Prenatal interventions that improve Native American pregnancy outcomes and reduce infant mortality : an integrative review

Abstract

Native mothers are at increased risk for negative pregnancy outcomes and within the first year of life, Native babies have substantially higher infant mortality rates than their White counterparts. The primary aim of this study was to identify a broad range of interventions/perspectives that positively affect pregnancy outcomes and reduce infant mortality in Indigenous communities. An integrative review using four databases was conducted. Thirty-four articles met the inclusion/exclusion criteria. The findings and recommendations of each article were documented in a chart (Appendix C) that gave rise to the development of a socioecological framework for pregnancy outcomes in Native women (Appendix D). Individual factors that influence pregnancy outcomes included behaviors/lifestyles, mental health, tobacco use, educational attainment, maternal age, prenatal care, breastfeeding, immunizations, family planning, and socioeconomics/WIC enrollment. Interpersonal factors included significant other, family support, peer support, and traditional beliefs. Community factors included: community health clinics, prenatal services, SIDS education, infant care education, home visits, smoking cessation & prevention programs, injury rates/environmental safety, tribal commitment to mothers and infants, and integration of traditional and western medicine. Public policy factors included WIC, safe water and sanitation, IHS funding, and systems to monitor Native health. In total, the synthesis of the findings from the literature appears to influence pregnancy outcomes. For Native American pregnancy outcomes to improve and infant mortality rates decline, interventions will need to target all levels of the socioecological framework: individual, interpersonal, community, and public policy. In addition, Maslow's Hierarchy of Needs must be considered.