“The COVID-19 pandemic has amplified pre-existing inequalities and vulnerabilities,” writes the United Nations Population Fund (UNFPA) in a recent report on the impact of COVID-19 on sex workers in East and Southern Africa. The pandemic has had an impact on people in marginalized communities around the world, but for sex workers globally, “the impact on livelihoods, human rights and health has been devastating, leaving many struggling to survive,” states the report.

COVID-19 continues to pose a high risk to pregnant people who contract the virus. Despite this concern, hesitancy surrounding the safety of the COVID-19 vaccine during pregnancy remains, write the authors of a preprint article on COVID-19 vaccines and pregnancy outcomes. As COVID-19 vaccines become more widely available, some have raised concerns regarding potential links between receiving a COVID-19 vaccine and experiencing miscarriage (also known as spontaneous abortion), and other adverse outcomes. However, miscarriage is a common occurrence – around 10 to 15 percent of all pregnancies in the United States end in miscarriage – and multiple studies have found no increase in miscarriage in persons who received a COVID-19 vaccine.

In the United States, approximately 10 to 15 percent of known pregnancies end in miscarriage. But this doesn’t capture the full picture. In reality, studies show that as many as half of all pregnancies may end in miscarriage, with the vast majority occurring before people realize they are pregnant. A miscarriage is defined as pregnancy loss before 20 weeks gestation. While some health conditions such as autoimmune disorders, polycystic ovary syndrome (PCOS), and diabetes can exacerbate the risk of having a miscarriage, the exact causes of pregnancy loss are largely unknown.

The United States is in the midst of a maternal health crisis. Indigenous and Alaska Native peoples are 2.3 times more likely to die from pregnancy-related complications than their white counterparts. In Alaska, unequal socio-economic status, lack of access to hospitals and quality health services, systemic racism, and a history of colonization drive these disparities in maternal health outcomes. “Weathering”—the deterioration of communal health outcomes caused by persistent socio-economic disadvantages—contributes to many poor maternal health outcomes for Alaska Native women. On top of these systemic problems, climate change impacts threaten to widen the existing disparities for Alaskan Native women.

Each year, 700 women in the United States die as a result of pregnancy-related complications. In fact, the United States has the highest maternal mortality ratio of all high-income countries—16.7 maternal deaths per 100,000 live births. For Indigenous/Alaskan Native women, that number is even higher: Indigenous/Alaska Natives are 2.3 times more likely to die from pregnancy-related complications than their white counterparts. While recent years have seen growing national attention to the U.S. maternal mortality crisis, research and advocacy for Indigenous peoples’ maternal health in the United States has been limited. This research gap includes the Alaskan Native peoples—Iñupiat, Yupik, Aleut, Eyak, Tlingit, Haida, Tsimshian, and multiple Diné tribes.

“Achieving true progress on sexual and reproductive health and rights requires a comprehensive approach and a commitment to tackling deeply entrenched inequities and injustices of which marginalized communities continue to bear the brunt,” said Dr. Herminia Palacio, President and CEO of the Guttmacher Institute. She spoke at a recent Wilson Center event where speakers analyzed findings from the Guttmacher Institute on the state of sexual and reproductive health and rights (SRHR) globally.