Investigative Failures Fuel Alarming Rise in Native Infant Mortality Rates

When Jessica Whitehawk co-founded a women’s health support center over a decade ago, her team’s workspace was a single, small room in a Yakama Nation Reservation nonprofit office in Washington state.

Pregnant women journeyed from the farthest corners of the 1.3 million-acre reservation to seek healthcare and prenatal advice, according to Whitehawk.

Many Native communities face similar resource shortages, leading to American Indian and Alaska Native infants having double the mortality rate of non-Hispanic white infants before their first birthday.

Recent research indicates that disparities in law enforcement investigations of sudden unexpected infant deaths (SUIDs) contribute to this high mortality rate. The study revealed that American Indian and Alaska Native SUIDs are more frequently investigated by police, often inadequately, compared to thorough medical examinations.

This gap means less information is available to develop preventive measures in communities already limited in prenatal care and culturally sensitive practices.

Medical examiners are more qualified to explore all causes of death. However, rural Native communities often lack these professionals and generally have strained relations with the police.

Dr. Nicole Jackson, a former associate medical examiner and now a University of Washington assistant professor, noted similar patterns during her training in New Mexico. Tribal law enforcement frequently led investigations into tribal infant deaths.

“The medical-legal death investigation system in America is severely underfunded and understaffed,” said Jackson.

A study covering over 3,800 cases from 2015-2018 labeled investigations as incomplete if lacking in details, an autopsy, or scene investigation.

This lack of thorough data impedes prevention efforts.

For instance, investigators often failed to use baby dolls for reenactment exercises, which are critical for determining dangerous conditions or sleep practices contributing to suffocation, as endorsed by the CDC and medical examiner associations.

Abigail Echo-Hawk, from the Seattle Indian Health Board, highlighted the struggles of families on high-poverty reservations where poor living conditions exacerbate risks.

She emphasized the necessity for culturally sensitive investigations, noting that misinterpretations of tribal practices by untrained investigators could hinder accurate data collection and family cooperation.

Naomi Harada Thyden, a public health research scientist, noted the lowest quality information often comes from groups with the worst health outcomes, exactly where more data is needed.

Whitehawk, from the Winnebago and Santee Tribes, tied high infant mortality rates to structural racism and underinvestment in tribal communities. She and other founders launched the Ttáwaxt Birth Justice Center 12 years ago to address these issues. The center now offers a range of reproductive health services and aims to open a birthing facility.

“Two hundred years of systemic racism and violence against women and children have clearly impacted the survival rates of our infants,” Whitehawk said.

Janelle Palacios, an attending nurse-midwife and professor at Montana State University, stressed that medical examiners should lead SUID investigations due to strained relationships between tribal communities and law enforcement.

Dr. Reade Quinton, a Minnesota medical examiner, echoed this sentiment, highlighting the mistrust Native communities have towards law enforcement.

Cultural competence is also crucial in these investigations. Erin Ivie, a coroner in Wyoming, described her office’s commitment to culturally sensitive training and collaboration with law enforcement, treating every case as a potential homicide until ruled otherwise.

Jackson supported a more holistic approach involving social workers and trained medical staff, which could better connect with grieving families and prevent future deaths.

Whitehawk’s team at Ttáwaxt found that families with elders present were less likely to experience infant loss, emphasizing the importance of community health in infant survival.

“Changing the narrative around maternal and child care alters the well-being of the entire community,” Whitehawk said.