The United States is in the midst of a maternal health crisis. Indigenous and Alaska Native peoples are 2.3 times more likely to die from pregnancy-related complications than their white counterparts. In Alaska, unequal socio-economic status, lack of access to hospitals and quality health services, systemic racism, and a history of colonization drive these disparities in maternal health outcomes. “Weathering”—the deterioration of communal health outcomes caused by persistent socio-economic disadvantages—contributes to many poor maternal health outcomes for Alaska Native women. On top of these systemic problems, climate change impacts threaten to widen the existing disparities for Alaskan Native women.

In Part 1 of this series, we explored some of the impacts of climate change on maternal health. To ensure a safe pregnancy and birth, women living in rural areas of Alaska often travel hundreds of miles to access quality maternal health services. Rapidly accelerating permafrost thaw and erosion threatens the integrity of critical physical infrastructure, like hospitals, tarmacs, and roads providing access to hospitals, making it even harder for Alaska Native women to access health services. Additionally, thinning ice and rising temperatures threaten subsistence food sources and safe food storage, contributing to increased food insecurity for Alaska Native peoples. These mounting challenges endanger the health and safety of communities. In Part 2 of this series, we will explore solutions to these issues and the importance of a human security approach.

Community-Led Models of Care Improve Maternal Health

Elevating and supporting Alaska Native-led work at the community level is essential to improving maternal health outcomes. When Indigenous peoples only interact with the conventional American healthcare system, they are directly exposed to structural inequities, exacerbating the impacts of weathering. These inequities include implicit biases, racism, and a lack of respectful maternity care. In contrast, interventions led by Indigenous people and communities in Alaska can address the root causes of poor maternal health outcomes—structural racism and a legacy of colonialism—and provide culturally-appropriate care.

Community-based models of care hinge on community participation, allowing members of the community more control over how they receive health services. Research shows that these models of care ultimately narrow health disparities across racial and ethnic groups because they address the social factors and barriers that impact maternal and infant health. Providing quality health services within communities lowers the cost of care and allows women to be secure in their homes with their families during pregnancy, birth, and postpartum.

Furthermore, moving towards distributed community-based maternal health services reduces reliance on the centralized infrastructure impacted by climate change. Embracing a more holistic community-based care system reduces the risk of pregnancy-related complications associated with climate change in Alaska.

Indigenous Knowledge and Local Organizations Benefit Alaska Native Women

Community-led programs are rooted in cultural traditions and norms that support women and their families during and after pregnancy. Organizations such as the Alaska Native Birthworkers Community elevate and promote Indigenous midwifery, which improves access to health services and maternal health outcomes. Southcentral Foundation—a non-profit that serves nearly 65,000 Indigenous and Alaska Native people and 55 rural villages in southcentral Alaska—leads the Nutaqsiivik Nurse-Family Partnership. The Partnership pairs registered nurses with families, mothers, and infants to provide supplemental education and support to regular prenatal care and well-child checkups.

The Alaska Native Birthworkers Community and Southcentral Foundation both show the potential for improving maternal health outcomes by combining approaches to maternal health care. By applying Indigenous knowledge to a biomedical model of care, Indigenous-led organizations are able to honor and benefit from tribal birth practices, provide mental health and family wellness counseling, and support women through pregnancy and the postpartum period.

Supporting Indigenous organizations’ initiatives to address the impacts of climate change on health services and food security in the Arctic would also bolster maternal health. For example, the Alaska Native Tribal Health Consortium addresses food insecurity through traditional food programs that promote Alaska Native health. As climate change is a major threat to traditional food sources, supporting these initiatives helps ensure that Alaska Native women and children receive proper nutrition.

“We are on the forefront of these changes,” writes the Inuit Food Security Project, a project run by the Inuit Circumpolar Council (ICC) to investigate the impacts of climate change on food security for Inuit peoples. Over generations, Alaska Native peoples have inherited crucial knowledge about the Arctic and northern environment and, today, they directly experience the intersection of climate change and health. “We have lived here for millennia and have grown and changed with all that is around us,” says the ICC.

Applying a Human Security Approach to Policy Change

Women are essential to the stability and prosperity of communities and are the primary providers of caregiving work. A “human security” approach to maternal health in Alaska —i.e., identifying and addressing widespread and cross-cutting challenges to people’s survival, livelihood, and dignity—can recognize the role women’s health and safety play in supporting strong societies. Applying this approach will better inform interventions that more sustainably and effectively address the maternal health crisis, as well as address the root causes of inequities and center Alaska Native people’s lived experiences.

Bringing together stakeholders from wide-ranging areas of expertise, like climate change, public health, security, and development can contribute to policy solutions that improve maternal health outcomes and combat health disparities. In addition to considering new policies and interventions focused on this approach, funding and institutional support for the many Alaska Native-run programs that are already in place should be prioritized. By concentrating on Indigenous knowledge, policies and programs can elevate Alaska Native peoples’ expertise to improve maternal health, address disparities, and mitigate the growing impacts of climate change. Without prioritizing Indigenous women’s health, well-being, and safety, the resources and interventions intended to serve Alaskan communities will miss the mark.

Read more:

• Community health workers serve as the link between the community and the response team
• Community leaders can also be climate change “champions”
• The resurgence of Indigenous midwifery is an “anti-colonial” act
• “Navigating the Poles” explores shifting realities in the Arctic