Just hours after Rhonda Swaney left a prenatal appointment for her first pregnancy, she felt severe pain in her stomach and began vomiting.
Then, 25 years old and six months pregnant, she drove herself to the emergency room in Ronan, Montana, on the Flathead Indian Reservation, where an ambulance transferred her to a larger hospital 60 miles away in Missoula. Once she arrived, staff could not detect her baby’s heartbeat. Swaney began bleeding profusely. She gave birth to a stillborn baby and was hospitalized for several days. At one point, doctors told her to call her family. They didn’t expect her to survive.
“It certainly changed my life – the experience – but my life hasn’t been a bad life,” she said KFF Health News.
Although her experiences took place nearly 50 years ago, Swaney, a member of the Confederated Salish and Kootenai tribes, said Native Americans still do not receive adequate maternal care. The data seems to support that belief.
In 2024, the most recent year for which population data is available, Native Americans and Alaska Natives had the highest pregnancy-related death rate among key demographic groups, according to the Centers for Disease Control and Prevention.
In response to this disparity, Indigenous organizations, the CDC, and some states are working to increase tribal participation on national maternal mortality review boards to better identify and address pregnancy-related deaths in their communities. Indigenous organizations are also considering ways for tribes to create their own committees.
National Maternal Mortality Review Boards investigate deaths that occur during pregnancy or within one year of pregnancy, analyze data, and provide policy recommendations to reduce mortality rates.
According to In 2021 CDC data compiled from 46 maternal mortality review boards, 87 percent of maternal deaths in the U.S. were considered preventable. Committees have reported this most, if not allDeaths among Native Americans and Alaska Natives were considered preventable.
State commissions have received federal money through the Preventing Maternal Deaths Act, which President Donald Trump signed into law in 2018.
But the money is expected to dry up on Jan. 31, when the short-term spending bill that ended the government shutdown expires.
Funding for the committees is included in the Labor, Health and Human Services, Education and related agencies appropriations bill for fiscal year 2026. That bill must be approved by the House of Representatives, the Senate and the President to become law.
Native American leaders said involving members of their community in the activities of the Maternal Mortality Review Board is an important step in addressing mortality disparities.
In 2023, tribal leaders and federal officials met to discuss four models: a mortality review commission for each tribe, a commission for each of the Indian Health Service’s twelve administrative regions, a national commission to review all Native American maternal deaths, and the addition of Native American subcommittees to state commissions.
Whatever the model, tribal sovereignty, experience and traditional knowledge are important factors, says Kim Moore-Salas, co-chair of the Arizona Maternal Mortality Review Committee. She is also chair of the panel’s American Indian/Alaska Native mortality review subcommittee and a member of the Navajo Nation.
“Our matriarchs, our mothers, are what moves a nation forward,” she said.
Mental health problems and infections were the leading underlying causes of pregnancy-related deaths among Native American and Alaska Native women as of 2021, according to the CDC report that analyzed data from 46 states.
The CDC found that an estimated 68 percent of pregnancy-related deaths among Native American and Alaska Natives occurred within a week of giving birth to a year after giving birth. The majority of these occurred between 43 days and a year after birth.
The federal government has a responsibility under signed treaties to provide health care to the 575 federally recognized tribes in the US through the Indian Health Service. Tribal members can get limited services for free, but the agency can underfunded and understaffed.
A study published in 2024 Analysis of data from 2016 to 2020 found that about 75 percent of Native American and Alaska Native pregnant women did not have access to care through the Indian Health Service around the time of delivery, meaning many likely sought care elsewhere. More than 90 percent of births to Native Americans and Alaska Natives occur outside IHS facilities. according to the agency. For those who did deliver to IHS facilities: a Report 2020 from the Department of Health and Human Services’ Office of Inspector General found that 56 percent of labor and delivery patients received care that did not meet national clinical guidelines.
The authors of the 2024 study also found that members of the population were less likely to have stable insurance coverage and more likely to experience a lapse in coverage during the period immediately before birth than non-Hispanic white people.
Cindy Gamble, a Tlingit and health adviser for the American Indian Health Commission in Washington, has been a member of the state’s maternal mortality review panel for about eight years. In her time on the state panel, she said, its makeup has broadened to include more people of color and community members.
The panel also began including suicides, overdose deaths and homicides in its data analysis and added racism and discrimination to the risk factors considered during the case review process.
Solutions must be tailored to the tribe’s identity and needs, Gamble said.
“It’s not one-size-fits-all,” Gamble said, “because of all the beliefs and different cultures and languages that different tribes have.”
Gamble’s tenure on the state commission is distinguished. Few states have tribal representation on maternal mortality review boards, according to the National Indian Health Board, a nonprofit organization that advocates for tribal health.
So is the National Council for Urban Indian Health working on enlarging the participation of urban Indian health organizations, which provide care to Native Americans living off reservations, in state maternal mortality review processes. As of 2025, the council had connected urban Indian health organizations to state review boards in California, Kansas, Oklahoma and South Dakota.
Indigenous leaders like Moore-Salas find the current efforts encouraging.
“It shows that the state and tribes can work together,” she said.
In March 2024, Moore-Salas became the first Native American co-chair of Arizona’s Maternal Mortality Review Committee. In 2025, she and other Native American members of the committee developed guidelines for the American Indian/Alaska Native subcommittee and reviewed the group’s first cases.
The subcommittee is exploring ways to make the data collection and analysis process more culturally relevant to their population, Moore-Salas said.
But it takes time for policy changes to create widespread change in the health of a population, Gamble said. Despite efforts across the country, other factors may hinder the pace of progress. For example, the number of maternity care deserts is growing nationally, due to the rapid closure of hospitals and labor and delivery units. Health experts have done that concerns expressed that the coming cuts to Medicaid will hasten these closures.
Despite her experience and the ongoing crisis among Native Americans and Alaska Natives, Swaney hopes for change.
Shortly after her stillbirth, she had a second complicated pregnancy. She went into labor about three months early and doctors said her son wouldn’t make it to the next morning. But he did, and he was transferred some 550 miles from Missoula to the nearest advanced neonatal unit, in Salt Lake City.
Her son, Kelly Camel, is now 48. He has severe cerebral palsy and profound deafness. He lives alone but has caregivers who help with cooking and other tasks, Swaney, 73, said.
He “has a good sense of humor. He is kind to other people. We couldn’t ask for a more well-rounded child.”
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the key operating programs at KFF – an independent source of health policy research, polling and journalism. Learn more about KFF.
This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
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