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Upstate physician works to create national tribal review board to prevent maternal deaths among Native American women

An Upstate doctor is working to prevent unnecessary maternal deaths among all women, and more specifically among Native American women, who suffer from a higher risk of avoidable death.

A recent report by the CDC found that almost all maternal deaths among American Indian and Alaska Native populations in the United States could have been prevented and in the general population, 80% of these deaths were avoidable.

Brian Thompson, MD, is an assistant professor of obstetrics and gynecology and public health and preventive medicine and a citizen of the Oneida Nation. He serves on New York state’s Maternal Mortality Review Board, which reviews the circumstances around pregnancy-related deaths to identify recommendations to prevent future deaths.

He is also working with the National Indian Health Board to create the first national tribal review board to better understand and prevent maternal mortality among Native women.

“At 93 percent of all maternal mortalities, essentially all Native American maternal deaths are preventable,” he said. “Because of the unique sovereignty of Native communities there is a strong desire for Native people to look at themselves and see what the commonalities are, what the root causes are, but more importantly how can we prevent each and every one of these from ever occurring again.”

The tribal review board is in the early planning stages and faces challenges getting data from all 50 states, including about a dozen that do not have state review boards. But Thompson said the need is urgent.

“Every day that goes by could be another preventable maternal death,” he said. “We have a responsibility to our Native communities, to our Native people who are a matrilineal society. Women are at the forefront.”

Overall, the rate of maternal deaths per 100,000 births has increased steadily in the U.S. since at least 2018. For the overall population, there are 24 deaths per 100,000 births and that number climbs to 55.3 for non-Hispanic blacks.

“The high rate of maternal mortality is not just alarming, it is at a crisis level,” Thompson said. “The number of moms who are passing away during pregnancy or within the first year just continues to increase and it is alarming and heartbreaking.”

Maternal deaths include those that occur during pregnancy, on the day of delivery and up to one year after giving birth.

The leading underlying cause of death varies by race and ethnicity.

Among American Indian and Alaska Native people, mental health conditions and hemorrhage accounted for 50 percent of deaths with a known underlying cause. About 64 percent of deaths occurred between seven days to one year after pregnancy.

Thompson said numbers are higher in minority and Native populations due to several factors including access to care, poverty, lack of transportation, lower rates of having insurance and lower rates of starting first trimester pre-natal care.

“Unfortunately, these things impact people of color more than others,” he said.

There are 9.7 million Native people in the United States. and according to the New York State Minority Health Surveillance report, 27.6 percent of Native Americans live below the poverty level in New York. Thompson said that per capita, health care funding for Native people through the Indian Health Service is significantly lower than Medicaid or Medicare enrollees or veterans.

Thompson said that the Native population in the Central New York region seen at Upstate has the highest rate of pregnancy and pre-pregnancy diabetes, of pregnancy and pre-pregnancy high blood pressure, of smoking and of pre-term delivery.

“When you have a lack of health care resources (money) and you have extreme poverty and socioeconomic conditions to begin with, you end up with a true health care crisis, which is what occurs in Native communities,” he said.

Upstate helps run a health clinic on the Onondaga Nation and is referral site for all Native people in Central New York. But, Thompson said, funding to that clinic has not increased in over a dozen years.

“Part of the solution is a continued commitment from the state to our Native community,” he said. “As well as increasing advocacy and using our expertise to work with the Native communities to increase access and resources.”

Thompson said serving Native populations is central to Upstate’s mission.

“The uniqueness of Upstate, that it is based at the capital of the Haudenosaunee, also known as the Six Nations, that it sits on the land of the Onondaga, we have an inherent commitment to Native people, not only as part of our community, but as part of our mission at Upstate,” he said.