Native American women face overwhelming barriers that deny them use of the emergency contraception pill known as the morning-after pill, otherwise known as Plan B, a new report by the Native American Women’s Health Education Resource Center (NAWHERC) has found.
The Plan B pill is legally available over the counter to any woman age 17 or older and to women age 16 and younger with a prescription. It is effective in preventing pregnancy up to 72 hours after intercourse occurs. American women routinely take it following a sexual assault in which pregnancy may occur.
But the Indian Health Service (IHS), the primary source of medical care for women throughout Indian country, does not consistently make Plan B available to its clientele, even though they are among the most likely group of women to be raped in this country. According to the NAWHERC report, more than one in three Native American women will be raped in their lifetime. Of Native American girls who have been sexually active, 92 percent reported having been forced against their will to have sexual intercourse on a date.
Why are Native Women being deprived of Plan B?
“There is very little oversight of the Indian Health Service,” said Charon Asetoyer, executive director of the NAWHERC on the Yankton Sioux Reservation in Lake Andes, South Dakota. “IHS also leaves too much to the local level, which does not honor the standardized policies and protocols that are mandated by the [Tribal Law and Order Act]. IHS is also leaving the decision of contraceptive choice up to the local level, which means these decisions are often made by the local tribal health boards, and have few or no women serving on them.”
Like other women, Native women who are already marginalized by the tribal health boards are further affected by a raging public debate about Plan B’s availability to young women under age 17. In December 2011, Health and Human Services (HHS) Secretary Kathleen Sebelius overruled a Food and Drug Administration (FDA) recommendation that Plan B be made available over the counter to all women of childbearing age. Sebelius based her decision on what she considered the potentially harmful effects of Plan B on a young woman’s body. But many politicians and activists, citing the science of the FDA recommendation, accused the Obama administration of caving in to pressure from social conservatives in advance of the 2012 elections.
Plan B, which has no effect on existing pregnancies, is not an abortion pill. Nevertheless, a heated debate fueled by press statements from both HHS and the FDA has ensued. Plan B is currently available to women age 16 and younger with a prescription, yet women in Indian Country 17 years of age and over are still unable to obtain Plan B in the communities where they live.
“Local community members can be influenced by the ‘church’ depending on the area, Oklahoma being the Bible Belt, the South West being the Catholic Church and so on,” Asotoyer says. To escape a kind of tyranny over her own body, a Native woman in need of Plan B on any number of reservations would require the resources to travel 100 or more miles to a pharmacy carrying Plan B. Then she would need an additional $50 to purchase Plan B once she gets there. For Asotoyer, a member of the Comanche Nation of Oklahoma living South Dakota, making Plan B available to Native women in the communities where they live isn’t just a legal issue—it’s a human rights issue. “For Indigenous Peoples,” she adds, “it also becomes a violation of the Declaration of the Rights of Indigenous Peoples. The Declaration sets out the individual and collective rights of Indigenous Peoples, as well as their right to health. Article 23 states Indigenous Peoples have the right to be actively involved in developing and determining health, housing and other economic and social programs, affecting them and, as far as possible, to administer such programs through their own institutions.”
Maya Torralba, a Kiowa from Oklahoma and founder of Anadarko Community Esteem Project, says, “The rights of Native American women are never at the forefront of any government policy or legislation.” She suggests that the politicization of the public debate over young women’s access to Plan B diminishes the opportunity for real action in Indian Country. “If we could get political leaders to put aside rhetoric and look at the realities of rape statistics in Indian Country,” Torralba says, “it could potentially end the discussion and create the start of a solution.”
Native women must empower themselves with the facts about Plan B, as Torralba says, to “gain better access to information about the differences between emergency contraception and abortion.” This basic fact-finding will help elevate the discourse and launch a real movement to improve women’s lives.
A rigorous discourse about the inseparable problem of sexual violence in Native communities must also reach critical mass. The high incidence of rape in Indian Country is comparable to that of a war zone; and, for survivors, the complex and severe consequences of rape include Post-Traumatic Stress Disorder, or PTSD, a condition commonly associated with war veterans.
This essential discussion has started under the auspices of the NAWHERC. Asetoyer says, “Years ago we started convening groups of Native women in a roundtable setting which are small group that provide a safe place for women to share information that they might not feel so comfortable doing otherwise.” A summary of their discussion of Plan B is available in “Indigenous Women’s Dialogue" report, and includes the voices of Native women who are advocates, health care workers, and ordinary women living in South Dakota, New Mexico, and Oklahoma.
