Maternal Mortality Among American Indian/Alaska Native Women: A Scoping Review.

Background: Maternal mortality decreased globally by about 38% between 2000 and 2017, yet, it continues to climb in the United States. Gaping disparities exist in U.S. maternal mortality between white (referent group) and minority women. Despite important and appropriate attention to disparities for black women, almost no attention has been given to American Indian/Alaska Native (AI/AN) women. The purpose of this scoping review is to synthesize available literature concerning AI/AN maternal mortality. Methods: Databases were searched using the terms maternal mortality and pregnancy-related death, each paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria (e.g., hemorrhage) were paired with initial search terms. Next, pregnancy-associated death was paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria in this category were homicide, suicide, and substance use. Results: The three leading causes of AI/AN pregnancy-related maternal mortality are hemorrhage, cardiomyopathies, and hypertensive disorders of pregnancy. AI/AN maternal mortality data for homicide and suicide consistently include small samples and often categorize AI/AN maternal deaths in an "Other" race/ethnicity, which precludes targeted AI/AN data analysis. No studies that reported AI/AN maternal mortality as a result of substance use were found. Health care characteristics such as quality, access, and location also may influence maternal outcomes and maternal mortality. Conclusions: Despite AI/AN maternal mortality being disproportionately high compared to other racial/ethnic groups, relatively little is known about root causes.

Lifetime and current abuse, pregnancy risks, and outcomes among Native American women.

This study examines the effects of current abuse, battering during pregnancy, and lifetime physical and sexual abuse on pregnancy risks and outcomes among 30 urban Native American women. One-third of the women in this study were battered during the index pregnancy, and nearly two-thirds had been abused by their current partner. All but 3 women had experienced physical or sexual abuse in their lifetime, and nearly three-fourths had been multiply abused. Significant relationships were found between current partner abuse, decreased birth weight, and inadequate prenatal care. The variable, increased lifetime abuse events, was significantly associated with increased risk factors for preterm birth/low birth weight. High rates of substance use and sexually transmitted diseases were noted among women in this study. Further research is needed to examine abuse and relationships between abuse and pregnancy risks and outcomes among Native American women.

Influences of income, education, age, and ethnicity on physical abuse before and during pregnancy.

OBJECTIVE: To examine the influence of socioeconomic status, education, ethnicity, and age on the prevalence of intimate partner abuse before and during pregnancy. DESIGN: Retrospective correlational analysis. SETTING: Data were collected at six postpartum maternity settings. PARTICIPANTS: 1,004 women from six ethnic groups. MAIN OUTCOME MEASURE: Prevalence of intimate partner violence. RESULTS: 15.9% of study participants reported physical abuse by their current partner and 5.2% reported abuse during pregnancy. Decreased income, not having a high school education, and ethnicity were significantly related to current abuse and abuse during pregnancy in bivariate analyses. Having less than a high school education emerged as the most significant predictor of both abuse variables in multivariate analyses. African American and Puerto Rican women had the highest incidence of abuse in their current relationship. No significant differences were found in rates of abuse during pregnancy among women from different ethnic groups. CONCLUSIONS: The results of this analysis support the notion that abuse is most prevalent among the most disadvantaged women. However, it is not income per se, but rather the highly related variables of education and ethnicity that have the largest effect. Abuse occurs frequently among all women, warranting universal screening during health care encounters. Further research is needed to evaluate relationships between education, ethnicity, income, and abuse.

Lifetime physical and sexual abuse, substance abuse, depression, and suicide attempts among Native American women.

Although there is preliminary evidence that violence against women and children may be particularly prevalent in some Native American communities, associations between abuse and substance abuse, mental health problems, and suicide attempts have rarely been studied in this population. This study examined lifetime and current physical and sexual abuse among 30 Native American women. Nearly half had experienced physical and/or sexual abuse as children, over half were sexually abused at some time in their lives, and over three-fourths were abused by a partner. All but four women (87%) had experience physical or sexual abuse in their lifetime. Significant relationships were found among childhood abuse, substance abuse, and adult revictimization, and among cumulative lifetime abuse events, substance abuse, and depression. Further research is needed to examine abuse and relationships between abuse and health sequelae in Native American populations. An accelerated public health and community response is needed to address abuse issues in this community.