Healthcare Discrimination and mental health among American Indian women: Implications for the Sámi

Background

Globally, Indigenous women are at high risk for postpartum mental health conditions. Additionally, Indigenous women often experience discrimination during prenatal care, a risk factor for postpartum mental health conditions. This study provides data on healthcare discrimination and postpartum mental health conditions among American Indian (AI) women in the United States (US), and discusses implications for Sámi communities in Finland, where there are limited data on health care discrimination.

Methods

We included 8,277 women (weighted sample) from the 2023 North Dakota Pregnancy Risk Assessment Monitoring System data. The sample included 79% White, 14% Other race, and 7% AI women. Participants self-reported 13 types of discrimination during prenatal care (i.e. race/ethnicity, language, age), with those experiencing ≥1 type of discrimination coded as “Any discrimination” and 0 experiences of discrimination coded as “No discrimination.” Postpartum depression and postpartum anxiety were self-reported, coded as “yes” or “no.” Estimates were obtained using Rao Scott chi square to account for complex survey design.

Results

AI women experienced a higher rate of discrimination (15%) compared to white (6%) and other race/ethnicity women (9%; p = 0.01). Among AI women who experienced discrimination, racial/ethnic discrimination (58%) was most common, followed by income discrimination (54%). Compared to those not reporting discrimination, AI women who reported discrimination had higher rates of postpartum depression (30% vs 18%; p = 0.33) and postpartum anxiety (56% vs 23%; p = 0.01).

Discussion

Our findings of health care discrimination and postpartum mental health among AI women aligns with data on Indigenous women’s experiences in Australia, Bolivia, and Canada. Recent efforts in Finland have called for more data on culturally-specific perinatal healthcare for Sámi people. Lessons from global Indigenous populations can inform future work among Sámi communities.

Key messages

• American Indian women reported higher prenatal care discrimination, which was linked to elevated postpartum depression and anxiety.

• Findings highlight urgent needs for culturally grounded perinatal care and offer guidance for Sámi health research.