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.

Narrative Indigenous mothers have the highest rates of maternal mortality and morbidity in the U.S. The primary objective of this U54 application is to establish a successful and self-sustaining Center for Indigenous Resilience, Culture, and Maternal Health Equity (CIRCLE) to understand and intervene to improve Indigenous maternal health. We will collaborate and work closely with other Maternal Health Research Centers of Excellence, Implementation Science Hub, and Innovative Data and Coordination Hub to provide insights on root causes and translational opportunities with the long-term goal of reducing Indigenous maternal mortality and morbidity and promoting maternal health equity.