth just to help ensure a safe pregnancy and birth. Solutions that focus on providing community-based care—like Indigenous midwifery—allow Alaska Native women to receive culturally appropriate care in their homes from qualified health care providers.

Climate Change Impacts Alaskan Native Food Sources and Nutrition

At least 19 percent of Alaska Native peoples experience food insecurity; in rural areas, this is as high as 25 percent. Climate change will disproportionately affect Alaska Native people and their maternal and child health outcomes by further complicating food security in the region. Subsistence food sources are significant sources of nutrition for Alaska Native peoples, especially women. With thinning ice and rising temperatures, harvesting and safely storing wild foods is more difficult and dangerous, contributing to increased food insecurity and poor nutrition. Food security in Alaska is also threatened by oceanic and atmospheric currents shifting due to a warming climate, which can deposit pollutants and contaminants into food and water sources.

As policymakers take steps to address climate risks in the Arctic, and in Alaska more specifically, recognizing the connections between climate change and maternal health in those policies could strengthen both the climate response and maternal health outcomes of Alaska Natives. Not doing so risks exacerbating existing disparities. In part 2 of this 2-part series, we will discuss the importance of taking a community-based approach to improve maternal health and resilience to the impacts of climate change, as well as the importance of honoring Indigenous knowledge.

Read More:

• Heat exposure due to climate change worsens maternal health outcomes, especially for minority women
• COVID-19 disproportionately impacts maternal health for minority populations
• Permafrost melt and sea level rise endangers Arctic communities
• Dramatic changes in the Arctic’s environment merits more investment in research