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- By Elyse Wild
Native American mothers on reservations often don’t receive prenatal care until after their first trimester, facing barriers of distance, specialist shortages, and systemic barriers rooted in mistrust, misinformation and under-resourced infrastructure.
Such delayed care contributes to Native American women having one of the highest maternal mortality rates in the country. American Indian and Alaska Native (AI/AN) women face pregnancy-related mortality rates more than three times higher than white women.
Jicarilla Apache pediatrician Yoldandra Gomez is working to change that. After nearly 20 years in private practice, the Princeton-educated MD returned to her home reservation in northern New Mexico in 2024 to improve maternal and child health outcomes in her community.
She now manages the Tribal, Maternal, Infant, and Early Childhood Home Visiting grant for her tribe. The federally funded program supports Native communities in establishing culturally centered home visiting programs for families who are pregnant or have young children, which have been shown to improve health outcomes for babies and mothers.
Gomez spoke with Native News Online about the structural and cultural challenges Native women face when seeking maternal care, how disconnects between state and tribal health systems hinder data collection, and how the Jicarilla Apache tribe aims to fill systemic gaps to create better health outcomes for Native families.
Editor’s Note: This interview has been edited for brevity and clarity.
What are some of the biggest barriers Native mothers face when accessing maternal care?
I can only speak for my region and my tribe, but one of the barriers I see for Native women is the distance they have to travel to get basic prenatal care. There’s a study called the Tribal Pregnancy Risk Assessment Monitoring System, which gathers information about Indigenous women who are pregnant and the barriers they face. One of the big findings is that most pregnant Native women do not get prenatal care until later in their pregnancy — they wait until either the second or third trimester.
I think Native women struggle with finding specialists, which are harder to access in the areas where we live. A lot of Native women have underlying conditions — like gestational diabetes, being overweight or obese, or substance use disorder — that require specialty care.
"Most pregnant Native women do not get prenatal care until later in their pregnancy. Native women struggle with finding specialists, which are harder to access in the areas where we live. A lot of Native women have underlying conditions that require specialty care."
You mentioned some women self-treat during pregnancy. Can you talk about that?
What I’ve heard through the grapevine — I haven’t verified this yet — is that a lot of women in our area self-treat using marijuana. One reason is that it’s legal in New Mexico, although not on our reservation. They feel that if they have existing anxiety or depression, it’s okay to continue using it during pregnancy. Or if they have nausea, they might continue using marijuana because it’s the only thing that helps, and they distrust some of the medications that physicians might prescribe.
What's changing in how medical providers engage with communities?
About 20% of the women on our reservation — which is a very rural area of north-central New Mexico — go across the border to receive care and give birth in Durango, Colorado. There’s not good communication between states, so we’re not getting that data.
One of the things I’m working on is trying to reach out and connect with those providers. I’ve connected with some of the pediatricians in Colorado who’ve been great. Making that connection is not difficult — it’s just a provider picking up the phone and calling. I think people get a little too entrenched in organizational barriers.
Many medical practices now, even in hospitals, are owned privately or run by people who aren’t necessarily clinicians. I think physicians have lost that connection to the communities in which they practice. That means getting outside your comfortable exam room and doing things like basic data collection or calling another provider and saying, “Hey, is there a way we can work together?”
I imagine a lot of non-Native providers don’t know how to work with Indian Country or might be intimidated by it.
That’s definitely true. I’ve been on phone calls and in conferences where I’ve heard people say — before they realized I was Native and that I’m Jicarilla, born and raised in that community — things like, “Oh, the tribes are so difficult to work with,” or, “I called them once and they never called me back,” or, “That tribe has a casino, so they’re rich and don’t need these services.”
There’s a lot of misinformation out there from non-Native people about tribes. We’re neighbors — our kids go to their schools, and some of their community members have married into our tribe and vice versa. These false senses of boundaries limit the discussion on both sides.
You've done community mapping work. What have you discovered about healthcare and resource access?
A lot of our children go to Pagosa Springs, Colorado — about a 50-minute drive — for pediatric care. Many families shop there because there’s a Walmart, and their kids go to school there, too. One of the community mapping projects I did in the fall identified our community as a food desert. We have only one grocery store and a limited selection of fresh fruits and vegetables.
I reached out to the closest food pantry I could find, which was in Pagosa Springs, and the response was amazing. They said, “We’ve been waiting for someone from Jicarilla to contact us!” It turns out they’re not just a food pantry — they offer training on how to grow your own vegetables and composting and all sorts of things.
It was really interesting — they were waiting for someone from our community to reach out.
Why is first-trimester prenatal care so important for expectant mothers?
Early care establishes a relationship with a provider, and that’s important for many reasons. It’s physical and emotional — it helps a woman understand the changes to her body that are going to happen.
It gives her resources and information to have the healthiest pregnancy possible. That can be something simple like prenatal vitamins or screening. A provider might ask, “Are you eating well? Are you still drinking alcohol or using marijuana?” Then there’s the emotional support, where the provider asks, “How are things at home? Do you have support from the baby’s father? How’s your family feeling?”
"Early care establishes a relationship with a provider. Getting care early sets a foundation so she's well supported through the rest of the pregnancy. Studies show that prenatal care helps prepare a woman for a healthy delivery and a healthy baby."
How does early prenatal care set the foundation for the entire pregnancy?
There’s a lot that happens in the first trimester that can be scary. Getting care early sets a foundation so she’s well supported through the rest of the pregnancy. It also gives her a chance to talk about what’s going to happen after the baby comes. Like, “Are you going to take time off from work?” or “Are you going to breastfeed?” or “How can we get you connected to WIC?”
There’s lots of support on many levels. Studies show that prenatal care helps prepare a woman for a healthy delivery and a healthy baby.
