The Blaine County Journal News-Opinion - We've Got The County Covered

When Amy Stiffarm was a graduate student at University of Montana, she learned that Native American women have low rates of breastfeeding. But she didn't understand why.

"Until one day, I came across (reports) about how historical trauma and boarding school trauma took away our parenting knowledge and knowledge around how to feed your babies," said Stiffarm, who is Aaniiih and a descendent of the Chippewa Cree and Blackfeet tribes. "I had never seen that before - something that was talking about the root causes. It was novel to me, it made sense, but why was no one talking about it?"

Stiffarm, who was earning a master's degree at UM with a focus on maternal child health, said she struggled at times during the program.

"I felt like I always had to do extra work to find Native American-specific information," she said. "It felt like I was always going out of my way."

Even participating in online discussion boards could be exhausting. "I remember so many times I felt like, I don't want to talk about Native issues because I don't want to have to explain all of this stuff," Stiffarm recalled. "But sometimes I would. I felt a little burdened to help educate people. I was just so tired and discouraged that people who were going to be public health professionals may not know anything about tribes."

Stiffarm's experience was not unique to UM, and she acknowledged that she could've had the same experience at other universities in the country. When she graduated, Stiffarm had two little girls. And while she'd dreamed of pursuing a doctoral degree, the prospect, at the time, felt challenging.

"I felt like I would need a dual Ph.D. in Native studies and public health, and that felt like it was too much," she said. "You hear horror stories of your committee or adviser or professor not valuing Indigenous knowledge, and I just thought, 'I can't fight that fight right now.'"

But when University of North Dakota launched its Indigenous Health Doctoral program in 2019 - the first program of its kind in the country - Stiffarm saw an opportunity.

"I felt like, I have to do this," she said. "This is what I've been waiting for."

Stiffarm enrolled in the program, but soon, the pandemic hit. Stiffarm's classes moved entirely online, and her daughters' daycare shut down, leaving Stiffarm, a single parent, to figure out how to care for them while being a student and working part-time. There were good times, like when her daughters were occupied with paper and crayons so she could study, and there were challenging moments, like when she wondered if she could even complete the program. Fortunately, Stiffarm's parents in Fort Belknap and other community members offered to help where they could, sometimes taking the children for a few days while Stiffarm prepared for exams. Stiffarm could tell the new doctoral program was unique right from the beginning. Instead of educating her peers and professors on Indigenous value systems and historical trauma, she said the cohort's baseline understanding of these topics allowed them to focus instead on solutions.

"We didn't have to always talk about disparities," she said. "It wasn't all negative all the time. It felt like a breath of fresh air, as a scholar. It felt magical to have Native professors and peers who were mostly Native as well as some allies."

At University of North Dakota, Stiffarm studied perinatal mental health for Indigenous women- an issue personal to her. When Stiffarm first became pregnant, she found she wasn't sure exactly what she needed to do.

"I realized, wow, I don't really know much about this," she said. "I know so much about death. I know exactly what to do at funerals, but when it comes to giving birth, I don't know what to do."

After she had her second child, Stiffarm struggled with postpartum depression, and as a researcher, she wanted to know what exactly was happening to her body and mind.

"I learned trauma is a risk factor, but no one talked about historical trauma," she said. "I was at risk but didn't even realize it, and no one was talking about it. I saw there was a lack of research, a lack of a full story with root causes, so I thought, 'Alright, I'll (study) this.'"

In her three-part dissertation, Stiffarm wrote first about how non-Native organizations can thoughtfully and effectively engage with tribal communities. In doing this research, she spent a year in conversation with tribal communities about what resources were available and what services were needed.

Second, Stiffarm created a toolkit for providers and others in the public health field about cultural safety. The kit includes Montana-specific historical context and outlines how past events can affect Native Americans who have babies.

"I had providers come to me and say, 'This is what I want to know,' and then I had people saying, 'This is what I want my provider to know," she recalled. "When there aren't programs or research specific to Native women, you start to feel like people don't care. But this work has helped me realize people do care. They just don't know where to start."

Third, Stiffarm analyzed Pregnancy Risk Assessment Monitoring System data. Rather than compare Native American pregnancy data with white pregnancy data, she instead chose to focus entirely on Native communities, making her research particularly unique.

Stiffarm was a member of the first graduating class of University of North Dakota's new program, and upon graduating, she moved to Helena to become the program manager of Native American initiatives at Healthy Mothers Healthy Babies.

Stiffarm hopes to continue to educate non-Native providers on how to improve care, and she wants to help tribes be more aware of risk factors and hopes to support increasing doula work in Montana.

"I can't even believe I have the opportunity to work with tribes in Montana, in my own state," she said. "My research projects always took me elsewhere, so I feel like, 'Wow, I really get to do this.' I want to give back."