Native Leaders Brief Congress on Reproductive Health Priorities

"It's high time we address the needs of Native women."

[Photo: Deb Haaland stands during the 116th Congress swearing-in ceremony.]
In a session organized by Rep. Deb Haaland (D-NM) along with the Center for Reproductive Rights and the U.S. Human Rights Network, Native leaders called on Congress to provide more federal money to community organizations that are already doing critical maternal and reproductive health care, and to honor treaty promises that include providing quality health care to tribal members. BRENDAN SMIALOWSKI/AFP/Getty Images

A panel of experts gave a briefing to a packed room of U.S. House of Representatives staffers Tuesday in hopes of bringing attention to the reproductive and maternal health concerns of Native people in the United States.

In a session organized by Rep. Deb Haaland (D-NM) along with the Center for Reproductive Rights and the U.S. Human Rights Network, Native leaders called on Congress to provide more federal money to community organizations that are already doing critical maternal and reproductive health care, and to honor treaty promises that include providing quality health care to tribal members.

Native reproductive health is a priority for Haaland, one of the first two Native women ever elected to Congress. “When mothers are healthy and thriving, their children can also grow and thrive, but there is a lack of services that promote maternal health in Indian Country,” she said in a statement emailed to Rewire.News. “That’s why I didn’t hesitate to bring the voices of expert Native women to Congress to talk about maternal health in the indigenous community. Bringing attention to this incredibly important issue will help us develop policy solutions that empower women and support healthier mothers and families.”

One policy change suggested by the panel’s experts was repealing the Hyde Amendment, a budget rider that bans federal funding from going toward abortion care except in instances of rape, incest, or life endangerment. “The Hyde Amendment disproportionately impacts those who predominantly rely on federal funding for their health care, such as Native” women, said Lauren van Schilfgaarde, one of Tuesday’s panelists and an attorney at the Tribal Law and Policy Institute, in an interview with Rewire.News after the briefing.

Van Schilfgaarde pointed out that Indian Health Services (IHS), the agency responsible for Native health care, is 100 percent federally funded. “The Hyde Amendment has really acted as a full prohibition in effect for IHS. Very few if any IHS facilities offer any abortion services whatsoever. So if a woman were to come in who was a victim of sexual assault, even though she’s entitled to abortion services to be paid for, she’s not going to be able to get them,” van Schilfgaarde said.

Using an example of a pregnant Native woman from South Dakota, van Schilfgaarde explained how Hyde acts as an abortion ban people in poverty. In her scenario, a pregnant Native person in South Dakota may be forced to wait up to eight weeks for their first prenatal appointment with IHS, which doesn’t offer abortion care. From there, they’d have to figure out if Medicaid would cover the abortion (it doesn’t), and then travel at least three-and-a-half hours to the state’s only abortion clinic in Sioux Falls. They’d have to pay to stay overnight in a hotel room to satisfy the state’s mandatory 72-hour waiting period, which doesn’t include weekends or holidays. Additionally, they would have to undergo state-required “counseling” designed to dissuade patients from having an abortion.

“She’s going to have to pay to drive, pay to stay overnight, as well as take time off work, [and] pay for any child care,” said van Schilfgaarde. “All of these expenses come out of pocket, and she’s the least likely to be able to afford [it]. That’s not even accounting for the trauma that she’s just endured, the trauma of navigating all of these issues, and the trauma of enduring the abortion itself. All of that serve as a huge barrier that most other women don’t encounter …. The Hyde Amendment is just not acceptable.”

The Hyde Amendment wasn’t the only issue discussed by the panelists. Melissa Rose, a Native midwife with the Changing Woman Initiative, a nonprofit health-care collective centering Native American women, discussed the barriers this population faces in accessing midwifery care and midwifery training. “Around the world, the midwifery model of care is the gold standard,” she said in an interview with Rewire.News shortly after the briefing. “Most women who are healthy receive care from midwives, [but] in the U.S. it’s marginalized within the health-care system. So that means that it’s not integrated into the health-care system in a way that makes it accessible for people, especially Native people, because we do receive our health care through the federal delivery system of Indian Health Services.”

There’s been significant congressional interest in addressing the country’s abysmal maternal mortality rate. Maternal death rates are higher in the United States than most industrialized nations even though we spend more money on health care than countries with comparable levels of economic development. According to a 2016 report from the American College of Obstetricians and Gynecologists, the rate of maternal death in the United States in 2014 was about 24 deaths per 100,000 live births. But a deeper look at the numbers reveals that the main driver in the country’s high rate is wide racial disparities in pregnancy-related deaths, specifically the extremely high mortality rate for people of color and Native people compared to other races.

Native people in the United States experience maternal mortality at a rate 4.5 times higher than their non-Hispanic white peers. Rose said increasing access to midwifery care, which is not always reimbursed by Medicaid, should be an integral part of solving that issue.

Though certified nurse midwives are utilized within IHS, Rose said they follow a federally required medicalized birthing model, rather than a traditional midwifery model. “[The medical model] treats pregnancy as a pathology, as a disease,” she said. “Whereas, on the other hand, the midwifery model assumes health and normalcy. We also rely heavily on evidence-based practices as midwives, and oftentimes within the medical model, practices are dictated by insurance companies’ protocols or institution-based protocols, like a hospital, clinic or state.”

Organizers of the congressional briefing hope that the staffers who attended will take Tuesday’s information and translate it into legislation that will make a real impact for the Native population. “The need to address the needs of Native women became apparent to us in the course of our work,” said Jennifer Jacoby Altscher, who delivered the briefing’s opening remarks and is the federal policy counsel for the Center for Reproductive Rights, in an interview with Rewire.News. “With [Haaland’s election] we can start to bring the real experts into Congress, and start to legislate around this issue given the immense interest in maternal health [in Congress]. It’s high time we address the needs of Native women.”