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General Health

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#400. The Impact of Aids in the Native American Community (Revised)

The report begins with a background on AIDS and methods of transduction, namely sexual contact with an infected person, contact with infected blood or plasma, and in utero infection. It discusses health care issues for those on rural reservations, such as scarcity of medical services, expensive travel requirements, and a lack of education, awareness, and confidentiality within a small community. Optimistically, the author admits that small communities are easier to educate as a whole if an effort is made. Unfortunately, behaviors that increase the risk of contracting HIV, for example early sexual activity, STDs, alcoholism, and drug use, are prominent in Native American populations. Often, Native Americans have a weaker immune system due to poor diet, economics, diabetes, or alcohol. Weakened immune systems lead to a faster progression to AIDS from HIV. The report discusses interesting aspects of culture-specific incidences of transmission, such as through piercings made during religious ceremonies, and the need for access to sterilized equipment. It takes on thorny topics such as injection drug use and needle exchange programs and their ethical implications, as well as the issue of maintaining a woman’s reproductive rights despite the presence of HIV and the potential for in utero transduction of the virus. Because homosexual men make up 67% of the HIV/AIDS infected Native Americans, the report questions why there are so few educational programs directly targeting this cross-section of the population. Statistics comparing the incidence of HIV/AIDS in Native American vs. Caucasian populations and graphs of several specific STDs by race and sex are included. Because a direct relationship between alcohol and HIV/STDs has been associated, the study suggests that controlling STDs would contribute to HIV control as well. The final discussion concerns HIV in prison populations and its implication in relation to the high percentages of Native Americans in prison. A conclusion explores the role of IHS amidst the epidemic.

#402. The Positive Impact of Community Based Self-Help Education among the Native American Diabetic Population of the Yankton Sioux Reservation

It has been estimated that 70% of the Native American population over age 40 is diabetic and that one new patient is diagnosed every week. Related health problems include a poor diet that consists largely of high-cholesterol commodity foods, obesity, and alcohol abuse. Treatment for diabetes is expensive, not to mention time-consuming, and secondary complications such as arteriosclerosis, heart failure, stroke, gangrene, and kidney dysfunction, are common. Diabetes education would help the Native American population manage their own nutrition and basic needs, effectively reducing the cost of treatment as well as the burden on health care providers. This program teaches participants about self-health care, diet, exercise, hygiene, and insulin, and includes individual consultations with physicians and dieticians. The report reviews the effectiveness of the educational program at the Native American Women's Health Education Resource Center in Lake Andes by surveying participants’ general health, improvements, and knowledge. The program was started in 1989, and the participants are taught how to use a glucometer, how to maintain charts, weights, and manage health through exercise and nutrition. They are instructed in foot and eye care, and are given a glucometer and pair of walking shoes to keep. The initial response to the program was enthusiastic and participation high. The report studied effects of the class on three separate groups: men, women over 40 yrs., and women under 40 yrs. It used blood glucose level as indicator of progress and mapped the information in tables and graphs, drawing comparisons by sex and age. Recommendations include coordinating different education programs and networking between tribally based programs as an effort to pool resources.

#000. Current Status of the Wagner Indian Health Service Health Care Facility and the Effects of Indian Health Service Inpatient Service Closure

On November 16, 1992, IHS discontinued their inpatient services, reflecting the government’s failure to honor the 1975 Indian Self Determination and Education Assistant Act by disallowing the tribe to choose the direction of IHS services. IHS claims tribal approval based on the questionable signature of Tribal Chairman Alvin Zephier, and it continues to ignore the countless resolutions passed by the Yankton Sioux Tribe pleading that inpatient services be continued. The report explains funding sources for the Wagner IHS unit; the closure of the inpatient ward was meant to increase revenue but has resulted in severe deficits, which in turn have caused the dismissal of 75% of the day-staff as well as a reduction of the 24hr. emergency room’s staff. If patients require hospitalization for more than 15 hrs, they are referred to Wagner Community Memorial Hospital, which has not met any of the stipulations put forth prior by the Program Justification Document in a letter justifying the initial services closure. However, because the Community Memorial Hospital refuses to treat “alcohol-related illnesses,” over 33% of IHS patients have to travel to Yankton, about an hour and a half away, to receive medical attention. Because IHS has extremely limited hours, Community Memorial Hospital faces a massive influx of patients after hours, and, as many cannot pay for treatment, has to absorb the costs. Understandably, they are not pleased either. The report discusses why IHS simply does not reinstitute inpatient services and how it has become ever more difficult for the facility to attract competent physicians. It includes extensive attachments and copies of the Yankton Sioux Tribe’s Resolutions in the appendix.

