Lifting Up Tribal Voices

Background: Arizona shares its borders with 22 federally recognized tribes including the largest tribe in the US, the Navajo Nation, and is home to almost 400,000 individuals who identify as American Indian/Alaska Native. American Indians/Alaska Natives are disproportionately burdened across a wide range of maternal and child health outcomes, including maternal mortality, infant mortality rate, and adolescent suicide. These differences in outcomes come from disparities in resource distribution, opportunities, and other social determinants of health. They also come from disparities in political power and voice.

Challenges: For the 2020 Title V Needs Assessment, Arizona’s Title V Program wanted to be intentional about seeking tribal inputs to align with the principles and values we established at the outset of the assessment. ADHS initially reached out to Navajo Department of Health (NDOH) to conduct the needs assessment for the Navajo Nation, but they did not have sufficient human resources for this, so they referred us to Diné College, a tribally controlled, accredited collegiate institution on the Navajo Nation. After several long drives between Phoenix and the Navajo Nation (approx. 12 hours roundtrip) for in-person meetings, an agreement was established⁠—leaving a shorter-than-anticipated timeline for implementation, which was about to be disrupted by a global pandemic.  The Intertribal Council of Arizona was onboard with creating a needs assessment for the other 21 federally recognized tribes in the state.

Actions: ADHS chose to manage the contract with Diné College like a cooperative agreement, putting an emphasis on the deliverables we needed (i.e., identified MCH needs and priorities) but not specifying the methodology to get these. ADHS provided technical assistance when requested, but we mostly saw our role as providing the resources (funding) for this work and empowering the Navajo team to create an assessment methodology that was relevant to their community.

Results: Diné College engaged partners across Navajo Nation on the design and implementation of the assessment, which applied a Navajo-specific cultural framework emphasizing that health outcomes go beyond socioeconomic and biomedical factors. They established an MCH Committee similar to that of the statewide MCH needs assessment steering committee that is now working, with additional Title V funding, to address the needs and priorities identified through the assessment. Title V has also provided funding to Diné College to conduct a series of listening sessions to learn more about the barriers and facilitators to accessing prenatal and postpartum care among tribal communities in Arizona.

The needs and priorities captured in the Navajo Nation and ITCA MCH needs assessments have been incredibly impactful for our programming⁠. In particular, our maternal health team⁠—by leveraging additional resources from the Maternal Health Innovation grant⁠, including staff time of the Tribal Maternal Health Innovation Program Manager⁠—is working with ITCA and Navajo Nation (Diné College/NDOH) to recruit members for their Steering Committee. The Steering Committee will then meet for strategic planning meetings to improve maternal health outcomes in our AZ tribal communities. The Tribal Maternal Health Program Manager planned over 100 classes (Apr-Sep 2021) through the Maternal Health and Family Wellness from an Indigenous Perspective training series to tribal communities and urban natives across Arizona among other activities.