Birth outcomes of Native Americans in Massachusetts: Policy implications of using either race or ethnicity on birth certificates

Native Americans in Massachusetts, who make up less than 1% of the population, suffer the worst health outcomes, including birth outcomes, of any race group in the state. We have found that “for most birth indicators, Native Americans had poorer outcomes than Massachusetts as a whole.” This issue must be addressed in policy and programs. The first step in developing successful policies and programs is understanding the demographics of the target population. For example, how many births, fetal deaths, and infant deaths are there each year. There are many reasons why counting is not straightforward. The Massachusetts birth certificate contains information that may yield insight. The parent worksheet, which is used to fill out the birth certificate, gives “American Indian” as a race category, and “Native American” as an ethnicity category. Further, when a mother indicates that her ethnicity is Native American, she is asked for her tribal affiliation. We have found that birth outcomes vary by whether mothers choose American Indian as a race and/or Native American as ethnicity. Mothers who chose “Native American” as their ethnicity and not their race, generally had the worst outcomes [of the three possibilities: American Indian by race only; Native American by ethnicity only; or both]. We will explore the meaning of the different choices, and we will examine how tribal affiliation interacts with these choices in birth outcomes. With this information, we can begin to explore how policies and programs can be designed to improve birth outcomes.