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Reproductive Justice

Plan B National Awareness Campaign

Our Goal is to ensure that Plan B® is available as an over-the-counter pharmaceutical for all Native women, and to incorporate access to the drug into standardized sexual assault policies. We also seek to inform Native women of their right to Plan B® so that they are able to make informed decisions regarding their reproductive health.

 

 

What is Plan B®? Plan B® is an emergency contraceptive used to prevent pregnancy up to 72 hours after unprotected sex. A form of back up contraceptive, often known as the "morning after pill," Plan B® can be used in situations including when a woman is raped or sexually assaulted, had unexpected unprotected sex, missed two or more birth control pills or a condom broke or failed during sex. When taken within 24 hours of unprotected sex, Plan B® is 95% effective at preventing pregnancy, and when taken within 72 hours of unprotected sex, Plan B® is 89% effective. Plan B® contains levonorgestrel, a hormone that prevents ovulation and fertilization by thickening or changing the lining of the uterus. Plan B® is a preventative measure, and will not affect or terminate an already existing pregnancy. It also does not protect against sexually transmitted diseases. Any person 17 years of age and older has the right to access Plan B® over the counter (OTC) without a doctor's prescription.

 

Update - Plan B One-StepTM : Plan B

® now comes in a single pill. In 2009, the Food and Drug Administration (FDA) approved Plan B One-StepTM, which is a single pill containing 1.5 mg of levonorgestrel, that signficantly reduces the chance of pregnancy if taken within 72 hours of unprotected sex. Previous emergency contraceptives required women to take two pills; one was taken as soon as possible and the next one, 12 hours later. Having to take only one pill increases the simplicity and convienence for women in need of a back-up contraceptive. Plan B One-StepTM works in the same method and has the same guidelines as described above. For more information, visit http://www.planbonestep.com/.

 


December 1, 2010

 

The Native American Women’s Health Education Resource Center (NAWHERC) is announcing a public awareness campaign that calls for rightful access to Plan B® through Indian Health Service (IHS), especially for survivors of sexual assault. Following a NAWHERC Survey Report and Roundtable Report, this campaign aims to address the erroneous actions exhibited by the Indian Health Service's inability to provide adequate healthcare choices to Native women, regarding their sexual health and reproductive rights.

 

 

 

 

Although Plan B® has been available without a prescription to adult women since 2006, the NAWHERC survey found that it is not provided over-the-counter (OTC) at 90% of IHS pharmacies. This alarming percentage clearly documents that IHS pharmacies are not abiding by the FDA’s decision to make Plan B® available OTC to any woman 17 years of age and older. Furthermore, the survey also revealed that 40% of IHS pharmacies provide Plan B®, but only by prescription. This is highly problematic as the efficacy of Plan B® is extremely time-sensitive, and requiring a woman to wait long hours at the clinic to see a healthcare provider could greatly reduce the effectiveness of Plan B® .

 

 

 

 

Currently, IHS facilities lack standardized policies and immediate access to Plan B® for survivors of sexual assault, which violates the reproductive rights of Native women. Only 56% of IHS facilities provide victims of rape with access to Plan B® , whereas an additional 17% of IHS facilities provide a different though less effective and more physically stressful prescription form of emergency contraception. Even more shocking is the fact that 12.5% of IHS facilities provide absolutely no form of emergency contraception.

 

 

Given the rural locations of many reservation communities, IHS facilities that do not provide immediate emergency contraception severely limit the reproductive freedoms of Native women in those communities. This campaign strives to ensure that emergency contraception, such as Plan B® or its generic equivalent, is available at all IHS facilities OTC to any woman 17 years or older and is incorporated into the IHS sexual assault policies and protocol.


Check out an article published about our campaign in the Lakota Country Times and keep an eye out for the November 2010 front page article inThe Circle News!


 

What Can You Do To Help? Call your local Indian Health Service pharmacy and demand that they carry Plan B ® over-the-counter, as every person age 17 and older has the legal right to fully access this emergency contraceptive. In addition, contact your Tribal Health Board and state legislators and alert them of the need for Plan B® to be fully accessible in Indian Health Service.

