These results reveal the Inupiat Eskimo mothers' (and their respective communities') experiences with and navigation of the maternal transport policy in the Maniilaq Service Area in Northwest Alaska and an important interplay between level of traditionalism and desire and lengths gone to by these communities to participate in a more biomedical mode of birth. These findings will help inform policy and bridge understanding between and among agencies, communities, and involved participants.
Methods: Participant observation was combined with standard structured means of data collection to create a holistic representation of the processes involved in birth and maternal care in the study area.
The community participatory research portion of the study acquired UAF Institutional Review Board (IRB) approval, affected Native Village Council approvals, and informed consent.
Using content analysis to search for common themes in an inductive, recursive fashion, liminality, communitas and embodiment of health in communities were explored —and level of traditionalism to paths towards community-accepted maternal health care practices of each study village community were linked.
Results: In 2009 (using latest figures available from Alaska Bureau of Statistics):
- 215 of 239 (right at 90%) of Alaska Native mothers from the Maniilaq region left their home villages to have their babies.
- 21 of 77 (28%) Alaska Native Kotzebue mothers birthed in Kotzebue for a ‘Local’ Birth
- 54 (35%) Kotzebue mothers and
- 101 (65%) Other MR mothers delivered in Anchorage
- for a total of 155 Maniilaq Region babies born in Anchorage
Findings include a network-type connection among changes in larger society concerning: views of proper “standard of care” for birthing mothers, the strong biomedical view of birth becoming the norm there, with perceived risk of birthing outside an urban hospital—and the level of traditionalism (and related liminality, communitas and embodiment) present among mothers and families in each village.
Conclusions: The more traditional (determined by governing structure, presence and involvement in traditional ceremony, rites of passage) an area and mothers living in the corresponding area, the more likely a traditional-based, community-oriented, birthing (and perhaps, health care) will be sought, thereby lessening the reliance on the transport policy.
Conversely, the more entrenched the community in a western model of governance, ritual and ceremony (less Alaska Native-based, more market-based); the less likely alternative or traditional maternity care measure will be sought, and the more risk will be leniently assessed, and further reliance on a bolstered transport system.