“This is real,” said Franka Cadée, President of the International Confederation of Midwives (ICM). “And we can no longer get around it. And we can no longer linger.” She spoke at a recent Wilson Center event, in partnership with the United Nations Population Fund (UNFPA) and Johnson & Johnson, launching a new study, Impact of Midwives, published in The Lancet Global Health. If any other intervention could have the same impact as midwives or midwifery, it would be implemented worldwide immediately, she said.

The United States imprisons the most women in the world. Across the United States, approximately 200,000 women are incarcerated—nearly an 800 percent increase since 1980. Women of color are disproportionately affected by the criminal justice system. In 2017, twice as many Black women and 1.3 times as many Hispanic women were incarcerated compared to white women. An often overlooked aspect of the increasing rates of women’s incarceration is the impact on the sexual and reproductive health needs of these women. “Despite being the fastest growing incarcerated population, women and girls are correctional afterthoughts,” writes Kimberly Haven, an activist and formerly incarcerated woman who had to undergo a hysterectomy—a surgical procedure to remove the uterus (and, with it, childbearing possibilities)—after being denied proper menstrual products while incarcerated.

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.

“I think we have to remember not to forget what these diseases did in the past and to actively collaborate, to work with each other, and to communicate well that vaccines work,” said Dr. Paul Duprex, Director of Pitt’s Center for Vaccine Research and Professor of Microbiology and Molecular Genetics at a recent Wilson Center event on the development of a COVID-19 vaccine, co-sponsored by the University of Pittsburgh (Pitt), March of Dimes, and the Jonas Salk Legacy Foundation.

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.