Contact the White House and Ask President Obama to support Native women's right to access Plan B® as an over-the-counter contraceptive through Indian Health Service. All women ages 17 and older have this legal right, and Native women should be no exception.

 



In order for Plan B and other reproductive health services to be uniformly available at Indian Health Service, policies must be changed. The Native American Women's Health Education Resource Center has authored and proposed IHS policies for reproductive health care. These guidelines cover topics including contraceptive, sexual assault procedures and pregnancy-related care, and can be presented to IHS, tribal leaders, legislators and others to show the changes that need to be changed. Click here to read these proposed IHS policies.


 

Check out the Native American Women’s Health Education Resource Center’s 2008 publication ‘A Survey of the Availability of Plan B and Emergency Contraceptives Within Indian Health Service,’ which documented the widespread lack of emergency contraception and access to Plan B within the Indian Health Services. In 2009, a Roundtable discussion among a diverse group of Native American advocates illuminated the gravity of this issue for women throughout Indian Country. The subsequent ‘Roundtable Report on the Availability of Plan B and Emergency Contraceptives Within Indian Health Service’ revealed numerous systematic barriers to comprehensive reproductive healthcare services for Native women.



For more information, call the Native American Women's Health Education Resource Center at (605)-487-7072.


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Reproductive Justice Videos

Reproductive Justice Videos

See our Reproductive Justice Videos on Youtube, or view them below.

Videos of NAWHERC Executive Director, Charon Asetoyer

 

 




Other Reproductive Justice Videos

 

 


 


 


 


 


 


 




Proposed IHS Policies


Proposed Indian Health Service Guidelines For Provision of Reproductive Health Care
The purpose of these policies is to provide guidance for medical professionals in the care of women's reproductive services, especially timely services for survivors of sexual assault. Once adopted by the Indian Health Services headquarters (hereinafter “I.H.S. Headquarters”), these policies shall pertain to and be followed by all Indian Health Service Units and Emergency Rooms, Direct Care Facilities, and Contract Health Services (hereinafter “I.H.S Facilities”).

I. GENERAL PROVISIONS

a. All I.H.S Facilities shall either provide or make referrals for reproductive health services on request. I.H.S. shall pay for the cost of services resulting from all such services or referrals.

b. I.H.S. Headquarters shall establish standardized protocols for the delivery of information regarding all I.H.S. coverage for reproductive health care services.

c. I.H.S. Headquarters shall establish a Sexual Assault Management Protocol and mandate that each I.H.S. Facility post a copy of the Sexual Assault Management Protocol for attending medical staff to reference.

d. I.H.S. Headquarters shall establish standardized protocols mandating that all I.H.S. Facilities provide reproductive health care in a culturally acceptable, gender sensitive, respectful, unbiased and confidential manner.

e. All I.H.S. Facilities shall strictly maintain patient confidentiality.

f. Memoranda of Understanding between I.H.S. Headquarters and contracted facilities shall reflect and be subject to this policy.


II. CONTRACEPTIVES

a. I.H.S. Facilities shall inform women seeking to prevent pregnancy verbally and in writing of the full range of FDA - approved contraceptive options, including emergency contraception.

b. I.H.S. Facilities shall provide women with the contraceptive method of their choice, including an advance prescription for emergency contraception.

III. PREGNANCY-RELATED CARE

a. I.H.S. Facilities shall provide, in writing and verbally, all women who request information related to pregnancy options with the relevant information in a comprehensive, non-directive, unbiased and confidential manner. This will include information on:

i. Prenatal care and delivery;
ii. Infant care, foster care and adoption; and
iii. Pregnancy termination (surgical and medical).

b. I.H.S. Facilities shall inform women who request information about an abortion, provision of an abortion, or a referral for an abortion of the following:

i. I.H.S. shall pay for an abortion where the pregnancy results from rape or incest or endangers the woman's life;
ii. Whether the Medicaid program in that state is required to cover abortions in additional situations (e.g., instances of fetal anomalies or medically necessary abortions);
iii. Whether I.H.S. and/or Medicaid are required to cover transportation costs associated with obtaining an abortion; and
iv. Available support services at I.H.S. Facilities, such as counseling and aftercare.

c. I.H.S. Facilities shall provide all needed assistance to access abortion services on-site or through contracted services to all women who request such assistance and whose pregnancy results from rape or incest or endangers the woman's life.

d. I.H.S. Facilities shall assist women who wish to seek Medicaid coverage of an abortion in enrolling in Medicaid if eligible and in obtaining a Medicaid covered abortion.

