Mental Health Conditions Are the Dominant Underlying Cause of Maternal Death for American Indians and Alaska Natives

Source: Centers for Disease Control and Prevention. (2026). Pregnancy-related deaths among American Indian or Alaska Native women: Data from Maternal Mortality Review Committees. https://www.cdc.gov/maternal-mortality/php/data-research/mmrc/aian.html?cove-tab=1

*Pregnancy-related deaths, or deaths during or up to one year postpartum

+Data are from 45 states that shared MMRC data—i.e., all states except Idaho, Nevada, North Dakota, Texas, and Vermont.

**Includes COVID-19

NOTE: Other causes (e.g., pulmonary conditions, injury, embolism) each accounted for roughly 3 percent of deaths.

Compiled data from 45 Maternal Mortality Review Committees (MMRCs) across the country—which review maternal deaths to understand their underlying causes and make recommendations to prevent future deaths—provide these and other insights into AIAN maternal health. For example, the data indicate that over 75 percent of AIAN maternal deaths in 2022 occurred postpartum. During postpartum, life gets more complicated as families juggle their recovery from birth while feeding and caring for an infant and dealing with disrupted sleep, potential work expectations, and minimal public and clinical supports. It is crucial that AIAN mothers have access to high-quality mental health supports, especially during this time.

In addition to determining the underlying cause of death, MMRCs can also identify other factors they think may have contributed.* In the case of AIAN maternal deaths in 2022, MMRC members thought substance use disorders contributed to roughly 44 percent and discrimination to 50 percent. These details broaden our understanding of what drives AIAN maternal deaths and how best to prevent them. For example, the data show that investments in integrated behavioral health services are likely to more effectively prevent maternal deaths than mental health services alone.

MMRCs also determine whether a maternal death was preventable. A maternal death is considered preventable if there was a chance it could have been avoided with reasonable changes to patient-, family-, provider-, facility-, system-, and/or community-level factors. Nationwide, roughly 80 percent of maternal deaths are considered preventable, but MMRCs determined that 94 percent of AIAN maternal deaths in 2022 were preventable. While individual-level factors may immediately come to mind when considering how to prevent maternal deaths due to mental health, 62 percent of MMRC recommendations are at the system (30%), provider (20%), or facility (13%) levels. As the bulk of AIAN maternal deaths are postpartum, more robust postpartum supports are a systemic change that could likely help.

Strong data are a critical input to expanding AIAN families’ access to supportive services (e.g., through policy, financing, and practice changes). While the data highlighted in this publication signal important progress in understanding AIAN maternal mortality in the United States, data with the following characteristics are pivotal to building more accessible, high-quality mental health supports for families during the perinatal period:

1. Timely and coordinated: The data reported in this publication reflect maternal deaths that occurred in 2022 but are being reported on in 2026. A National Indian Health Board (NIHB) report from a 2025 convening of Tribal MMRCs identified a lack of infrastructure for data sharing across agencies and states—while protecting Tribal data sovereignty—as a key issue. Recent federal legislation has increased authorized funding for MMRCs through 2030 to $100,000, which—if allocated—could give Tribal MMRCs time and resources to improve data sharing.
2. Informed by community: The same NIHB report highlighted that MMRCs should engage Tribal members as decision makers, rather than simply inviting them as a symbolic gesture. Further, data on AIAN maternal health should include other data sources meaningful for Tribal communities and contexts. For example, storytelling is an important tradition for many Tribes, and qualitative approaches may be particularly valuable given smaller populations within specific Tribal Nations and communities.
3. Higher quality: While AIAN maternal health data are dominated by deficits (e.g., mortality) and paint a grim national picture of this population’s well-being, we know that AIAN mothers’ strengths and the challenges they experience vary by region, Tribe, and level of rurality. Further, postpartum data are largely nonexistent. While small sample sizes are a constraint, innovation is possible. For example, case reports could provide ongoing and more comprehensive insight into AIAN maternal health and how it varies across the country.

Strengthened data systems could improve service delivery, funding decisions, and ultimately reduce preventable AIAN maternal deaths and contribute to improved perinatal outcomes for Native families and communities.  

* Maternal Mortality Review Committees can document four circumstances surrounding a pregnancy-related death and whether the committee thinks the circumstance contributed (or probably contributed) to a given death.