#409. Health Survey for the Yankton Sioux Reservation

This survey canvassed eighty-five homes, of which, it found, more than 60% were headed by females. Information was gathered through a questionnaire and interview, a process that lasted from 1-3 hours, and is presented in graphs and tables. Participants were questioned about their satisfaction with hospital services received and the ready availability of these services. The study graphed how many participants actively partook in preventative medical exams, for example pap smears, breast exams, and proctologic exams, and mapped smokers by age and sex. It gathered information on dietary habits, such as the number of meals per day, snack, types of food, and dieting history. Also diagrammed are frequencies of dental checkups, exercise, and blood glucose levels. Although figures about STDs may be a bit skewed due to the personal nature of the question, participants were questioned about their STD history and pregnancy prevention methods, and their reasons for not using condoms were recorded. Charts graph breast-feeding vs. bottle-feeding practices. Other data incorporated into the report concern community knowledge of radon gas. During interviews, the conductor questioned participants on active testing of levels of radon gas in homes and the frequency with which they used their basements. The report concludes with a discussion of its findings and is dotted with recommendations for improving general health and awareness.

#413. Report on and Analysis of the Yankton Sioux Reservation Community Health Fair 1993-1994.

The report initially discusses the background and evolution of local health fairs and goes on to describe the levels of community participation and types of information and tests offered at the fairs. It explains the hardships encountered by rural inhabitants; for example, over 34% use hospitals that are more than 100 miles away and 12% are not affiliated with a hospital at all. High turnover rates for physicians at IHS ensure inconsistent treatment and the need for educated self-monitoring of one’s health is apparent. The information gathered at the fairs on the general health of Native American participants, such as cholesterol levels, diabetes, blood glucose levels, and blood pressure, is graphed and explained. The report concludes by discussing the benefits of health fairs in aiding the Yankton Sioux community with maintenance of general health.

#411. Revictimizing the Battered: An Investigation of the Charles-Mix County Criminal Justice System's Management of Domestic Violence Cases

This report was published in the face of severe inconsistencies on the part of city authorities in treating cases of domestic violence. It begins by defining domestic violence and introduces cycles of violence, dynamics between the batterer and victim, and how violent actions are reinforced in today’s society; it attempts to resolve the ever-present question of why a woman simply does not walk away from the situation. The prevalence of domestic violence cases in Charles Mix County, 95% of which featured a male batterer, is analyzed. It is frightening to note the casualness with which the police treat domestic violence crimes as opposed to crimes committed by strangers. In Charles Mix County, as many as 25% of the criminals were undercharged despite severe injuries to the victim, an action that sends a message of tolerance to offenders. Police failure to gather crucial evidence and take photographs of visible injuries is apparent and the inclusion of irrelevant, even inappropriate, information in the initial police reports create a ready bias for the next examiner of the case. The report discusses the abundance of releases granted to batterers based on personal recognizance without regard to the danger that this leniency could place upon the victim. Native American women, in particular, are often caught in “a bureaucratic net;" while they reside on tribal land, the state police have no jurisdiction to enforce a restriction order, and if the charge was not filed through the Bureau of Indian Affairs courts, BIA police have no right to insist that the order be followed. In the cases where the victim herself requests dismissal of the case or refuses to testify out of fear of retaliation or financial burdens, it is the responsibility of the police to carry out a proper investigation and prevent future attacks. Often, in fact, the woman is ordered to attend counseling sessions more frequently than the male offender, revealing a sexist attitude towards gender roles in a family. The report is well-written, comprehensive, and includes recommendations for change in the conclusion.


