Women from Native communities face several economic, logistic, and cultural barriers to high-quality maternal health care, resulting in a significantly higher risk for illness and death compared to White women. According to a new study led by scholars at the University of Minnesota, receiving care through the Indian Health Service could greatly improve maternal care among Native women and reduce the persistent disparities facing Tribal nations.
The Indian Health Service is an agency within the U.S. Department of Health and Human Services that is responsible for providing federal health services to American Indians and Alaska Natives. However, the service does not provide insurance, making it difficult for many Native women seeking maternal care to access the federal network. Through examining data on nearly 13,000 Native women who gave birth between 2016 and 2020, the authors sought out to determine if access to care through the Indian Health Service and health insurance coverage could provide higher quality care for Native women before, during, and after pregnancy.
Although the findings revealed that the majority of participants had not received high-quality maternal care, Native women – both with and without insurance – who used the Indian Health Service reported higher quality prenatal and postpartum care compared to Native women who did not use the federal program. Among Native women who were uninsured before or during pregnancy, access to the Indian Health Service was associated with a 16 percentage point higher care use before pregnancy and a 7 percentage point increase in care during pregnancy.
Notably, access to insurance, specifically Medicaid, did not guarantee high-quality maternal care. Native women who were insured by Medicaid, but did not receive care through the Indian Health Service frequently reported lower-quality healthcare during pregnancy than those who had both Medicaid and access to the Indian Health Service.
Based on their findings, the authors stress that policy efforts to address maternal health inequities for Native women must focus on providing a sufficient investment in Medicaid, the Indian Health Service, and other programs to support high-quality perinatal care.