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. Womens reproductive power
our sexual and reproductive health is vitally important
to the future of Indian country.
to the growth and development of our communities is the power of
the womens voice. For too many generations now, Native womens
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
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.
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.
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
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.
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 womens 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 womens advocacy.
major victories accomplished by Native womens 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.
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 womens 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.
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.
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.
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.
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.
births, dreams and ceremonies are the primary life experiences and
processes through which we women develop, and then channel, our
voices and energies.