Alaska Maternal Child Death Review Program Takes Steps to Improve Cultural Diversity in Infant Mortality Reviews
Improving Representation in Mortality Reviews
In Alaska, infant, child, and maternal mortality disproportionately impacts indigenous, rural, and other minority communities, such as Black and Asian or Pacific Islander persons. These deaths are individually reviewed by a multidisciplinary committee of experts through Alaska’s Maternal and Child Death Review (MCDR) Program. Alaska’s MCDR Program has a long-standing core group of experts with strong clinical qualifications. These experts volunteer their time to engage in the death review process to help protect the lives of other infants, children, and birthing people from preventable mortality. To ensure that MCDR Program recommendations are culturally appropriate, relevant to place and context, and not stigmatizing, the MCDR Program identified a need to increase representation of cultural and disproportionately impacted populations among its review team members to ensure diverse community voices are part of the review process.
Prioritizing and Valuing Representation in Reviews
“Engage early and often,” was the advice shared with the review team by a member of an indigenous community-based organization. Since receiving this advice, the MCDR Program decreased their review team size to allow reviews to be more focused on each type of death they review. Furthermore, the program worked to ensure cultural and regional representation at every review. To accomplish this, they rotate members as determined by multiple factors, such as the type of case being reviewed, firsthand community experience or knowledge, regional affiliation, and professional expertise. The aim is to have two or more community members at each review when deaths from disproportionately impacted populations are discussed. Additionally, the program begins each meeting with land acknowledgments (respecting and recognizing indigenous people as traditional stewards of the land), followed by setting of intentions for the meeting.
An Ongoing Act of Listening
In addition to increasing representation, the MCDR Program is committed to continually ensuring that recommendations have community context in mind. For example, a recent review team recommended that local child welfare staff should engage tribal leaders when working with families, so as to support interruption of the cycle of intergenerational trauma in a culturally appropriate manner. As a result of these efforts to improve the cultural, regional, and disciplinary diversity of its mortality review panels, the Alaska MCDR Program observed increased depth of discussion during reviews and more specific prevention recommendations, prioritizing the communities and populations they serve.