An enduring source of strength for Native women is the small world web of social and cultural relationships that we maintain in our communities. Our births, dreams and ceremonies are the primary life experiences and processes through which we women develop, and then channel, our voices and energies. Women’s reproductive power – our sexual and reproductive health – is vitally important to the future of Indian country.

Inherent to the growth and development of our communities is the power of the women’s voice. For too many generations now, Native women’s voices have been silenced by the legacies of federal Indian policy, including historic trauma, family disruption, and sexualized violence and victimization resulting in loss of unity in the body image from internalized shame. Federal and state laws and policies continue to restrict the scope of reproductive and sexual health services that perpetuate this soul-wound of shame suffered by Native women whose bodies, minds and spirits are the First Environment of the generations.

An example of the politicized movement to further marginalize self-determination of Native women and nations is an amendment attached to the long-awaited and much-needed Indian Health Care Improvement Act. The Vitter amendment bans the use of federal funds for abortion services at IHS facilities.

Chronic underfunding of the IHS system and its inability to meet American Indian/Alaska Native health care needs compounds persistent sexual and reproductive health disparities experienced by Native women.

According to the CDC Division of Reproductive Health, AI/AN women are at greater risk of pregnancy complications and adverse pregnancy outcomes than most American women. Native women give birth at younger ages and generally seek prenatal care later in their pregnancies than their non-Native counterparts. They are more likely to participate in risky behavior during pregnancy (20 percent of AI/AN women versus 14 percent of “all-races” women report smoking during pregnancy).

Native women have greater risk of having high birth weight babies. High birth weight is associated with an increased prevalence of gestational diabetes mellitus and an increased risk of serious complications for both mother and fetus in pregnancy, labor and delivery, as well as the development of Type 2 diabetes later in life.

Sexual and reproductive health care has not been a priority of IHS, evidenced by underfunding and underdeveloped service delivery. In tribal communities, some Native women report feeling rushed, powerless, and left out of their own birthing experiences. Maintaining control is important to women’s perceptions about their birthing experiences. Native women feel they can be empowered through less formal modes of education than clinical settings. This highlights an urgent need for even greater attention from the medical community, other scholars and Native women’s advocacy.

Recent major victories accomplished by Native women’s advocacy have resulted in new legislation and new standards for IHS to address the sexual health needs of sexual assault survivors. This includes the provision of emergency contraception, training, and forensic equipment to support the Sexual Assault Nurse Examiner Programs. These breakthroughs are significant toward closing the vast chasm of health disparities experienced by Native women and present historic opportunities to advance reproductive health, rights and justice agendas in Indian country.

We hope the unanimous, bipartisan confirmation of Dr. Yvette Roubideaux to lead the IHS signals a new era for addressing the health concerns of Native women. To date, Native women’s voices have not been adequately sought out in the ongoing national debates around health care. Improvement depends on the inclusion and consideration of their specific needs and objectives.

With the vision to promote woman-centered models of reproductive health care through the life cycle in our communities, many nurses, midwives and advocates who serve Native communities are working to promote and strengthen programs. Their goal is to empower Native women to effectively access and navigate the health care system, and to exercise more control over their health care decisions.

The Centering Pregnancy model of prenatal care is gaining ground in Indian country. Based on continuous healing relationships where the patient is the source of control, and developed by midwife Sharon Rising of the Centering Healthcare Institute, the Centering paradigm is a research based empowerment model that increases access to medical care, education and peer support within a privileged circle of participants. Other research based and woman-centered improvements include the development and strengthening of doulas, professionals who provide continuity of physical, emotional and informational support to women from the prenatal to the postpartum period.

As communities get serious about an alignment of services that makes sense in terms of available funding levels and the complexity of medical care, these kinds of health developments that build from the ground up will provide women with the kinds of culturally congruent care they – we – need.

Katsi Cook, Mohawk, is a traditional aboriginal midwife. She directs First Environment Collaborative, a program of Running Strong for American Indian Youth. Visit her at www.indianyouth.org.

Our births, dreams and ceremonies are the primary life experiences and processes through which we women develop, and then channel, our voices and energies.