Charlene Apok was seated at a computer with multiple displays in an Anchorage office, and flipped through a list of murders and missing Indigenous Alaskans.
The attractive boxes that appeared on the screen were marked with information such as name of missing date, place of death and cause for death however, Apok observed more stories of familial love and loss as well as a history of violence dating back to the time of colonization and the boarding schools of Alaska.
“I recognize patterns in these stories and experiences since I’ve experienced the same ones,” they said.
Apok manages Data for Indigenous Justice, an online data base that contains the names of Missing or Murdered Indigenous People. The center has been running the database since its inception in 2018. Apok states that it’s a database for family and community.
“My mother died in the last year, and my family believes she was killed. It was later determined to be suicide. It’s just one of the statistics we speak about. It’s because I can study data and visualize the lived story and the events very easily,” they said.
Apok doesn’t just keep the information, but strives to improve its humanization. The mothers listed on the list are part of the reason Apok collaborates in conjunction with a state-run program, called the Maternal Child Death Review, to better identify and prevent deaths that happen during the time between birth to the mother’s first baby.
The most fundamental fact that drives these figures is alarming: The majority of Alaskans who die within the first year following the birth of the baby die due to an overdose or violence, instead of medical reasons. Alaska Native people are disproportionately in the majority of. Recent data show that almost twice as many of the deaths associated with pregnancy in the state stem from suicide, homicide or alcohol or drug overdose as are those due to pregnancy-related medical reasons. Over 70% of mothers who died suffered from prior history of intimate partner violence.
State researchers believe the data suggests that the effects of trauma and intimate partner violence is leading to the death of Alaska mothers. Therefore, as state health professionals as well as birth professionals fight stop mother’s lives from being lost, they’ren’t only fighting to increase access to medical services. They’re fighting for increased accessibility to health care.
Trauma of the underlying cause
Ness Verigin who is the manager of the Maternal Child Death Review, states that the state is beginning to combat maternal deaths caused by violence, however there’s a plenty of room for further preventative initiatives.
“If you’re healthy enough to become pregnant it’s not a reason to be dying,” they said. “It’s the time of year when security and safety and health needs to be a part of a woman’s life. In addition, the reality that violent acts are more prevalent at this time is a major issue.”
Apok said that when individuals go through a lengthy period of sexual or domestic violence assault and overdose or commit suicide their deaths must be considered as a result of the violence.
“How we convey those stories, those experiences and the connections into a manner that we can improve the quality of prevention and treatment is a major challenge,” Apok said. “So the majority of these things are considered to be stigmatized, particularly for people of certain races or ethnic groups.”
Research studies reveal that pregnant women who have been abused may turn to suicide to stop the abusing. Similar to Apok, Verigin also said the deaths caused by overdose of alcohol or drugs are often a result of violence.
“Women particularly pregnant women, don’t drink because they’re having a party or are having fun or are just reckless people,” Verigin said, saying that direct treatment professionals with programs for addiction claim that the majority customers have been victims of sexual or intimate violence throughout their lives. “There’s often something very serious going on. Most often, it’s about being targeted and losing their power. It’s a method to numb the hurt and staying alive.”
Health professionals are trained to look for domestic violence. Verigin stated that medical facilities are a good place to be where women who are pregnant are safe from their abuser and are able to discuss their experiences.
The state’s postpartum Medicaid expansion law permits new parents to enjoy health insurance benefits for up to 12 months after the birth.
“The prolongation of Medicaid postpartum is crucial, in that it provides more opportunities to seek out care when such issues can be addressed,” Verigin said. “That postpartum time is an extremely stressful time, and when there’s a possibility of violence within the relationship is more likely to be exposed during this period.”
Jennifer Harlos, a nurse and member of the committee that oversees the Maternal Child Death Review, stated that seeing the non-medical concerns that impact medical treatment inspired her to pursue a doctoral studies of public health. She worked for the Alaska Native Tribal Health Consortium for 12 years. She has worked mainly in labor and birth.
“You’re sitting at the bedside during this moment of vulnerability in the life of a person. You’re able to see all these problems but there’s only a certain amount you can do with this lens at the moment,” she said, talking about things like the violence of intimate partners. “If you speak to me or one of my colleagues we’re all aware of what the issues are. We are aware of the issues and we’re not able to solve them from our seats at the hospital.”
Domestic violence is a factor in maternal mortality in suicides and murders and suicides, but it may also be a factor in deaths due to medical reasons.
“If you’re not allowed to leave your home that’s why you’re not going to attend your appointment. If you’re certain that your spouse is likely to drink and harm your children, you’re probably not going to be admitted to a medical facility,” Harlos said.
“People don’t really think about that. However, a lot of women don’t receive the medical treatment they require because their children are in danger or are incapable of going for treatment in a hospital. This is more often than you do.”