About the roundtable discussion, Torralba says, “My experience from this forum was that the participants were strong Native women who have dedicated their lives to working hard for the issues in their communities. What I learned from them is that we, as Native women, need to speak up more and work harder for our daughters and the sanctity of their lives. I speak not only as an advocate, but also a survivor.”
Many of the participants shared personal narratives, stories of their own experiences with, or as rape victims. One of those participants was consultant Pamela Kingfisher, a Cherokee, born to the Bird Clan, who lives in Cherokee County, Oklahoma. Kingfisher praises Asetoyer’s organization for honoring a tradition of female empowerment through female talk: “Native women have utilized our women’s societies to support and discuss women’s issues in this way throughout history. I find it is best to bring a variety of voices to the table in order to get the full picture and hear from many differing perspectives. The NAWHERC is known for their Roundtable discussions. I attended my first one in 1988 and I respect the traditional ways of operating and applaud their continuance and respect, for community women, not just our leaders or media stars.”
The community women at this roundtable expressed the ways socio-political issues impact their personal lives. Kingfisher honors them by remembering her own mother, and she bears witness to the violence Native women experience behind a veil of indifference that renders them invisible.
“Post-colonial, inter-generational traumatic stress,” contribute to the high incidence of rape in Indian Country, she says. “Many of our elders (including my mother) were raised in boarding schools and were sexually abused by Priests and Nuns. These are the only ‘schools’ in America that have graveyards, and with babies in them! The poverty, isolation, depression and alcohol abuse will wear a person down to their base selves and they act out in return. Our people don’t talk about sex, birth control, and predatory actions, so we have generations of secrets and un-educated teenagers having sex and babies. The legal systems on reservations preclude local police, only FBI has jurisdiction, and many of the tribal leaders are abusers, so most rape goes unpunished and not talked about.”
According to Asetoyer, before passage of the TLOA, the FBI didn’t spend resources to investigate rape charges on reservations where there were no forensic witnesses available, and forensic witnesses were not consistently available because the IHS “could take several months to get approval” for the health care provider who conducted the rape exam to appear in court to testify. Even more egregious, according to Asetoyer: rape exams do not consistently take place in Indian Country. Even today, “Due to a lack of resources,” she says, “IHS staff are not trained or do not always have the necessary equipment to do rape exams.”
Without evidence that a rape has occurred, Asetoyer continues, “a lot of cases never end up in court and the perpetrator is left to rape again. Many rapes are committed by non-Indians and the issue of jurisdiction complicates cases even more. Tribes need to have the right to jurisdiction of people that commit crimes on reservations no matter what race they are. In other words, the law protects those perpetrators that are not Indian and prevents Native Americans from the protections of due process.”
Kingfisher adds that reliable protections have never been in place for Native American women. “Rape is a tool of war,” she says. “It was used on us beginning in the 1500’s.” Alluding to the psychological damage that began to manifest, according to Kingfisher, by the mid-20th century, she says, “After progroms of annihilation and assimilation didn’t work, we became our own worst enemies by the 1950’s. This powerful tool took on new meaning to completely powerless and degraded warrior men who had no choice but to become oppressors, as they had been oppressed.”
The battle to make emergency contraception available to the women most in need of it is, according to Kingfisher, “a silent war.” With women who attended their meetings contending with “their families and tribal leaders praying for them because they had come to this dangerous meeting to talk about contraception,” she says incredulously, and tribal leadership reluctant to support “any negative discussions about what goes on… women end up taking the brunt of it all.”
These real women literally, physically, taking the brunt of ignorance, fear, shame, and generations of displacement and loss often don’t even know emergency contraception exists. Kingfisher asserts that when the IHS refuses to stock Plan B—and inform women that this form of contraception is a legal option for them to consider—religion, politics, and patriarchy “get in the way” of women and their right to reclaim their bodies from the rapists who would continue to possess them with an unwanted pregnancy even after the rape has occurred.
The Affordable Care Act guidelines, Asetoyer says, “include women’s preventive services, including FDA-approved contraception methods and contraceptive counseling. If this was being followed Native American women would be receiving Plan B upon request as an ‘OTC.’”But with all the recent public debate surrounding contraception, abortion, and women’s rights, particularly in this election year, the issue of rape and Plan B access in Indian Country has not been part of that mainstream discussion.
“As less than 1 percent of the population,” Kingfisher says, “hidden from sight on remote reservations or in the urban melting pot, we are the forgotten people of this land. America will never fully address the wrongs done to Native peoples in order for them to own this country, so we are the shameful orphans of America. We are reminders of their own ancestors’ inhumanity and America doesn’t know how to begin to heal this wound.”
It is a wound slicing Native women, cutting them from the power to reassert authority over their own bodies following sexual assault, cutting them from their essential selves.