Native American Resources

Strengthening MCH Surveillance among American Indian and Alaska Native Women: Native American Pregnancy Risk Assessment Monitoring System (PRAMS) Survey in Michigan

For more information on Michigan's Native American PRAMS click here (PDF)

Native Americans are at an increased risk for feto-infant mortality in Michigan (2006-08 Feto-Infant Mortality Rate of 12.2 for Native infants compared with the reference rate of 5.3 for White, Non-Hispanic mothers over the age of 20 years and with more than 13 years of education). The Michigan PRAMS did not adequately capture necessary information about Native American health experiences due to inadequate sample sizes, no response options for tribal clinics as locations of care, and no information about experiences with racial discrimination.

As a result, the Michigan Department of Community Health initiated a parallel Native American PRAMS. The Michigan PRAMS Phase 7 survey was modified for the Native population, including the addition of questions about parental tribal affiliation, tribal health service utilization, and questions about racism and social determinants of health. The survey will sample all women who give birth to a Native infant in 2012. "Native infant" is defined as any infant where the mother or father has American Indian/Alaska Native listed as their primary or bridged race in the birth records. Outreach activities to increase response rates include: designing a logo that would resonate with the Native community, developing a factsheet to inform clinicians about the project, obtaining a letter of endorsement from the Inter-Tribal Council of Michigan, and creating a media campaign for tribal communities. Collaborating with the Inter-Tribal Council was essential for developing and implementing a culturally tailored survey to better understand the health experiences of native peoples in this state. This survey will be the first Native American specific PRAMS survey to be implemented in Michigan.

Assessing the impact of using maternal race in Vital Birth Records to measure racial and ethnic disparities in birth outcomes and maternal risk factors in Michigan

Race is a social construct, not grounded in biology, but one that changes depending on social norms and cultural attitudes. Thus, the classification of race has changed over time. Currently, a newborn's race is assigned based on the mother's race, ignoring the race of the father. This method discounts the impact of father's race on an infant's exposures and health outcomes. Especially for smaller populations, such as Native Americans, the classification strategy may not accurately capture all native American infants. If both parents' races are considered, perhaps more Native American infants will be recognized, resulting in a more accurate understanding of the number of Native Americans and providing more data about their health outcomes or health disparities related to their racial classification.

As a response to this, the PRIME project, in association with the Health Disparities Reduction and Minority Health Section, the Inter-Tribal Council of Michigan, the Division for Vital Records and Health Statistics and the Bureau of Family, Maternal and Child Health, have decided to 1) assess the impact of including the father's race to classify the infant's race when estimating infant health outcomes in birth records and 2) to assess the impact of including the father's race to classify the infant's race when measuring disparities in the birth records. In this study, the infant was classified as race X if either the mother is race X, the father is race X, or both the mother and father are race X. Health outcomes of interest included tobacco use during pregnancy, low birth weight, preterm birth, mother's education, inadequate prenatal care, and Medicaid use to pay for delivery. For more information on how each infant was classified, the records that were reassessed, and the methods used, please view the attached poster found here (PDF).

The results of this study demonstrated that using the mother and/or father to classify race resulted in a larger sample size than using the mother's race alone. Additionally, when compared against the White, non-Hispanic reference group, the significant disparities were found in rates of tobacco use, low birth weight, mother's education, inadequate prenatal care, and Medicaid use.