Tell me about the maternal infant and early childhood visiting program — the Tribal MIECHV — you’re running for your tribe.
The Tribal MIECHV has been around for about 15 or 20 years and runs in five-year grant cycles. We’re in the first year of our grant, and our overall goal this year is to develop an evidence-based home visiting curriculum tailored to our community — culturally and geographically, and based on the resources we have.
Home visiting programs have been studied extensively and exist around the world — in Africa, South America, and elsewhere. They have successful, evidence-based curricula that show long-term benefits for children and families. The biggest impacts we’ve seen are reductions in child abuse and neglect.
How does home visiting work in practice within your community?
Home visiting in our community doesn’t necessarily have to happen in the home. We can meet people at Head Start, the clinic, or a relative’s house. The idea is that a home-visiting educator goes through a series of lessons with a family — about nutrition, developmental milestones, managing stress when your baby cries a lot, and where to seek care and advice.
What are your priorities for your first year of the program?
My goal this year is heavy on information and data collection. We looked at what resources our target population uses — pregnant women and families with kids under five. That’s how we found the food desert. Right now, we’re collecting hard data — on infant mortality, how many women access prenatal care in the first vs. second or third trimester, and how many are exposed to substances. We’re pulling that from different organizations.
There’s an exciting program through the CDC’s COVID-19 electronic case reporting system that allows tribes to act as public health authorities. That means we can get hospital and medical provider data on our tribal members.
I also want to make myself available as a pediatrician. Home-visiting educators usually aren’t medically trained — they’re trained to meet families, follow the curriculum, and offer basic support. I’m trying to build a medical component into the program so I can meet with families, including women thinking about getting pregnant, and connect them to resources and providers before they even conceive.
How does this program help restore traditional community support systems?
Traditionally, we had a strong community of support for pregnant and postpartum women — always people around to help, like grandparents, aunties, or cousins.
I feel like the loss of extended family support has made it harder for women to breastfeed and feel supported.
We used to breastfeed each other’s babies — that was common. I still see that in some immigrant families. Until your milk came in, someone else would feed your baby, and you’d return the favor.
But breastfeeding can be hard, and it hurts. Having someone with experience — not necessarily a provider — say, “Let’s try this” or “Try that” can be helpful. Women need that kind of support during a time of overwhelming emotion and hormones.
"Traditionally, we had a strong community of support for pregnant and postpartum women — always people around to help, like grandparents, aunties, or cousins. I feel like the loss of extended family support has made it harder for women to breastfeed and feel supported."
How will you measure the outcomes of the grant at the end of the five years? What will you look for in the community that tells you, “Yes, we’ve achieved what we wanted to”?
There are some specific minimum data points that the federal granting agency requires us to collect. There are several categories we’ll be gathering data from: community demographics, maternal, newborn, and child health; school readiness and achievement; family economic self-sufficiency; and coordination and referrals to community services. It’s a fairly long list, but we will start small — with at least two markers from each category.
For demographics, we’ll collect data on how many children live in the community, how many community members are of childbearing age, geographic and environmental factors, and even cultural and historical context — like traditional practices related to family and child well-being.
What specific health indicators will you track?
The second group — maternal, newborn, and child health — includes the data I mentioned earlier: how early women are receiving prenatal care, how many are breastfeeding, what postpartum care looks like, and traditional birthing and healing practices. This includes quantitative data (the numbers) and qualitative data (what people in the community share about their experiences and traditions).
School readiness and achievement is something we’ll only see over time. We won’t have quick results. However, I’m trying to measure whether the children who start in our home visiting program — beginning in October 2025 — are more educationally ready for kindergarten in four or five years compared to the current group. That will mean getting educational scores and standardized test data from local schools for current four- and five-year-olds and then tracking those participating children as they progress through Head Start, pre-K, and kindergarten.
What about measuring economic and social impacts?
The family economic self-sufficiency data will take even longer. We’re talking about things like financial stability and income levels — data that’s harder to gather, but we’re going to try. What’s a bit easier to collect are indicators of coordination and referrals to other community services — things like early intervention for speech or physical therapy. We’ll also look at perceptions of those services. Are women currently hesitant to reach out for help? In a couple of years, will they hear about these services through our providers or home-visiting educators and feel more comfortable accessing them?
For example, maybe they keep hearing about that food pantry I mentioned across the border in Colorado, and one day, they say, “Maybe I’ll reach out and see if they have suggestions for my family on growing our own fruits and vegetables at home.”
So ultimately, we’re using both quantitative and qualitative data — some of it from existing organizations, and some we’ll need to start collecting ourselves, in ways it’s never been collected before.
Why is having tribal ownership of this data so important?
It’s so needed. Historically, tribes have been reluctant to talk about data collection and research. However, as a physician and researcher, I really want us to own this data and information.
I always tell people, “Data tells a story.” I actually heard that from a university researcher. When we tell that story, we get to decide what the next step is going to be. The food desert is a good example. We knew it was happening, but no one had visualized it in a way that made it clear. Now we can say, “Hey, this is where we need to focus our efforts.”
"I always tell people, 'Data tells a story.' When we tell that story, we get to decide what the next step is going to be... It's important that tribal communities do this work themselves."
How does this approach differ from past research in Indian Country?
What I hope to do is identify both strengths and opportunities — not “negatives” — where we can build relationships or fill gaps that we keep seeing. It’s important that tribal communities do this work themselves. It needs to start at the community level. In the past, outsiders would come in, take a snapshot of our community, tell us what’s wrong, publish a paper in a journal no one here would ever read — and then they’d leave. How did that help us?
I’m trying to bring that research knowledge and data collection ability — and the program planning that follows — back to a tribal community level.
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