IV. SEXUAL ASSAULT SURVIVORS

a. I.H.S. Headquarters will establish standardized, written protocols for the delivery of information and services to sexual assault survivors in a culturally acceptable, gender sensitive, respectful, unbiased and confidential manner for all I.H.S. Facilities. I.H.S. Headquarters will develop these protocols in consultation with representatives of the Native American community and national groups with expertise in assisting sexual assault survivors. These protocols should be adapted from the Department of Justice's National Protocol for Sexual Assault Medical Forensic Examinations (available at http://www.ncjrs.gov/pdffiles1/ovw/206554.pdf), with the important addition that all sexual assault survivors be informed about and offered emergency contraception.

b. I.H.S. Facilities shall develop sexual assault treatment services by working in consultation with representatives of the Native American community served by that I.H.S. Facility and with local community groups involved in assisting sexual assault survivors (e.g., rape crisis centers, rape response teams, women's domestic violence shelters/programs).

c. I.H.S. Facilities shall offer emergency contraception to all survivors of sexual assault and provide such contraception upon request. Providers must document this offer by having each sexual assault survivor sign a form, to be kept in her confidential patient file, acknowledging that she has been offered emergency contraception.

d. I.H.S. Facilities shall provide screening for Sexually Transmitted Infections (STI) and Reproductive Tract Infections (RTI) and shall provide STI treatment and RTI treatment to all survivors of sexual assault.

e. I.H.S. Facilities shall provide testing for HIV and shall inform all rape and incest survivors about PEP (Post-Exposure Prophylaxis).

f. I.H.S. Facilities shall inform all rape and incest survivors that I.H.S. Headquarters provides coverage for abortions where the pregnancy results from rape or incest; document the provision of this information by having each rape and incest survivor sign a form, to be kept in her confidential patient file, acknowledging that she has received this information

V. TRAINING

I.H.S. Facilities shall provide training to all relevant staff regarding the provision of reproductive health care and treatment for sexual assault patients, which includes the following requirements:

a. All I.H.S. Facility service providers shall be appropriately trained to provide services in a culturally acceptable, gender sensitive, respectful, unbiased and confidential manner. This training shall be specific to the Nation/Tribe being served.

b. Trainings shall be revised, updated, and re-administered to all relevant staff as any changes in delivery of services occur and as technological changes occur that would affect a sexual assault survivor or reproductive health patient.

c. Every I.H.S. Facility shall have one Sexual Assault Nurse Examiner or Sexual Assault Forensic Examiner (SANE/SAFE) on staff and/or on call.

d. All I.H.S. Facilities' medical staff that has occasion to treat sexual assault victims shall be familiar with medical protocol acronyms relevant to such treatment, such as SANE (Sexual Assault Nurse Examiner); SAFE (Sexual Assault Forensic Examiner); SART (Sexual Assault Response Team); Chain of Custody (Protocol followed when working with the Sexual Assault kit.); SOR (Sexual Offense Report - specific to regions hospital); SAER (Sexual Assault Exam Report) and SO/SA (Sexual Offense/Assault).

e. I.H.S. emergency room medical professionals shall administer rape kits on-site without requiring travel or transfer to a contracted facility to perform the rape kit.

f. I.H.S. Facilities shall include current information regarding the provision of information and delivery of reproductive health services and treatment for sexual assault survivors within a staff manual.

g. I.H.S. Facilities shall promptly inform patients and all relevant staff when new reproductive health services or services for sexual assault survivors become available and when coverage of services changes.

h. I.H.S. Facilities shall establish policies, procedures, and protocols for training all relevant staff regarding the provision of information and the delivery of services described under Parts ll and lV above.