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Native American Community Board, Inc. Annual Report

Reproductive Justice Reports & Roundtables

Environmental Issues Reports

General Health Reports

NAWHERC’s reports have been used by Congress, the U.N., the World Health Organization, Amnesty International, universities, and policy institutes to bring awareness of the environmental and reproductive justice issues facing Indigenous women. NAWHERC’s work has resulted in policy changes such as improvements in informed consent, providing patients with results for abnormal pap tests and mammograms, treatment of HIV+ patients, patient confidentiality, and the discontinuation of Norplant.

To order a report, call the NAWHERC at (605) 487-7072 or use the PayPal buttons on the screen.

Electronic copies of some of our newer reports are now available online.

Environmental Issues

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#404. Radon in My Community: The Impact of Radon in the Yankton Sioux Communities

After cigarette smoke, radon gas is most often cited as the cause of lung cancer. Radon in My Community begins with a brief history of early study of radon, which largely began in 1984 when a nuclear power plant worker’s clothing detonated alarms in the building. Officials traced the radioactivity not back to the facility, but to the man’s home. The report then explains the correlation between cigarette smoke and radon gas--smoking amplifies the effects of the radon gas on lungs. The smoke allows radioactive daughter particles to remain in the atmosphere where they’re an omnipresent threat to breathing lungs. The report discusses EPA recommendations for homes with high levels of radon, proper testing, and the costs involved. Issues specific to Native Americans are also addressed, such as widespread smoking, high levels of uranium and radon naturally present in the soil, and socio-political factors that make it hard to address the matter of radon poisoning when there are other more immediate maladies demanding attention as well. The report introduces a federally organized 1989 screening test that found that 61.5% of the homes tested on the Yankton Sioux Reservation were over EPA recommended radon levels. Both the findings and the faults of the survey are discussed; the report questions the lack of follow-up testing and failure of the sanitarian to act in a timely fashion upon discovering the over-high levels.

#406. A Report on Southern Missouri Waste Management Association's Proposed Landfill Project in Lake Andes Area, South Dakota

The report begins by defining “environmental racism,” during the application of which, industries target communities that are less educated, older, conservative, and of lower socioeconomic means, for example, communities of color. Solid waste regulations as put forth by the EPA are explained, followed by a discussion of violations of these federal regulations during the submission of SMWMA’s permit application. The proposed facility site is located less than 1000 ft. from a stock dam, springs, and tributaries, and may pollute the Lake Andes water tablet; its proximity to Lake Andes farms, wildlife sanctuaries, and the eagle refuge is also obvious. Further, blatantly ignoring EPA recommendations, the site is located on a sloping plane, magnifying the danger of toxic erosion. SMWMA intends to use a clay liner base to contain waste on the dumpsite and prevent leakage into the environment. They would be better off using a composite liner, however, as leakage due to natural deterioration, lightning strikes, and molecular diffusion are inevitable; leachate that does escape ought to be removed from the site rather than sprayed back into the landfill as SMWMA intends. As dumps can easily become “disease vectors,” documented increases in health problems in populations living close to landfill sites have been noted. Similar to the case with Hydromex, if the facility is located on tribal land, the Yankton Sioux tribe becomes responsible for future leaks and management of dumpsite in the case of company closure. The appendix includes copies of several documents cited in the report, such as Resolution 91-39 of the Yankton Sioux Tribe and a technical review of SMWMA’s landfill permit by the Department of Environment and Natural Resources.

#410. Recycling or Alleged Recycling? A Review of the Hydromex Waste Processing System.

Hydromex International Ltd. intends to recycle waste material at dumpsites, including toxic chemicals such as paint and leachate, to make low-cost construction products. They claim that the toxicity of their materials is firmly contained or neutralized within the finished product and will not dissipate into the environment over time. This report questions that claim and expresses concern about the neutralization process. From the data gathered from common Hydromex brochures and booklets, the study found surprisingly little information on the limits placed on different kinds of toxic materials that are accepted for processing. It expresses skepticism about Hydromex’s ability to guarantee a complete absence of emissions from the processing as well as their physical ability to “neutralize” chemicals. It is sensibly noted that a majority of users of Hydromex construction products are likely to be of low-income backgrounds, leaving much room for misuse of toxic materials and unethical procedures. Besides the danger presented by the finished product itself, there is the risk of spills when transporting waste to the facility site, not to mention the problem of the facility itself which, complete with large amounts of wastes, could be abandoned at the location if the company were to file for bankruptcy. The Yankton Sioux Tribe, who is considering signing a contract with Hydromex, would then be economically responsible for all medical and environmental damage caused by the forsaken project. Although Hydromex is more established in Europe, there is no information about how their product will be received in the United States, as there has been little formal testing on the finished material. Further, the company’s venture has not been formally approved by the EPA. The report suggests that traditional mandatory recycling would be more effective than Hydromex’s dubious method and includes recommendations for ways to start. Also included in the appendix are letters from other organizations, such as Greenpeace, EPA, and Boulder County Land use Department, and local newspaper articles, urging caution against Hydromex products.

