A few months after South Dakota banned abortion last year, April Matson drove more than nine hours to take a friend to a Colorado clinic for the procedure.
The trip brought back difficult memories of Matson’s own abortion at the same clinic in 2016. Unable to afford a hotel, the former grocer and parent of two slept in a tent near a horse pasture – bleeding and in pain.
It has long been extremely difficult for Native Americans like Matson to obtain an abortion. It has gotten even tougher since the Supreme Court Roe v. Wade lifted.
New, restrictive state laws add to existing hurdles: a decades-old ban on most abortions in Indian Federal Health Service clinics and hospitals, fewer nearby health centers offering abortions, vast expanses of countryside for many to travel, and poverty affecting more than a quarter of local people Population.
“That’s a lot of barriers,” said Matson, who lives in Sioux Falls and is a Sicangu Lakota. “We’re already an oppressed community, and then this oppression adds to it.”
Of the six states with the highest percentages of Native Americans and Alaskans, four — South Dakota, Oklahoma, Montana and North Dakota — have moved or are ready to further restrict abortion. South Dakota and Oklahoma ban it with few exceptions.
In some communities, the distance to the nearest abortion provider has increased by hundreds of miles, said Lauren van Schilfgaarde, a member of Cochiti Pueblo in New Mexico, who directs the Tribal Legal Development Clinic at the University of California-Los Angeles.
“The indigenous people have to travel huge, huge distances and cover all travel expenses and childcare,” she said.
Experts say the issue should be seen in the larger context of the tormented history between Indigenous peoples and white society, which began and includes the taking of Aboriginal lands forced sterilization by local women until the 1970s. Native Americans on both sides of the abortion debate are citing this story — some arguing that the procedure is reducing the number of potential citizens in a population that has been threatened for centuries, and others saying new restrictions are another assault on Indigenous women’s rights.
Many advocates fear that restricted access to abortion will make matters worse for women, who already have maternal mortality rates twice those of their white peers, teenage births more than twice those of whites, and the worst rates of sexual violence.
“Indigenous women have no access to reproductive justice, and that includes abortion,” said Natalie Stites Means, a member of the Cheyenne River Sioux Tribe who serves on the board of the Justice Empowerment Network, an abortion fund. “Any restriction on our health care and any restriction on abortion will have an impact on our health and well-being.”
DECADES OF RESTRICTIONS
Experts said tribal peoples had their own healthcare systems for centuries, which in some cases included natural abortion practices.
Today, the primary source of care for many is the Indian Health Service, which serves 2.6 million American Indians and Alaska Natives belonging to 574 recognized tribes in 37 states. Its clinics and hospitals operate under the Hyde Amendment, which prohibits them from using federal funds for abortions except in cases of rape, incest, or threat to a mother’s life.
Even if an IHS patient falls under one of these exceptions, many facilities “do not have the materials, staff or expertise to offer this abortion treatment,” van Schilfgaarde said.
Matson uses the pronouns they and is two spirit, a term used to describe those who combine characteristics of men and women. Matson, who lived in Rapid City at the time, said IHS staff did not discuss abortion as an option for her unplanned pregnancy. After undergoing surgery in Colorado at 13 weeks, they were uncomfortable returning to IHS despite ongoing bleeding.
While IHS employees can refer people to places that offer abortions, federal funds can only be used for “Hyde-approved” procedures and associated patient travel, agency officials said in a statement. And a federal report shows that nearly 1 in 5 American Indians and Alaska Natives are uninsured.
Also, there are often no abortion providers nearby. A reason? The proportion of Catholic health systems that generally prohibit abortion has grown significantly. A 2020 report by Community Catalyst, a nonprofit healthcare organization, found that 1 in 6 acute care hospital beds in the US is in a Catholic system. The proportion is 40% in South Dakota and 32% in Oklahoma.
SEARCH FOR SOLUTIONS
After Roe’s ouster, restrictive “trigger” laws went into effect in more than a dozen states, including South Dakota and Oklahoma. which had already stopped most abortions. North Dakota’s abortion ban has been blocked in court.
Some local women were inspired to organize.
Cherokee women in Tahlequah, Oklahoma, gathered over the summer to discuss a possible amendment to the tribe’s constitution that would protect access to reproductive health for its citizens. They were frustrated that the leaders of this tribe of around 450,000 had not addressed the issue.
“Fear was just palpable,” said group leader Alissa Baker, who teaches psychology at Northeastern State University. “We felt the need to protect our community … and in a way, really reclaim some of those traditional roles of a Cherokee woman who is effectively the voice of the community.”
But efforts faltered as the school year approached, as members were spread across a rural area, busy with jobs and children.
Other efforts by activists have failed. D’Arlyn Bell, a graduate student at the University of Kansas and another member of the Cherokee Nation, joined with other Native activists to thwart a proposed amendment to the Kansas state constitution that would have paved the way for stricter abortion restrictions.
“We’ve done it not only for the local women in our own states, but also for the local women in our own home areas, particularly Oklahoma,” she said.
Experts emphasize that abortion views vary between tribal leaders and members — something the Cherokee Nation, the only one of the five largest tribes in South Dakota and Oklahoma, responded to a request for comment from The Associated Press in a statement.
Opening a clinic on tribal land would be a legal challenge, experts said. The Cherokee Nation said it would establish none, and there have been no announcements from other tribes since Roe was overthrown. History shows that the issue is sensitive: The first female president of South Dakota’s Oglala Sioux tribe was impeached in 2006 after publicly proposing an abortion clinic on the reservation.
According to Roe, Native Americans on both sides of the problem are taking personal and collective action.
Elizabeth Terrill, a board member of the Native American anti-abortion organization Life is Sacred, said she is a foster mother, provides post-abortion counseling and supports mothers. She said extended families in tribal areas have historically banded together when faced with an unplanned pregnancy, and most women chose to continue it.
“I think there’s just a different cultural understanding of what life is and when life begins and why life is so sacred,” said Terrill, a mental health therapist near the Navajo Nation in New Mexico and a member the Osage Nation of Oklahoma.
Matson, executive director of summer camp Rock the Rez, said they share their experiences, donating money to those in need and telling others about resources like the Justice Empowerment Network, which covers most of her friend’s abortion and travel costs.
“Any time someone goes through something like this, I offer support,” said Matson, 32. “I hope I’ve helped in any way I can.”
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