Project Summary/Abstract
Indigenous mothers (those who self-identify as American Indian, Alaskan Native, or Native American)
experience the highest rates of maternal mortality and morbidity (MMM) in the U.S. Structural, social, and
biobehavioral factors driving these inequities such as food insecurity induced by food apartheid, chronic stress
perpetuated through intergenerational trauma, and loss of traditional birthing practices and roles require
innovative solutions. To accomplish this, the Center for Indigenous Resilience, Culture, and Maternal Health
Equity (CIRCLE) has been formed to better understand and address these factors through individual, family,
community, and health systems interventions. The long-term goal of the CIRCLE is to eliminate disparities in
Indigenous MMM through effective translational science spanning best practices in preconception, prenatal,
and maternal postpartum care through the first 2 years of life. The immediate goal of the CIRCLE is to bring
together researchers and community partners in Oklahoma/Southern Plains region to discover the sources of
Indigenous MMM disparities and translate scientific results into solutions that eliminate maternal health
inequities. The CIRCLE will: (1) leverage existing and expand current partnerships with tribal health partners
on patient-centered outcomes research and interventions; (2) cultivate and support an interdisciplinary team of
independent experts focused on discovering the bases for, and solutions to, Indigenous maternal health
disparities; (3) establish the foundation and initial processes necessary to enable translational research and
interventions focused on eliminating Indigenous maternal health disparities; and (4) exchange strategies, data,
findings, and recommendations from Aims 1-3 with key partners. Achieving the aims of the CIRCLE is
significant. Over 90 percent of Indigenous maternal deaths in the U.S. are preventable. Reducing MMM and
achieving maternal health equity are a national priority. An essential step in reducing MMM and assuring
maternal health equity in the future is the elimination of Indigenous maternal health inequities. The CIRCLE’s
focus on identifying solutions for Indigenous maternal health disparities therefore addresses a critical barrier to
achieving a national public health priority. The CIRCLE is innovative. Research centers focused on maternal
health disparities and inequities exist throughout the country; however, none of these centers focus specifically
on Indigenous maternal health. We also emphasize a strengths-based “culture as protective” approach at the
core of the CIRCLE.