#713. A Study of the Herbicide and Pesticide Use within Lake Andes Watershed on the Yankton Sioux Reservation

One encounters pesticides frequently in daily life in the form of household cleaners, urban exposures, through diet, and at recreational areas. These chemicals can enter the body through a number of channels: oral, dermal, ocular, and through inhalation. One may not feel the effects of the exposure until much later, as children and adults have widely different metabolic rates, and the bodies of adults store chemicals in bone and fatty tissue more easily than those of children. General effects on health may range from minor allergies to serious birth defects and cancer. This report describes EPA registration of pesticides, as all chemicals must be catalogued before they may be sold commercially, and speculates that there must be grave flaws in the process, since many harmful compounds have passed through EPA’s lenient policy. Companies are not required to provide data on long-term effects of their products, and they are required to list only active ingredients in the finished material. As it is the company, and not the EPA, who decides which chemicals ought to be considered active as opposed to inert, there is a wide margin for illegally including dangerous substances in commercial products. Further, the EPA studies the effects of the chemical using a very narrow definition of population and does not account for differences in tolerance based on race, size, age, or sex. In order to assess pesticide use patterns, increased risk patterns, and types of chemicals used around Lake Andes, the Resource Center conducted a household pesticide survey in which they examined health effects, storage and safety practice, and methods of disposal; a copy of the questionnaire is in the appendix. Tables of popular herbicides used by local farmers as well as the drift effect of machinery and techniques used to spray were constructed, and detailed profiles of the chemicals are included in the appendix as well. The report ends with recommendations for cautious and limited use of pesticides.


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Reproductive Justice Reports & Roundtables

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Indigenous Women's Dialogue - Roundtable Report on the Accessibility of Plan B as an Over The Counter (OTC) Within Indian Health Service - February 2012 Available Online


A Survey of the Availability of Plan B and Emergency Contraceptives within Indian Health Service. 2008. Available online

Over the years Indian Health Service has denied Native women the same options of birth control that is afforded to mainstream women. IHS has provided a narrow set of options that in many cases has forced Native women into sterilization that would not have done so if other options were available. The lack of standardized policies that govern reproductive services within this Federal system has allowed this history of Human Rights abuses to occur. It has denied Native women services that other women have access to. As in the case of emergency contraceptives this situation has created an environment that forces women to carry unplanned and unwanted pregnancies to term. This situation has occurred in history during Hitler’s years of control in Germany, when women were raped and forced to have babies for the Third Reich and when Black women in the US were raped by slave masters to produce more children to be forced into slavery. Forcing women to have children against their will is an act of slavery and denying them health care and services to terminate a pregnancy under these circumstances are truly Human Rights violations. This survey examines the access and inconsistent application of emergency contraceptives within the Indian Health Service system.

Roundtable Report on the Availability of Plan B and Emergency Contraceptives within Indian Health Service. January 2009. Available online

The Indian Health Service (IHS) clinical manual states that “all FDA-approved contraceptive devices should be available” to its patients.9 However, despite the fact that Plan B® has been FDA-approved for nearly a decade and ruled safe for over-the-counter use since 2006, the Resource Center’s January 2008 study A Survey of the Availability of Plan B® and Emergency Contraceptives Within Indian Health Service shows that EC and Plan B® are still not adequately available at Indian Heath Service facilities.10 To date, a mere 10% of surveyed IHS pharmacies have Plan B® available OTC. Plan B® was not available–even with a prescription–at 50% of the pharmacies in the study. At 37.5% of these pharmacies, the older Yuzpe regimen was offered instead; the remaining 12.5% of IHS facilities still had no form of EC available at all.

