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Reclaiming American Indian maternal and infant health.

Article Excerpt
For the first six years of my life, Mother's thoughts were so largely centered upon me that she sacrificed even companionship with my father in order to give nee her full time. A weak or puny baby was a disgrace to a Lakota mother. It would be evidence to the tribes that she was not giving her child proper time and attention and not fulfilling her duty to the tribe. More than that, it was evidence that she has not used proper social discretion and defied age-old tradition. It was a law with the Lakotas that for the first six years of a child's life it should have the unrestricted care of the mother and that no other children should be born within this six-year period. To break this law was to lose the respect of the Tribe, and both father and mother suffered the penalty. A fine, healthy child was therefore a badge of pride and respect, and healthy babies were the rule.

Luther Standing Bear "Land of the Spotted Eagle," Copyright 1933

Traditionally, Northern Plains and Rocky Mountain region Indian tribes considered their children sacred. Regrettably, childrearing practices, like so many other aspects of American Indian culture, have suffered over the past 100 to 150 years as a result of white America's westward expansion. The traditional norms described above are no longer observed by Luther Standing Bear's descendants or tribe, with great implications for maternal and child health.

Medical research and technology have made great strides in the United States during this same time period. Still, American Indian infants in the Rocky Mountains and on the Northern Plains die more frequently than white infants in the region, making infant death one of the major health problems facing tribes and urban Indians in the area.

Infant Characteristics and Maternal Risk Factors

Infant characteristics at birth provide information regarding the health of a pregnancy and an infant's risk of illness, death, or long-term disability. Some of the factors considered include birth weight, gestational period, and infant mortality.

Low birth weight and very low birth weight--defined as weighing less than 5 lbs 8 oz and 3 lbs 4 oz, respectively, at birth--are both associated with a multitude of health problems, including greater risk of increased chronic conditions and limitations of activity (Overpeck 1989). All low birth-weight infants are more likely to experience long-term disability or to die during the first year of life than are infants of normal weight, with very low birth weight infants having the lowest survival rate of all. Major contributors to low birth weight are births--infants born before 37 weeks of gestation--and multiple births (MCHB 2006). Reducing the number of both low birth weight and very low birth-weight infants are goals of the Healthy People 2010 initiative (www.healthypeople.gov).

The infant mortality rate, which relates the number of infant deaths to the number of live births for a population, is one of the most commonly used measures of the overall health of a population and serves as a fundamental measure of development. In fact, overall reduction of infant mortality in the United States has been hailed as one of the 10 greatest public health achievements of the 20th century (MMWR...

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