VI. DISSEMINATION OF INFORMATION TO PATIENTS AND I.H.S. STAFF

I.H.S. Facilities shall:

a. Inform all patients and relevant staff of what reproductive health services I.H.S. Facilities provide and what reproductive health services I.H.S. Headquarters covers (including, but not limited to abortion, emergency contraception, the full range of FDA-approved contraceptive drugs and devices, services and treatments for survivors of sexual assault.)

b. Amend the Patients' Bill of Rights to inform women of their right to obtain the full range of FDA - approved contraceptives (including Emergency Contraception), non-directive pregnancy options counseling, PEP and I.H.S. coverage of abortions (surgical and medical) in certain circumstances.

c. Post the amended Patients' Bill of Rights in every I.H.S. Facility throughout all patient waiting rooms or other areas where patients are regularly received for intake and/or provided care.

d. All policies, procedures, and protocols must be posted and accessible to medical staff, in the emergency room. Emergency room medical personnel shall receive Sexual Assault treatment protocols upon new hire and appropriate training/understanding of protocols. Staff shall be required to review policies, procedures and protocols on a regular basis.

VII. RECORD KEEPING

I.H.S. Facilities shall maintain and report to I.H.S. Headquarters the following data, in a manner that maintains the confidentiality of all patient records and identifying information:

a. The number of women who came in for health services after experiencing incest, rape, or other sexual assault, how many of those women were offered emergency contraception, and how many of those women accepted emergency contraception.

b. The number of women who requested information about an abortion and the number who requested an abortion. For those women who requested an abortion, the number of women who:

i. Received a referral for an abortion;
ii. Had an abortion performed at an I.H.S. Facility;
iii. Sought an abortion because they were pregnant as a result of rape;
iv. Sought an abortion because they were pregnant as a result of incest;
v. Sought an abortion because continuation of the pregnancy endangered their life;
vi. Were Medicaid-eligible and received assistance from an I.H.S. Facility in obtaining an abortion; and
vii. Obtained Medicaid coverage of an abortion.

c. The gender identity of each sexual assault patient.



VIII. REVIEW AND AUDIT

I.H.S. Headquarters shall require all I.H.S. Facilities to establish a review/audit process by which it will ensure that the protocols developed pursuant to the above items are followed at all I.H.S. Facilities. The review/audit process should include, but not be limited to, an evaluation of whether Facilities have kept records or can provide proof to establish that:

a. Patients seeking to prevent pregnancy have received emergency contraception information/prescription;

b. Sexual assault victims have been offered counseling;

c. A sexual assault victim's advocate was contacted and whether or not she/he was present when a sexual assault patient was treated;

d. The number of sexual assaults presenting annually in the emergency room;

e. Patients have been informed that if a pregnancy resulted from a rape, I.H.S. will provide coverage for an abortion;

f. The number of requests for abortion and/or information requests regarding abortion;

g. The number of abortions provided by an I.H.S. Facility;

h. A SANE/SAFE is in place or on-call at every I.H.S. Facility; and

i. SANE/SAFE training is current and comprehensive and occurs on a yearly basis.


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Reproductive Justice Agenda

Native Women for Reproductive Justice

 

 

"Empowerment Through Dialogue," a historical three-day meeting was held in Pierre, South Dakota, on May 16th, 17th, and 18th, 1990. More than 30 Native Women, representing over eleven Nations from the Northern Plains came together in a collective decision-making process to form a Reproductive Justice Coalition. Their efforts resulted in an Agenda for Native Women's Reproductive Justice.


