Our ability to feel good and our level of health are intrinsically linked. And access to safe, culturally relevant sexual health services is essential for living a healthy life.

But if we measure our sexual health in relation to the World Health Organization’s definition—that it’s “not merely the absence of disease” but requires “the possibility of having pleasureable and safe sexual experiences, free of coercion, discrimination, and violence”—then many of us fall short.

Across the United States, those of us who got sex education in school likely only received instruction covering abstinence, pregnancy prevention, and STI prevention. But abstinence-only (or abstinence-favored) sex ed programs don’t actually give people the skills and tools they need to live sexually healthy lives.

That’s especially true for Indigenous people, whose access to culturally relevant health services is fraught with centuries of abuse and neglect at the hands of the U.S. government.

“It always goes back to the trauma,” said sexuality educator Gabrielle Evans, who’s also a doctoral student, the co-founder of The Minority Sex Report, and a member of the Haliwa-Saponi Tribe. “From the very recent history of forced sterilization to ‘Pocahontas’ tropes that exoticize and sexualize Native women without their consent, many Native women feel like their sexuality isn’t their own.”

For Indigenous people to own their sexuality, the education needs to reach them when they’re young. (There are more than 1 million Indigenous youth between the ages of 15 and 24 in the United States.) Sex ed curricula rarely—if ever—actually meet their needs, reflecting a lack of access to culturally relevant, Indigenous-centered, positive and preventative health services and education.

Consider this:

• One major evidence-based curriculum for Indigenous youth focuses heavily on pregnancy prevention, although family planning is just one aspect of sexual health. Pregnancy prevention is also an especially difficult and complex topic in Indigenious communities; in the 1970s, Indian Health Service (IHS) facilities sterilized thousands of Native women.
• According to Centers for Disease Control and Prevention data, American Indian/Alaska Native people were diagnosed with chlamydia at 3.7 times the rate of white people in 2018. That same year, the rate of reported gonorrhea cases among those populations was 4.6 times that of white people.
• The 2010 National Intimate Partner and Sexual Violence Survey found that 56.1 percent of American Indian/Alaska Native women had experienced sexual violence in their lifetime, while 55.5 percent had experienced physical violence at the hands of an intimate partner. The statistics about men are similarly alarming: 27.5 percent were survivors of sexual violence, and 43.2 percent experienced physical violence within an intimate relationship.

Both individuals and organizations are working to provide access to sex ed and help Indigenous people own their relationship to sex, which spans the full spectrum of reproductive health: pleasure, STI prevention, birth work, postnatal care, and more.

Centering birth work

Due in no small part to the stigma and lack of information and access to birth workers such as doulas and midwives, pregnant people might they have no other option but to give birth at an Indian Health Services (IHS) facility.

Aspen Mirabal, a full-spectrum doula, family support specialist, certified Indigenous breastfeeding counselor, and member of the Taos Pueblo Tribe, said her hospital birth was traumatizing for her parents. Despite the fact that home births are both rare and stigmatized in Mirabal’s community, her parents decided to have a midwife-assisted home birth for her younger sibling.

“My middle sibling was born at home, and then my youngest sibling was born at a birthing center, and that went great. Each birth just went better and better for them,” Mirabal said.

The midwife plays a key role—across North America, more and more Indigenous people are becoming midwives and birth workers. Mirabal, in fact, is training to be a midwife; there are no midwives currently practicing in Taos Pueblo.

Pregnancy and birth can be highly medicalized, traumatic experiences for anyone. Being able to control your reproductive health, pregnancy care, and birthing options helps give autonomy back to the individual instead of handing it over to a system that wasn’t designed for them.

The problem is, choice isn’t equally accessible to all people.

Although many Native women have been traumatized while in IHS care, many also feel it’s the only place where they can receive sexual health care, due to both financial strain and physical distance. Approximately 90 percent of Pueblo Native Americans are Catholic, which adds a layer of shame and silence to sexual health issues. Midwives and other birth workers help fill in that crucial gap, bringing culturally responsive and patient-guided care to the people who need it.

That work isn’t just relevant during pregnancy.

“We need consistent sexuality education all throughout our lives,” Mirabel said. “And it needs to be tailored. My dream is that my community, the Taos Pueblo community, would have a sex education curriculum that is truly designed for us.”

Centering sexual health, pleasure, and safety

For communities to thrive, it isn’t enough to focus solely on physical, psychological, and social illnesses. Pleasure (and the cultivation of pleasure) has to be at the heart of the work. Evans’ training started in HIV prevention, but today her primary work as a sexuality educator is professional development. Through The Minority Sex Report, she trains other educators on cultural competency in the classroom, and to her, that means creating curricula that go far beyond STI and pregnancy prevention.

“There are so many things that fall under the umbrella of sex education,” Evans said. “It’s so much more than learning about illnesses and infections. It includes good touch and bad touch. It includes communication. It includes birth control. It includes learning your likes and dislikes.”

That’s where Evans’ work as an educator and Mirabal’s work as a doula and midwife-in-training meet. Both aim to educate people about boundaries and touch and to restore autonomy and power to the people they work with.

“Whether it’s labor and delivery or conversations that we have throughout pregnancy, it’s essential for me to pay attention to my clients’ cues about the care they need and the boundaries they have,” Mirabal said. “It’s not just about how I interact with them, but also how I observe them interacting with their partners. That’s one way that we prioritize comfort.”

For Evans, that work starts even earlier; good touch and bad touch are two of the biggest focus areas for sexuality education for kids.

When so many people’s experiences of touch are negative (either nonconsensual, highly medicalized, or traumatic in another way), restoring positive, pleasurable associations with touch can be both radical and fundamental.

“I want Native women to know that they can own their pleasure,” Evans said. “They can explore their bodies and learn their boundaries, and they can do that well before they share themselves with a partner.”

Restoring sexual pleasure as a value happens at the individual level, but for there to be major change, it needs to happen at the generational level too. Having the buy-in of elders is essential, not only because elders and their knowledge are influential in many Native communities, but also because many Indigenous people live in multigenerational housing, where the beliefs of older generations affect how the younger ones live their lives.

“Some curricular options, like Native It’s Your Game, utilize the presence of elders even in the interactive game format,” Evans said. “It’s also the in-person education, though. Having elders in the space to learn with the youth and also to say, ‘Hey, this is important’—that makes a difference.”

The intro video to Native It’s Your Game says it all: Being healthy also means being happy, which means cultivating a pleasurable life in ways that are best for you. Those shifts won’t happen overnight, and there still is progress to be made, but between individuals advocating for change on the ground and organizations finally prioritizing Native well-being, the momentum is picking up.

“We’re not an artifact. This is our culture; it’s who we are. We’re still here,” Evans said. “And it will take a community of us to make sexual health and safety a common experience.”