Higher quality maternity care associated with Indian Health Service access

A new study by the University of Minnesota School of Public Health, published in Health Affairs, examined how well the health care system functioned for pregnant Native American and Alaska Native women.

Native people experience significant financial, logistical and cultural barriers to maternal health care and face double the risk of illness and death compared to white people.

Many Native communities access health care via the Indian Health Service, a system of federally-operated health care facilities that provides care to tribal citizens and other eligible individuals in fulfillment of the government’s federal trust obligation. However, not all Native people are eligible for, or can easily access, Indian Health Service care. Because the Indian Health Service is not an insurance provider, most Native pregnant women are covered by Medicaid, private insurance or are uninsured.

The researchers looked at the relationship between access to Indian Health Service care and health insurance coverage on medical services and quality of care before, during and after pregnancy. Analyzing data from 12,920 Native American and Alaska Native women who gave birth between 2016 and 2020, the researchers found:

• Native women with access to the Indian Health Service reported higher quality of care compared to those without access. Among uninsured Native women, access to Indian Health Service care was associated with a 16 percentage point increase in use of care before pregnancy, and a seven percentage point increase in use of prenatal care.
• Over half of those surveyed were not receiving high-quality pre-pregnancy care. Fewer than one in five people received high-quality care before pregnancy, and fewer than half received high-quality care postpartum.
• While Medicaid was the most common form of insurance, it did not guarantee high-quality care before, during and after pregnancy. Pregnant Native women with Medicaid, but without access to Indian Health Service care, often received lower-quality care compared to individuals with both Medicaid and access to the Indian Health Service.

“It was compelling to see the significant impact of the Indian Health Service and health insurance coverage in supporting high-quality care,” said Julia Interrante, a researcher in the School of Public Health and lead author. “These findings offer insights that policymakers could use to address critical gaps in maternal health care and improve the health and well-being for Native women, their families and the broader community.”