A Survey of Sexual Assault Policies and Protocols within Indian Health Service Emergency Rooms. 2005. Available online

It is important to understand that for most Native American women private health care is unaffordable, so the Indian Health Service serves as our primary health care provider. For Native American people health care is not a privilege, it is a right. It is a right granted in exchange for land seized and is defined by treaties written by the United States Government. The staff of the Native American Women’s Health Education Resource Center is known for taking on the role of activist in order to help Native American women receive better and improved health care. The Resource Center has put together this briefing paper on emergency room services and policies for Native American women who go to an Indian Health Service facility for assistance after a rape or sexual assault. The findings of this survey are alarming and document a substantial gap in services for Native American women.

Roundtable Report on Sexual Assault Policies and Protocols within Indian Health Service Emergency Rooms. 2005. Available online

In October 2002, the Native American Women’s Health Education Resource Center (NAWHERC) released findings that the Indian Health Service (IHS) was not providing lawful abortion services under the Hyde Amendment to Native American women. The findings underscored the fact that Native American women’s health care and rights are in jeopardy. In 2003, representatives from the U.S. and Canada gathered for a Roundtable on access to abortion and provided recommendations for action at the national, international, and community levels. Since then, NAWHERC has partnered with the National Abortion Federation (NAF), the American Indian Law Alliance, the American Civil Liberties Union (ACLU), Cangleska Inc., the Center for Reproductive Rights and other advocacy and women’s health organizations to ensure that treaty-negotiated women’s reproductive health care through IHS remain accessible to Native American women.

#001 Indigenous Women's Reproductive Rights: The Indian Health Service and Its Inconsistent Application of the Hyde Amendment

Traditional Native American customs left the issue of abortion in the hands of the woman facing the choice; the decision was hers alone and was not, as it is today, imposed upon by impersonal governmental policy. Although illegal abortions can be extremely dangerous due to the lack of proper and sterilized equipment, abortions were not legalized in the United States until 1973. At the time, a federal account was specified in order to fund abortions for women on Medicaid or those who received health care through IHS. In 1976, the Hyde Amendment was established, and limited federal funding to abortions where a woman’s life was threatened physically. A 1997 revision to the Hyde Amendment allowed financial aid in cases where rape or incest caused the pregnancy. The report goes on to discuss individual states’ ability to determine Medicaid policies and thus, the ability to expand or restrict funding for abortions. Regardless of whether a state is able to expand its Medicare policy, Native American women are still constrained by the Hyde Amendment. Given their rights under the Hyde Act, however, IHS abortion policy in practice is yet more limiting. A survey conducted by Native American Women's Health Education Resource Center found that 85% of the IHS units surveyed were “noncompliant with official IHS abortion policy” and 62% stated that they do not provide abortions even in the case of life endangerment. Although IHS Chief Medical Officer permits the use of Mifeprex (RU-486, the abortion pill), not one of the units surveyed carried the drug in stock. The report includes a brief description of RU-486 and ends with a plea to IHS and other organizations to at least provide the health care guaranteed to women by the constitution and the Hyde Amendment.

#002 Indigenous Women's Reproductive Rights: Roundtable Report on Access to Abortion Services through the Indian Health Service under the Hyde Amendment

The state of South Dakota has been known to be conservative, and it is extremely difficult for a woman to obtain abortion services here. In fact, only one private abortion clinic, located in Sioux Falls, exists in the entire state. Indian Health Service, under the directive of the Department of Health and Human Services, is required to follow federal abortion policy that permits federal financial aid in cases of rape, incest, or life endangerment; they have failed to provide these guaranteed services in the past. Since 1981, a mere twenty-five abortions have been performed by the 352 IHS units established nationwide, a figure that is hugely disproportionate to the number of rapes reported by Native American populations. The issues covered in this report include the massive turnover rates of physicians at IHS, a phenomenon that results in a sexist, cultural, and religious bias. These traveling doctors have few connections with the communities in which they work, and their impersonal outlook helps muddle the question of whether a patient’s case fulfils the requirement of rape, incest, or life endangerment needed to obtain the necessary abortion. The report includes recommendations for involving the Native American community in actions for change and ways to work specifically with, as well as potential challenges in working with, Native American populations. An outline guides the reader through the group’s strategy for approaching individual IHS units, and finally, moving on to an international scale.

