iving birth if one lives in rural Alaska can be challenging for a variety of reasons, including the need to travel to larger cities and the scarcity of post-partum care for mothers, babies, and young children once they come home. These realities can make it hard for new parents to even know where to turn for help with common topics like breastfeeding, nutrition, and developmental milestones.

According to the Alaska Maternal and Child Death Review committee (MCDR), the rates of pregnancy-associated deaths increased 184 percent in rural areas between 2012 and 2021, compared to an increase of 66 percent in urban areas, and 44 percent of those deaths were associated with barriers to healthcare access.

According to the US Department of Health and Human Services, because many rural communities are not equipped with facilities for childbirth, pregnant women must leave their homes a month before their due dates and travel to a community with a hospital. Further, the only place equipped to handle high-risk pregnancies is Anchorage. Once a baby is born, it’s difficult for mothers and babies who have returned to rural areas to access medical exams like well-child checks and dental visits.

SouthEast Alaska Regional Health Consortium (SEARHC), one of the largest Native-run healthcare organizations in the United States, is focused on improving maternal, infant, and child health in its service area. Two related pilot programs are aimed at supporting the health and well-being of American Indian/Alaska Native families through prenatal, postnatal, and early childhood years.

The first of the programs was a one-time Community “Baby Shower” and Health Resource Fair held on September 21 at the Chilkat Center for the Arts in Haines. The event provided prenatal, postnatal, and culturally appropriate support to help lessen anxiety for women who must leave their homes a month before their delivery dates. New moms were connected to labor and delivery teams and other social services in order to create a warm, comfortable, and welcoming environment to receive maternal healthcare as well as get medical concerns addressed.

“The Haines Community Baby Shower was funded by a one-time grant award called the Build Up Trust Challenge, in which we were able to host an event that encouraged families, expecting mothers, and new moms to utilize our healthcare services,” says Dr. Cate Buley, SEARHC’s chief medical officer. “We held the event in Haines, and over seventy families joined to learn what is available at the clinic to make sure they’re getting what they need—whether it’s vaccinations or well-baby checks to keep babies healthy in their communities.”

The consortium’s labor and delivery nurses will continue to offer pre- and post-natal education at Sitka Patient Housing and at several SEARHC community clinics to support families through their child’s first two years of life.

The second of the two programs is in the early stages of development. The Healthy Families Early Start program is funded by a $500,000 per year grant from the federal Maternal, Infant, and Early Childhood Home Visiting Program. The program’s initial funding is for five years, but SEARHC hopes to make it part of its regular operating budget once the federal grant runs out.

Using an evidence-based home visiting model to meet families where they are, nurses and other healthcare professionals will visit families and provide in-home care. Services will include needs assessments and referrals to community-based support and comprehensive care that includes breastfeeding counseling, well-child exams, nutrition assistance, infant safety, dental care, physical therapy, and mental health support. As the pilot program ramps up, SEARHC anticipates that services will be available in early 2026.

“This program was really driven by our OB nurses who take care of those families,” says Buley. “They see expectant moms leave their community approximately four weeks before their due date so they can be close to the hospital for safe delivery. Nurses see how difficult that can be physically and mentally, so they try to provide a welcome environment, provide needed baby essentials, and start breastfeeding support before mom and baby go home. This grant will help extend that care and connect families to resources in their home communities, making sure mom, baby, and family have the resources they need.”

Other tribal entities are already in the third year of Healthy Families Early Start, so SEARHC isn’t alone in its planning. “Cook Inlet Tribal Council, Fairbanks Native Association, Southcentral Foundation, and the Central Council of the Tlingit and Haida—they’ve all formed an Alaska home visitor’s alliance where we can share information and learn from each other,” says Buley. “This is really neat because they’re sharing information, so we don’t have to reinvent the wheel.”

While SEARHC’s service area includes twenty-six communities and a population of about 72,000, the grant’s initial five-year period will focus on seven pilot communities: Angoon, Craig, Haines, Klukwan, Klawock, Sitka, and Wrangell. The first year will be dedicated to an assessment that will provide the basis for a customized, evidence-based program.

Buley says, “This first year we are going into these communities and asking what their needs are. We’ll be training and collaborating with community partners to work with families who want to be enrolled in the program, making sure they are receiving the care they need during those early times.”

After the initial assessment of community needs, Buley says they’ll be able to set some concrete goals for the program. Some examples of those goals might be to make sure that each mother has a postpartum depression screening and to make sure that mothers are signed up for the Women, Infants, and Children (WIC) supplemental nutrition program. Other goals might be to look at immunization rates for both six-week immunizations and those needed throughout the first year of life—and to make sure that babies don’t fall behind on those first-year immunizations.

Home visits are expected to begin in the second and third years of the pilot program, but the program will also provide access to a host of other services. “One of our strategic goals is to bring care closer to home, and this brings care into the home where you can really see what’s going on,” says Buley. “That’s one of the silver linings of the pandemic. It made telemedicine blossom, and you’re really able to see what’s going on in a patient’s life rather than just seeing what’s going on at the clinic.”

While expecting mothers are spending time in the maternal housing next to the hospital in Sitka before having their babies—or waiting for clearance to return home with their new infants—the Healthy Families Early Start program will set them up with a host of comprehensive services including referrals to breastfeeding support; oral health for mom or siblings; pediatric physical, occupational, or speech therapy; and referrals to tribal services or housing support services. “So if you see any issues developing within that first year, we’ll help with that,” says Buley. “And we also want to partner with early childhood educational services during the first year.”

Social determinants are major factors in the health of rural populations, such as health literacy, infrastructure, and environmental factors, so SEARHC cannot ignore them.

“The grant is to address the social drivers of health,” says Buley, who refers to it as “the upstream work. For example, you see someone falling in the water downstream and you try to pick them out and save them, and then you see another and another fall in—so you look upstream to see what’s causing it.”

In a less metaphorical sense, Buley says, “Maybe they weren’t connected to WIC so they could get the resources they need to feed the baby, and maybe they didn’t get vaccines because they didn’t have insurance. Those are the social drivers that will help drive this program. That is working upstream to prevent disease and health risks that occur later in life.”

The overall goal of SEARHC’s focus on maternal and newborn health is to improve outcomes and address those social drivers of health before they develop.

“Something really great about this grant is that instead of just coming into a community or village and telling them ‘This is what we’re going to do,’ this is going to allow us to assess what the village wants and needs and to work with our community partners to develop a home-based visit that they want and own and trust, and I think that will go a lot farther than by just saying ‘This is what we’re going to do.’… Training and partnering locally within the villages will go a long way to sustain the program even after the grant is over.”