Land Use Barriers to Native and Western Food Security are Associated with Indigenous Maternal Death Occurrence and Changes to Nutritional Value of a Key Traditional Food

medRxiv, July 2025

40778173

CA Ricci, AE Orloff, M Wynne, L Pflueger, P Hallos, A Lopez, M Phelps, JM Postma, LE Hebert

For American Indian/Alaska Native (AI/AN) populations within the United States, nearly every pregnancy-related maternal mortality is preventable. Factors contributing to AI/AN pregnancy disparities are numerous, complex, and interacting, but there is recognition that diet and nutritional disparities have major roles. Many AI/AN individuals who are Western food insecure turn to traditional (Native) foods to augment general food security. Barriers to Native and Western food security exist, including those imposed by land use. We analyzed publicly available data to investigate relationships between agriculture (the number one land use purpose in the United States), Native and Western food securities, and the occurrence of AI/AN pregnancy-related maternal mortality. We additionally investigated agricultural associations with the nutritional status of a vital traditional food for AI/AN Peoples from Northern Pacific latitudes (coho Pacific salmon, Oncorhynchus kisutch). We demonstrate that relationships exist between food security, land use, and AI/AN pregnancy outcome. Relationships between land use and Native food security also indicate a need to consider the nutritional value of traditional foods consumed by pregnant AI/AN mothers.