#419 The Current Status of Indian Health Services Reproductive Health Care: Report #1: A Focus Group Examining the Indian Health Service's Reproductive Health Care for Native American Women in the Aberdeen Area

This focus group study featured eight women, between ages 18-37, from six different Lakota and Dakota nations, who used IHS as their primary health care providers. The purpose of the study was “to bring awareness to IHS’s present delivery of services to Native American women,” to examine IHS policy and protocol, and to see if women who receive care there felt well informed of their condition, medication, and capable of administering to themselves afterwards. A study such as this also helps initiate formal dialogue between IHS and their patients. The report includes a brief history of IHS, funding, and an echo of the IHS mission statement. Statistics comparing the health of Native Americans with all other races indicates a much lower health status. Many women questioned mentioned the lack of information presented to them during their hospital visit. The physicians seem to have no interest in educating their patients about short-long term effects of various RTIs or prevention methods, and this type of attitude leads to women making uninformed decisions about the birth control device appropriate for them. Instead, they often report feeling pressured to use certain kinds of contraceptives, particularly long-term types. Even more shocking is the fact that the men and women these patients see are sometimes not physicians at all but practicing PAs or fraudulent doctors not in good standing with their certification board. IHS also has a history of severely violating their oath of confidentiality to the point where pregnant women delay seeking prenatal care in order to delay informing the public of the news of their pregnancy. The report includes a review of IHS health care practices and a discussion of the implications of the focus group’s dialogue.

#003 Young Native American Women's Knowledge of Reproductive Tract Infections: Report #2: A Focus Report Examining the Reproductive Health Awareness of Young Native American Women in the Aberdeen Area

Written between June-July in 1999, this report examines the level to which young Native American women in the Aberdeen area have been educated on the topic of common reproductive tract infections. The Resource Center has been concerned by the high incidence of RTIs reported in the communities, and, in the process of this report, conducted a focus group discussion with 27 young women between the ages of 14-19 years from seven different Lakota and Dakota nations. The intent of the discussion was to empower the girls’ voices through publication, thus allowing their words to reach school officials, counselors, and policy makers, as well as directly affecting the direction of the Resource Center’s educational programs’ curriculum. The report includes a brief explanation of RTIs and a paragraph on the history of sexual education policy at the area schools. The listed questions were put to the girls in a near survey style, and their responses are reported as quotes. The study found that there was little clarity about the terms RTIs, STDs, and even HIV/AIDS due to the lack of effective or consistent sex-education in schools. Group leaders also recorded the girls’ primary sources of information and their suggestions for improving sex education curricula. The discussion placed a clear emphasis on culturally specific and appropriate health education, and recommendations include proposals for involving the community and schools in future programs.

#414. The Dakota Roundtable: A Report on the Status of Native American Youth in the Aberdeen Area

The Dakota Roundtable was part of the Native American Women’s Leadership Development Program initiated by Native American Women's Health Education Resource Center. In May of 1993 twenty-eight representatives from Lakota, Dakota, Omaha, and other nations in the states of South Dakota, North Dakota, Iowa, and Nebraska met to discuss the unrealized health needs within their communities. The committee’s goals were to identify and develop recommendations for the existing issues in their communities and to improve partnerships and policy-making strategies; they also intended to promote political activism, creative problem-solving skills, and leadership roles among young women. To better identify specific needs of the community, the group was divided into three sections defined by children’s developmental stages. The first group focused on ages 0-5 yrs. and discussed matters such as a mother’s ability to access health care resources, substance abuse and its consequences, parenting skills, teen pregnancies and family planning programs, and the presence of violence in the household. The next group battled, through debate, concerns for the 6-12 age group such as domestic violence, physical health basics, child-care and parenting, the definition of health as put forth by indigenous people, and the lasting effects of colonialism. The final group discussed the health of children from ages 13-21 and the pressures of their lives, such as pregnancies, drug abuse, violence, and suicide. The recommendations made by each assembly are recorded at the end of the report.