The stakes are particularly high for women who have to travel to seek medical attention.
Harlos explained that a pregnant woman who has experienced violence from a domestic partner tends to develop certain conditions that could increase the risk. The risk is higher for women to enter preterm labor, suffer an abruption, which occurs when the placenta is separated from the womb because trauma to the abdomen or high blood pressure drug use, and to suffer from intrauterine growth restrictions because of emotional and physical stress.
“The majority of us who die include Alaska Native women. Most of them happen on the outskirts of Alaska where they are in the least accessibility to services” She said.
Family members by family
Harlos explained that the challenges to access are a an important reason for the most frequently-recommended recommendation of the Maternal Child Death Review Board is to have the state extend home visiting nurses across Alaska.
“These women, whether due to intimate partner violence or for a variety of other reasons, aren’t in need of help, aren’t they? Therefore, we have to visit them and provide this assistance. This is the purpose of these programs,” she said.
Home nurse visiting programs exist in Alaska however not all Alaskans who are pregnant have access to these programs. They are available to all pregnant Alaskans. Maternal Child Death Review began in a collaboration in conjunction with the Alaska Native birth worker program to provide culturally sensitive support. The program received the $250,000 annual grant by the Office on Women’s Health. The state is still in the middle of three grants to fund available and is transferring the program to collaboration in conjunction with universities. Verigin said.
Harlos explained that the birth assistant or doula acts as a link between family life as well as the medical world and they are aware of the demands and limitations of those working in health care. They know about the personal and home issues for the client. They are able to utilize that understanding to advocate for their patients.
“They’re well-versed in what is happening at hospitals, and they are also aware of situations to our patients, which we’re not even aware of,” she said.
“And it’s because of the culturally-managed care that patients do not always receive from everyone on the health team that they work with,” Harlos said. “That helps a lot in creating confidence when you think about the past and what might have occurred.”
Abra Patkotak, a mother professional who provides care to pregnant women at their homes prior to and after the birth. Along with Charlene Apok of Data for Indigenous Justice, is part of the Alaska Native Birth Workers Collective which offers care at no cost in the home of Alaska Native families. At present, the group is being funded by the crowd, said Patkotak.
The group began as an idea within the group’s text thread but it has since grown. According to Apok’s estimates the group has been certified by around 40 doulas as well as lactation experts. The group also offers classes on childbirth and also facilitates men’s groups.
“The inability to support the cause is a major issue,” Patkotak said.
She attributes her violence with a system not supporting Alaska Native families, especially families who live away far from hospitals to the point that women have to leave their homes at least a month before the time of delivery to be close to hospitals this is a common practice in the majority of rural Alaska communities.
“For Alaska Native people, especially those who live in rural Alaska you’re also dealing with the anxiety of being forced to leave your community typically around 35 weeks or earlier, to leave your family and friends behind, and frequently being forced to leave your children behindthe strain that this creates for families is enormous. The issue isn’t being studied and there’s no place else within the United States that this forced evacuation has been happening,” Patkotak said.
She noted that most doctors do not consider themselves Alaska Native They haven’t visited the remote areas of Alaska and are unable to comprehend the hardships these families go through to be admitted into the medical facility.
” The health care system by yourself can be a daunting experience,” she said. “Who you meet in the health care system might not understand the culture of your family, your beliefs or and even the language you use … Understanding culturally how to communicate with others, even if they don’t speak is a significant factor in creating peace, especially when you’re born.”
Patkotak added that her and the other birth professionals are able to assist pregnant women get the help they require in hospitals and also assist them to remain safe as their work helps ease anxiety and tension at home.
“If there’s a good position We’ve already established the trust and the security that people need to are confident in our services when they need help, they can contact us and we’re able to help them access resources they may not be aware about, should they need assistance,” she said.
Apok and Patkotak stated that the high proportion of Alaska Native families that are victimized by family violence can be a pattern that could be stigmatizing if people don’t understand the historical background.
“This comes directly related to colonization.” Apok said. “Living elders are today sharing the horrors of the boarding schools. It’s horrifying . . . The men didn’t just start to become violent. It happened because of the way they were taught and their experiences. There are children who were as young as 4 who were snatched and then maltreated, and later required to create families. What were we expecting to occur?”
“It was a thing which was forced upon us and that we are trying to recover from,” Patkotak said. “We’re not violent However, we’ve been severely hurt by unsafe systems.”
In the end, they believe that education about childbirth and the direct efforts to build stronger families is helping repair and heal the past. Apok stated that in spite of the grim statistics they deal with, and the ongoing violence in the state there is optimism.
“I am certain that it is making an enormous difference,” they said.
“Family is family, right?”
This piece was created as part of the Annenberg Center to Health Journalism’s 2023 domestic Violence Effect Fund. The article first appeared in the Alaska Beacon and is republished here with permission.
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