Reproductive Justice Agenda:
  1. The right to knowledge and education for all family members concerning sexuality and reproduction that is age-, culture-, and gender-appropriate.
  2. The right to all reproductive alternatives and the right to choose the size of our families.
  3. The right to affordable health care, including safe deliveries within our communities.
  4. The right to access safe, free, and/or affordable abortions, regardless of age, with confidentiality and free pre- and post-counseling.
  5. The right to active involvement in the development and implementation of policies concerning reproductive issues, which include but are not limited to pharmaceuticals and technology.
  6. The right to include domestic violence, sexual assault, and AIDS as reproductive justice issues.
  7. The right to programs which meet the nutritional needs of women and families.
  8. The right to programs to reduce the rate of infant mortality and high-risk pregnancies.
  9. The right to culturally specific comprehensive chemical dependency prenatal programs including, but not limited to, prevention of Fetal Alcohol Syndrome and Effects.
  10. The right to stop coerced sterilization.
  11. The right to a forum for cultural/spiritual development, culturally-oriented health care, and the right to live as Native Women.
  12. The right to be fully informed about, and to consent to any forms of medical treatment.
  13. The right to determine who are members of our Nations.
  14. The right to continuous, consistent, and quality health care for Native People.
  15. The right to reproductive justice and support for women with disabilities.
  16. The right to parent our children in a non-sexist, non-racist environment.
  17. The right of Two Spirited women, their partners, and their families to live free from persecution or discrimination based on their sexuality and/or gender, and the right to enjoy the same human, political, social, legal, economic, religious, tribal and governmental rights and benefits afforded all other Indigenous women.
  18. The right to give birth and be attended to in the setting most appropriate, be it home, community, clinic or hospital and to be able to choose the support system for our births, including but not limited to, Traditional Midwives, Families and community members.
  19. The right to education and support for breastfeeding that include but not limited to, individuals and communities that allow for regrowth of traditional nurturing and parenting of our children.

In order to accomplish the foregoing stated rights, Native Women for Reproductive Justice will create conditions and alliances to network with other groups.

Attending Participants, May 18, 1990
Authors of the Indigenous Women's Reproductive Justice Agenda : Points 1 - 16
Sherrie Agneau
Cheyenne River Sioux
Viola Poorman
Rosebud Sioux
Anita Sanchez
Yankton Sioux
Barbara Bruguier
Three Affiliated Tribes
Karen Artichoke
Oglala/Winnebago
Maria Provost
Cheyenne River Sioux
LeAnn Swenson-Wall
Chitamaiche/Cherokee
Janice Howe
Crow Creek Sioux
Charon Asetoyer
Comanche
Naomi Renville
Omaha, Seneca, Sioux
Laura Trudell
Yankton Sioux
Theresa Red Bear
Crow Creek Sioux
Ellen Ashes
Yankton Sioux
Nancy Denny
Santee Sioux
Wanda Wells
Crow Creek Sioux
Darlene Medicine Crow
Crow Creek Sioux
Winifred E. Boub
Rosebud Sioux
Antoinette Eagle Boy
Standing Rock Sioux
Phyllis Wilcox
Oglala Sioux
Delores O'Connor
Yankton Sioux
Corrine Black Bear
Rosebud Sioux
Mollie A. Emery
Santee Sioux
Myra A. Winckler
Yankton Sioux
Debra Pickner
Crow Creek Sioux
Tillie Black Bear
Rosebud Sioux
April Fallis
Crow Creek Sioux
Georgine Young
Yankton Sioux
Lisa M. Iyotte
Ft. Belknap Sioux
Judy A. Bridwell
Cheyene River Sioux
Carmel C. Flood
Yankton Sioux
Mona Fischer
Yankton Sioux
Jackie R. Rouse
Rosebud Sioux
Donna Haukaas
Rosebud Sioux
Evelyn New Holy
Oglala Sioux
Bessie L. Long
Yankton Sioux
Brenda Hill
Blackfoot
Mary Louise Defender-Wilson
Northern Dakota Sioux
Amended May 28, 2000: Points 17 - 19
Attending Participants
Charon Asetoyer
Comanche
Lona Fast Horse
Cheyenne River Sioux
Barbara Moore
Apache
Pattie Salas
Chicana Coahuilteca
Nilak Butter
Inuit
Adelina Alva Padilla
Santa Ynez Chumash
Yako Myers
Mohawk
Consuelo Schimpf
Comanche
Dorothy Davids
Mohican
Pamela Kingfisher
Cherokee
Leslie Hawkins
Metis
Beverly Scow
Kwa Guilth
Cecilia Gomez
Chicana
Beverly Little Thunder
Lakota Sioux
Julian Paul
Penobscot
Alice Skenandore
Ojibwa
Luz Guerra
Mestiza
Mia Luluqusien
Ilokano/Heiltsuk
Colette Powers
Anishinabe
Dagmar Thorpe
Sac and Fox

In appreciation to the Women of Color Partnership Program of RCAR of Washington, D.C., and the Native American Women's Health Education Resource Center of Lake Andes, South Dakota, for co-sponsoring this meeting, and to the Ms. Foundation for continued support.