#414A. Dakota Roundtable II: A Report on the Status of Native American Women in the Aberdeen Area

The Dakota Roundtable II was held in Sioux Falls in September of 1994 and was intended as a forum, a safe environment, in which participants could openly share their experiences as Native American women. The meeting also provided an opportunity for organizations to build partnerships, develop strategies to maneuver the issues discussed into the policy-making domain, and to advance leadership roles for women in the community. The assembly divided into three sections to discuss Health Issues Facing a Native American Woman, the Traditional Ways of Being a Native American Woman, and Violence and Abuse Issues. The first topic included concerns such as the state of existing health and medical programs, diseases such as diabetes that are prevalent in the race, and other health issues such as reproductive rights, menopause, and domestic violence. This group also included a brief section on medical attitudes and unethical research practiced on Native American women. The second section recorded their thoughts in a unique memoir style, as accounts told by participants. The women attempted to define the meaning of “traditional Indian,” and spoke of the role of and importance of language, culture, and historical names and labels. They further discussed elitism and class-ism and the place of tradition within this imposed structure. Spurred by the fact that although Native Americans only make up 6.9% of the population in South Dakota nearly 50% of all domestic abuse reports come from Native American households, the final group focused on spousal violence and “formalized, institutionalized abuse” by the community. In addition, they wrote of the lack of recognition for a woman’s work, lack of leadership roles for women, discrimination in public schools, and a variety of issues at the workplace.

#414B. Dakota Roundtable III: A Report on the Status of Young Native American Women in the Aberdeen Area

The third in its series, the Dakota Roundtable III was held in Sioux Falls in April 1996. Organized a bit differently from the previous ones, this one featured a forum for sixteen girls, age 12-19, from the tribes of Crow Creek, Lower Brule, Rosebud, Santee, Sisseton, Wahpeton, and Yankton. Before splitting into smaller groups, the girls spoke in an open dialogue of the difficulties they have perceived in their daily lives. While the younger girls listed issues such as prejudice, ignorance among their peers about their culture, and smoking and drugs, the older girls went on to mention the complexities of being a single parent with little financial or emotional support from a spouse, and the pressure to succeed put forth by one’s family as opposed to the stereotyped roles imposed on them by society. One group discussed the effects of drugs and alcohol on female teens, including relationships with drinking parents and friends, personal views and experiences with drinking, tragedies, violence, and reasons for indulging in drugs. A second group spoke of issues faced by teen mothers, such as personal and familial responses to the event, drugs taken during pregnancy, financial instability, housing, and childcare. The final topics discussed incorporated the issues of racism and prejudice. The report relates points of racism experienced by the team itself while stationed in Sioux Falls for the conference as well as the anecdotes told by the participating girls. They noted the effects of relationships within their families on their own personal outlook, attitudes on interracial dating, and power interplay between the races prior to the introduction of violence into any situation. A 1994 survey on Native American sexual health revealed startling results that are discernible in this study as well. For example, a massive 92% of sexually active girls reported being forced into sexual intercourse on a date, and 67% have been pregnant by the end of their senior year in high school. Within the age group 15-19, 50.6 out 100 girls have one or more children.

#403 The Impact of Norplant in the Native American Community

Norplant became available in 1991 in the United States and within a year had cornered 12% of the U.S. contraceptive market. Written in 1992, this report recognizes the potential for social control present in the method of delivery of Norplant and attempts to differentiate for the reader the issues of reproductive choice and population control. It includes a background of the drug and a summary of concerns, such as the lack of information available that pertains directly to Native Americans and their limited access to Norplant removals. Although Norplant is extremely effective compared to other hormonal contraceptives, several side effects, such as decreased efficacy in women of greater weights and prolonged menstrual cycles, make it an inappropriate choice for many women. Add to this the fact that the drug is downright dangerous for women with diabetes and blood pressure problems, and it becomes a particular threat to Native American women, among whom the above-mentioned illnesses are relatively common. Pamphlets included with Norplant packages fail to emphasize the gravity of the situation. Patients are given little counseling and are told to watch a one-sided video provided by the manufacturing company to assuage their fears. Furthermore, there have been no long-term studies on the effects of Norplant, particularly on selective sections of the population such as teenagers, whose bodies may react differently to an extended use of the drug. Several foreign research studies have been conducted but seem inconsistent and untrustworthy due to a lack of regulation and controlled environment. Indian Health Services (IHS) still has no formal policy regarding Norplant; welfare policy permits financial aid for Norplant insertion but not for early removal unless the reason is a serious medical reaction to the product. The report goes on to discuss involuntary use of long-term contraceptives for parents accused of drug or child abuse; it is an intrusive punishment as well as a violation of a person’s right to procreate and to refuse medical treatment. A conclusion and recommendations for developing an effective IHS policy for Norplant and for restructuring of Title 19 welfare policy to include removal costs within initial fees follows.

