“It took me three bus rides to get to my prenatal care appointment today.”
“When I went into labor, we had to drive 200 miles to get to the nearest hospital.”
“The border crossing was closed for the night. We drove around through another state to get here for care.”
These stories of lived experience may be familiar to staff who have provided care to families in the Indian Health Service. Since 2020, 124 rural hospitals have closed their maternity units or plan to close them before the end of this year, representing a 12 percent reduction in rural labor and delivery (L&D) services (Center for Healthcare Quality & Payment Reform, 2026). Over one-third of U.S. counties are now considered maternity care deserts, with no access to L&D, OB/GYNs, midwives, or family practice providers. In 2022, nearly 1 in 10 babies were born to American Indian and Alaska Native (AI/AN) women living in areas without access to care (March of Dimes, 2024).
Data does not always capture the full story, and we must acknowledge that there are systemic gaps and barriers to maternity care that contribute to inequities for Native women. The additional effects of historical trauma can last for generations and, together with adverse childhood experiences and social drivers of health, such as transportation or access to electricity and clean running water, disproportionately affect AI/AN communities. This can contribute to a higher rate of co-morbidities, including mental health conditions and substance use, and mistrust or avoidance of seeking health care.
The Indian Health Service has adapted innovative approaches to increase access to care in the community and support families during and after pregnancy. The goal of the Maternal and Child Health (MCH) program is to bring national resources into the Native community. It is also important that our initiatives and efforts lead with, to transform and ensure that the health system is led by the people it serves.
In response to the closure of rural labor and delivery units, IHS developed an Obstetric Readiness in the Emergency Department (ObRED), which provides tools and training for sites without obstetric services to provide safe care during obstetric emergencies. The manual includes checklists, protocols, and training curriculum. Over 458 staff have participated in ObRED training and reported increased confidence in managing obstetric emergencies and improved safety and outcomes for pregnant patients and newborns.
To address preventable maternal morbidity, IHS launched a Maternal Child Health Funding Opportunity for sites to improve access to culturally safe care in Tribal communities. The funding it provides helps support maternity care coordinators and the purchase of equipment, supplies, and training. The program has successfully awarded 11 sites across seven Areas with $12 million over the next five years to reach more than 12,000 pregnant and postpartum patients and their families.
To provide on-demand continuing education and consultation in the field, IHS is proud to have partnered with the Northwest Portland Area Indian Health Board to create the Indian Country ECHO Pregnancy Care and Access series. From 2024–2025, the learning series reached 1,861 participants in 37 states and 275 Tribes and urban Indian organizations. Topics include Indigenous birthing practice, maternal mental health, substance use, cardiovascular health, field testing and treatment for syphilis, and pregnancy loss and stillbirth. In 2024, 94 percent of participants that were surveyed reported an increased understanding of the topic, while 65 percent reported they were likely or very likely to change practices after participating in the series.
For additional maternal and child health resources, please visit the IHS MCH Website to access the IHS Obstetric Readiness in the Emergency Department (ObRED) Manual, Pediatric Primary Care Toolkit, CDC’s Hear Her campaign on early maternal warning signs, and HRSA’s Maternal Mental Health Hotline. For questions, reach out to IHSMCH@ihs.gov.