Reproductive Justice Program

Through the Reproductive Justice Program, NAWHERC works with a national, broad-based, and diverse coalition of Native American, women’s health, and civil liberties organizations to move forward an Agenda to protect our health and Human Rights. NAWHERC has brought to the forefront the issue of Indian Health Service’s lack of standardized sexual assault policies and protocols for sexual assault victims, documenting IHS's violations of Native women’s right to health care and pregnancy prevention services.

NAWHERC brings Native women together through the Roundtable process to document their voices concerning the impact of Federal Indian policy on their lives. By increasing awareness of government policies that affect the daily lives of Native women, NAWHERC uses activism to promote the voices of Native women at local, national, and international decision-making levels.

NAWHERC’s reports have been used by Congress, the U.N., the World Health Organization and university and policy institutes to bring awareness of the reproductive justice issues facing Indigenous women, and by Amnesty International’s Maze of Injustice report just released April 2007, which shows the failure to protect Indigenous women from sexual violence in the United States. NAWHERC’s work has resulted in policy changes such as improvements in informed consent, the provision of patients with results for abnormal pap tests and mammograms, treatment for HIV+ patients, patient confidentiality, and the discontinuation of Norplant.

In the News:
SisterSong Native Women's Reproductive Rights and Health Roundtable Convenes
Focus Group Details IHS Response to Reproductive Health Issues

Welcome to the Indigenous Women's Reproductive Justice and Pro-Choice Page!

The purpose of this page is to provide information concerning Indigenous women's reproductive health and their perspectives on pro-choice issues. Throughout history, Indigenous women have interacted with other Indigenous women through various women's societies. Traditionally, the matters pertaining to women were the business of women. All decisions concerning women's reproductive health were left up to the woman as an individual. Her decision was respected, and it was final. Oftentimes an Indigenous woman would turn to other women within her society for advice, mentoring, and assistance concerning reproductive health.

The aboriginal people of the North Central Plains lived in not only a democracy, but also a matrilineal society when Pierre Radisson, the first white person, visited the villages in 1654. The Native women enjoyed a life unknown to white women in Europe, being free to own their own homes, participate in decisions about their government, and have control of their bodies.

In the ensuing years, the People were herded onto reservations and today live in hostage status, suffering every deprivation and loss of freedom. Our grandparents were forcibly taken from their families and sent long distances to schools where the teachings and wisdom of thousands of years of our civilization were brainwashed out of our grandparents' generation. The insidious erosion of identity, culture, spirituality, language, scientific, technical knowledge, and power created the chaos and violence in which we, as women, struggle to survive and live a decent life. With the imposition of colonization and Christianity, foreign values, belief systems, and practices were forced upon our communities. Within those foreign systems, decisions pertaining to reproductive health were made by the Church with little regard to individual rights. Traditionally, reproductive health issues were decisions made by the individual, and were not thrusted into the political arena for any kind of scrutinization. The core of decision-making for the Indigenous woman is between her and the Great Spirit.

Within traditional societies and languages, there is no word that equals abortion. The word itself is very harsh and impersonal. When speaking to traditional Elders knowledgeable about reproductive health matters, repeatedly they would refer to a woman knowing which herbs and methods to use "to make her period come." This was seen as a woman taking care of herself and doing what was necessary. Oftentimes women would turn to the women within her society that were the keepers of those herbs, medicines, and techniques for assistance.

With knowledge and appreciation of our history, we fully realize our status in today's society, as we state our rights and aspirations as Native women.

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