#405 A Study of the Use of Depo-Provera and Norplant by the Indian Health Service

This report discusses several important aspects of the use of Norplant and Depo-Provera contraceptive devices by the Indian Health Services (IHS). The topics covered include the policy and procedures of IHS, counseling of patients, and the lack of information made available to them. The drugs’ failings and effects of lifestyle are also mentioned, as well as the issue of informed consent prior to procedure and the lack of a standardized protocol with a tracking system for patients with Norplant inserts. The report delves into the potential for misusing both drugs for purposes of social control rather than as contraceptives chosen for and by a woman. It cites, as proof, past testing of the drug in an unethical and ineffective manner on women of lower socio-economical means as exemplified by the studies done in Brazil and India. Overviews of both foreign studies are included in the appendix. The report briefly describes the background, basic facts, and chemical processes of the drug, and discusses drawbacks, particularly culturally specific problems such as diabetes, obesity, and the interference of prolonged menstrual cycles with religious ceremonies. It goes on to convey the enormity of the 1970’s sterilization abuse by IHS, where 25,000 Native American women were coerced into sterilization through uninformed consent in 1975 alone. More recently, Depo-Provera has been used on severely retarded Native American women with the intention of eliminating their menstrual bleeding altogether for the convenience of their caretakers; the fact that the drug eliminates bleeding completely in only a fraction of the cases remains ignored. Further concerns with IHS treatment of Norplant include its decentralized structure where implant services must be contracted to traveling physicians, leading to limited availability of doctors licensed to remove the insert. High rates of physician turnovers and patient mobility also ensure a lack of consistency at IHS service units. The report also questions the applicability and absolute trustworthiness of a FDS approval.

#405a A Review of the Use and Impact of Depo-Provera on Native American Women

Written two years after the 1993 Depo-Provera report, this document studies the drug in more detail than the previous. The information presented in the report was gathered through interviews and questionnaires, a copy of which is included in the appendix; of the forty-two women that were consulted, 88% were Native American and 12% Caucasian. Results are graphed in statistical percentages; graphs tabulate the entire medical process, the information received by the women, and their understanding of the drug and its side effects. The report was conducted in response to concerns about side effects of Depo-Provera and its irreversible, provider-controlled distribution. The side effects include an increased risk of breast cancer with prolonged use, genital abnormalities in cases of fetal and infant exposure, blood clots and higher cholesterol levels, and reduced glucose tolerance. With a history of diabetes in Native American populations, some of these side effects can be debilitating. The survey found that many users were young teenagers at the time of their first injection. Women who started using Depo-Provera at an early age face the added risk of developing advanced osteoporosis by the time they reach their thirties, as well as dealing with irregular periods and a lack of protection from STDs. A brief history mentions past unethical uses of the drug and the potential for coercive practices regarding social control. The report discusses on whom the responsibility for a patient’s health ultimately falls and the extent of a physician’s role in decisions made by the woman concerning long-term birth control. Recommendations in the conclusion encourage further study on the long-term effects of the drug, particularly on over-weight women, and the development of a culturally sensitive and consistent protocol on the part of the IHS.

#414C. SisterSong Native Women's Reproductive Health and Rights Roundtable: Moving Forward the Native Women's Reproductive Rights Agenda

The SisterSong collective is made up of four ethnic groups: African American, Asian American, Latina Americana, and Native American, with four further subgroups within each of those categories. This roundtable report was developed by the Native American women’s branch. It begins with a section of thoughts and comments as quoted by the participants at the event. Following this are recommendations for “implementing Native American women’s right to knowledge, education, and policy development on reproductive Health and rights” at the individual, family, social, and policy level. Also included are recommendations concerning a woman’s ability and right to access reproductive health education, prevention programs, and reliable health services. The report is formatted by subject topic with relevant quotes by participants underneath.

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