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Could Indigenous Midwifery Improve Maternal Health for Native Women?

It was a chilly Wednesday in January when Kaylynn Begaye, six months pregnant, walked into the lobby of the Changing Woman Initiative, her mother, Christine, by her side. Begaye, 33, found herself in this clinic in Santa Fe, N.M., after one too many doctor visits in nearby Albuquerque had left her stressed out. Since giving birth to a son eight years ago, followed by a daughter five years later, Begaye, who is Diné (Navajo), said the treatment she endured during both of those deliveries left her dreading having to go through it all over again: getting separated from her newborns at birth without her consent, being rushed out of her hospital room while still in postpartum recovery, seeing her family treated poorly by a mostly white staff. The birth of her third baby would be different, she vowed. This time, it would be on her own terms.

The hostility that Begaye says she encountered from health workers is a common complaint among Indigenous women, although one that’s only beginning to be taken seriously. Those complaints align with stories that surfaced after news reports revealed the country’s disproportionate maternal mortality rate among Black women. According to one study, nearly a quarter of Native patients reported experiencing racial discrimination while visiting a doctor or health clinic, and 15 percent of those surveyed also said they avoided seeking health care altogether because they feared mistreatment. It’s easy, then, to understand why expectant Native mothers like Begaye are more likely to receive late or no prenatal care in New Mexico than non-Hispanic white mothers, a trend that matches national averages. But the data isn’t often interpreted this way.

“If you look at the data and you don’t know us, you make assumptions that we just don’t care, that we don’t go to appointments,” said Nicolle Gonzales, a Diné certified nurse-midwife and the founder of the Changing Woman Initiative, a birth center explicitly intended to serve the Indigenous community. “There are all these other issues. That’s why the data looks the way it does.”

There are many systemic factors that hinder Native American maternal health—problems arising from a legacy of neglect regarding Indigenous life. Today, many pregnant Native women lack insurance or struggle to find transportation to their medical appointments. Others face hurdles finding affordable housing or dealing with abusive partners and domestic violence.

Since 2015, Gonzales has been increasing the reach of her nonprofit health care collective, in part to respond to a broken health care system that has marginalized Native women. Although the Indian Health Service provides perinatal care at many of its 24 hospitals and 51 health centers across the country, a majority of these chronically underfunded facilities are overcrowded with patients, understaffed with medical experts, and, in the case of one facility last summer, unreliable. In August, dozens of Native mothers suddenly found themselves without health care when the Phoenix Indian Medical Center announced that it was closing. The obstetrics unit was being shuttered because of staffing problems, the IHS said. Some women were mere weeks away from giving birth. The center has since reopened, but only partially. The delivery ward remains closed, meaning expectant mothers are transferred to other facilities across Phoenix between their 32nd and 34th weeks of pregnancy. In response to this disservice, patients have mounted peaceful demonstrations, holding signs that read “Honor Native women.” They want answers from the IHS, but more than anything, they just want their treaty-protected health care back.

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