Caught in the Crossfire: Indian Health Services

Passage of the Indian Health Care Improvement Act has been delayed by anti-abortion politicians, who have proposed restrictions on abortion funding that would discriminate against Native American women.

Recent efforts by anti-abortion policymakers have injected language prohibiting the use of Indian Health Service (IHS) funding for abortion services into the Indian Health Care Improvement Act. This past February, the US Senate passed an amendment offered by David Vitter, a Republican from Louisiana, banning the use of IHS funding for abortion except in the cases of rape, incest of a minor, or life endangerment. Congressman Joseph Pitts, a Republican from Pennsylvania, is now poised to do the same in the House of Representatives.

These measures unfairly target Native American women based solely on race, and are the latest in a long line of abuses against Native people by the US government. This legislation also duplicates existing policy – the Hyde Amendment – which already unfairly restricts coverage of abortion by IHS.

In providing an exception only for the incest of a minor, not any case of incest, the recent proposals are even more restrictive than the Hyde Amendment, existing government policy which already unfairly restricts coverage of abortion by IHS. The Hyde Amendment, first passed in 1976, prohibits federal Medicaid dollars from being used to pay for abortion, except in cases of rape, incest and danger to the life of the woman. Even in these cases, however, IHS rarely pays for abortion.

IHS paid for only 25 abortions during a 21-year period, and a survey of IHS units found that 62% reported that they do not provide abortion services or funding even when a woman's life is in danger. Beyond the problems of IHS policy and practice, Native women who live on reservations tend to be geographically isolated. Not only are abortion services often far away in urban centers, but tribal lands may not be served by public transportation or private bus lines.

For Native women and the more than 6 million women of childbearing age who depend on Medicaid and other federal programs, the impact of the Hyde Amendment and the funding bans enacted in 33 states is staggering. Prior to 1976, when Medicaid funds paid for abortion nationally, one-third of all abortions were fully covered. Since the Hyde Amendment took away abortion coverage, federal Medicaid has paid for less than one percent of abortions. As part of the continuum of reproductive health care services, safe abortion care must remain accessible for women who need it – not just for women who can afford it. The Hyde Amendment is so restrictive that it even denies coverage when abortion care is deemed necessary to preserve a woman's health.

These most recent restrictions discriminate against Native American women for whom the Indian Health Service is their primary healthcare provider. A survey conducted by the Native American Women's Health Education Resources Center in 2002 found widespread non-compliance and confusion about abortion restrictions. In fact, 85% of the service units contacted denied women services even in cases where they were legally entitled to coverage.

Historically, Native American women have faced other governmental policies restricting their reproductive lives. Native American children were removed from their communities and placed by the government in non-Indian boarding schools, foster homes and adoptive families. In the 1970s, involuntary sterilization by the Indian Health Service was exposed as a civil rights violation in a lawsuit brought by Norma Jean Serena of the Creek-Shawnee. In the 1980s, although Depo Provera was banned by the FDA because of inadequate health and safety studies, it was administered to Native American women, who were said to be "mentally impaired," without their consent.

The National Network of Abortion Funds is opposed to these recent proposals to amend the Indian Health Care Improvement Act as well as any other efforts to restrict public funding for abortion. In 2006, we spearheaded the Hyde – 30 Years is Enough! Campaign to restore federal Medicaid funding for abortion. This national coalition has grown to include more than 70 social justice organizations. For more information, visit our website at