Many Head Start families may experience health disparities, which are differences in health outcomes based on their race, economic status, or other factors. Health disparities may be the result of not having access to resources, such as healthy food, safe neighborhoods, or preventive health care.
American Indian and Alaska Native (AIAN) people experience higher rates of poverty, less health insurance coverage, and reduced access to quality health care services than other populations. These barriers to accessing health care are often driven by racism and discrimination.
One area with major health disparities is birth outcomes. The United States has the highest maternal death rates of any wealthy nation in the world, and AIAN pregnant and postpartum women and people and their babies have higher rates of death than their white counterparts. They are more likely to die because of a long history of inequality often referred to as systemic oppression. When unfair systems target certain populations, it is considered systemic racism. It has a huge impact on maternal health outcomes in the United States.
Note: This document uses the term "pregnant and postpartum women and people" to refer to anyone who gives birth, regardless of their gender identity, which may be female, male, nonbinary, or other. For more information about inclusive language, read Exploring a Nonbinary Approach to Health.
Historical Trauma
Historical trauma refers to the collective trauma experienced over time and across generations, related to forced assimilation, colonization, and genocide of AIAN people. Ongoing and historical trauma negatively affects the health of AIAN people. They are more likely to experience chronic health conditions and mental health problems such as depression, suicidal ideation, and substance use. This trauma can also lead to a lack of trust with health care providers, which can affect the ability of AIAN pregnant and postpartum women and people to access prenatal and postpartum health care.
Racial Disparities in Birth Outcomes for AIAN Pregnant and Postpartum Women and People
AIAN pregnant and postpartum women and people experience stark racial disparities in birth outcomes. For example, they are:
- Two times more likely than white women to die of pregnancy-related causes. AIAN infants are nearly twice as likely as white infants to die before their first birthday.
- More likely to have preterm births, babies with low birth weight, or births for which they received late or no prenatal care compared to white women.
- AIAN women and people who receive pregnancy-related care late in a pregnancy or not at all have an increased risk for pregnancy complications.
- The same is true for those who do not receive treatment that is inclusive of traditional cultural birth practices found in indigenous communities.
- More likely than white women to live in rural areas with decreased access to health care services. Often, AIAN families living in rural areas travel over 100 miles to access care and often can’t attend health care appointments because they lack transportation.
- More likely to use substances (e.g., amphetamine, alcohol, cannabis) compared to women from other ethnicities.
- More likely to have chronic hypertension and preexisting diabetes compared to white women.
- Likely to have difficulty accessing culturally appropriate health care.
- More likely to have postpartum depression versus people from other ethnicities.
Racial Bias Plays a Role in Maternal Deaths
Maternal Mortality Review Committees (MMRCs) are multidisciplinary committees in states and cities that perform comprehensive reviews of deaths within a year of the end of a pregnancy. MMRC members have reported that bias and discrimination play significant roles as contributing factors leading up to maternal deaths.
How Head Start Programs Can Help
As many as eight out of 10 pregnancy-related deaths are preventable. Head Start services can address pregnancy-related health disparities by recognizing the role of structural and systemic racism and discrimination in contributing to worse health outcomes for AIAN families. Despite these challenges, culture and tradition are protective factors that support the resilience of AIAN expectant families.
Programs can help families overcome barriers to accessing health care before, during, and after pregnancy. Refer to How Head Start Services Can Improve Birth Outcomes for tips to improve services for expectant families.
Learn More
Check out Hear Her – Resources for American Indian and Alaska Native (AIAN) People Campaign from the Centers for Disease Control and Prevention. It has resources for pregnant and postpartum women and people, their family members, and health care providers.
Find recommendations to address health disparities faced by AIAN pregnant and postpartum women and people by reading American Indian and Alaska Native Women’s Maternal Health: Addressing the Crisis.
View webinar recordings on topics related to supporting AIAN expectant families by visiting Inter-Tribal Council of Arizona Pregnancy and Postpartum Webinar Series for Pregnant People and Families.
Last Updated: September 18, 2024