NIH IMPROVE · CCMH 2.0
A community instrument for maternity care deserts.
IRM-ERA (Indigenous & Rural Maternal Environmental Risk Assessment) is a symbolic, anonymous, pictorial screening for Indigenous and rural mothers. It is not a diagnosis. It is a map of what hurts — bleeding, heart strain, safety, preeclampsia, mental load, toxins, food, water, housing — and of what holds: doulas, midwives, kinship, and traditional foods.
Why it exists
Rural maternal mortality in the United States runs as much as 65% higher than urban rates. More than 35% of counties are maternity care deserts. On Tribal lands, untested wells, abandoned mines, and agricultural nitrates stack on top of language, distance, and distrust. Community organizations often lack research infrastructure to lead the work they already do.
Research idea
Pilot IRM-ERA as a community research-capacity instrument: (1) validate pictograms and Diné Bizaad with community advisors; (2) measure whether temperature triage moves mothers toward care or safe water without collecting PII; (3) produce de-identified need maps that Tribes and CBOs can carry into NIH/HHS proposals. Aligned with IMPROVE: preventable deaths before, during, and after birth, with community at the center.
How it is built
- Zero PII: answers never leave this device. Month and year of birth are optional.
- English, Diné Bizaad, Spanish, and a low-literacy pictorial mode.
- Immediate red-flag routing: 911, StrongHearts, 988.
- A printable care path to carry to clinic or birth worker.
- Prototype Diné Bizaad needs fluent-speaker review; it is not offered as finished clinical translation.
How to demo
- Start the screening and answer Yes on a red question.
- Open the picture map and tap Doula or Mining.
- Switch to Spanish or Diné. Turn on larger text or voice.
- Open the care path and print it.
IRM-ERA framework · Tassos Gioia · 1stsymptom.com
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