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Native American mothers whose children were separated from them—either through child removal for or through —experience the kind of grief no parent should ever feel. Yet theirs is a loss that is ongoing, with no sense of meaning or closure.

While some families have eventually been reunited, far too many languish in the child welfare system, where as a result of discrimination and racial bias, structural racism and .

A panel I attended years ago in California was composed of three birth mothers representing three generations of Native American women who had lost a child to foster care or adoption. While each story was unique, they had one thing in common: a never-ending grief that had stayed with them long after they were separated from their children.

I still vividly recall that, with a lump in her throat, one of these mothers said, "I can still hear my baby crying." Those mothers and their stories left a lasting impression on me and my colleagues, which was the catalyst for a new line of research for us. After listening to the panel, my collaborator Sandy White Hawk, a Sicangu Lakota elder of the , responded, "We have to do something for our birth mothers. We cannot let them pass to the other side carrying this grief."

I am an assistant professor of human sciences and I in partnership with the . This work focuses on the health and well-being of Native American families that have experienced family separation by way of the foster care system and adoption.

For the past 10 years, we have of .

Foster care and adoption

The adoption era refers to a period of time beginning in the 1950s with the , a between the Bureau of Indian Affairs and the Child Welfare League of America. It aimed to and has been criticized as another attempt at forced assimilation into non-Native American culture and the .

The continued until the enactment of the , which aimed to protect the best interests of Native American children by . An estimated 25% to 35% of Native American children were removed from their families prior to the .

The Indian Child Welfare Act protects Indian children by with extended families, within the tribe or with an Indian family.

The child welfare system tracks when children leave the system with family of origin. Reunification can occur after aging out of foster care at age 18 or .

To date, there is no way to consistently track how many fostered and adopted Native American children have . However, our team's studies suggest that more than 80% of Native American people who were fostered or adopted .

Separated families

The loss of a child to foster care, adoption or both is not uncommon in the United States. In 2021, approximately 606,031 children were involved in the foster care system. According to the latest data provided by the , an agency of the U.S. Department of Health and Human Services, in September 2021 more than 391,000 children were residing in foster care and over 113,000 were waiting to be adopted. In addition, were adopted through public child welfare agencies in 2021.

Legislation known as the requires only that states report adoptions that occur in public child welfare agencies. Therefore, the statistics above do not account for the thousands of children who are adopted, often as infants, through private agencies outside of the child welfare system. Unfortunately, there is no way to determine each year in the U.S.

This is especially true for Native American children. remain . Allegations of abuse and neglect of Native children at the hands of their parents and other caregivers are twice as likely to be investigated, and Native American children are four times than white children.

In my view, the rights of Native American caregivers to raise their children have been violated by systematic practices of child removal that . Until recently, Native American mothers have been omitted from research on the .

Ambiguous loss

As a family therapist, I have sat with hundreds of families that were grieving the loss of a loved one, particularly a child lost to miscarriage, stillbirth and even death. Still, I was struck by the grief of Native American birth mothers. This grief was different. While it sounded like the grief that follows the death of a child, these children had not died. They were taken. They were alive but still lost.

While my colleagues and I have spoken with dozens of Native American birth mothers over the years, we interviewed eight of them who lost a child to adoption for what is called a phenomenological study. Phenomenology is used to explore the lived experiences of a group of people who experienced a similar event or phenomenon.

We wanted to understand the lived experiences of these mothers. We asked them how they became a birth mother, how their child came to be adopted and how this experience affected their health and well-being.

Our study found that these Native American birth mothers , which is a and .

In Native American culture, mothers are revered as "life givers." The loss of a child to adoption stripped Native American birth mothers of this respected role and of their dignity.

Loss is often linked to death, but there are other types of losses. In ambiguous loss, there is . Ambiguous loss is different from other kinds of loss. It is unfathomable, confusing and immobilizing.

There are two primary types of . One is a psychological absence with physical presence, such as when a loved one has dementia. Another is physical absence with psychological presence, such as the .

The downstream effects

Our research suggests that many Native American birth mothers to adoption because they were young and lacked resources. In many cases, they were unable to say goodbye or hold the baby. They felt ashamed and unworthy.

In addition to the unresolved grief, these mothers became vulnerable to mental health and .

From my perspective, there are glaring and unanswered questions on the ethics and well-being of foster and adoption practices for children separated from Native American families. Native American adults who were that parallels the ambiguous loss felt by Native American birth mothers.

The healing of Native American birth mothers will be an ongoing and collective effort. One by one, . These stories are gaining momentum. What happened to one woman happened to many others.

Credit to Sicangu Lakota elder Sandy White Hawk, founder and director of First Nations Repatriation Institute, whose vision guides this work. White Hawk is a senior author on studies that emerge from this work.