After weeks of debate over personhood, Planned Parenthood funding, transvaginal ultrasounds, fetal pain, Fluke-fest, aspirin-between-the-knees, and the little matter of 130,000 economically disadvantaged Texas women losing access to basic health care starting today, discussions about the accessibility of Plan B seem so...December 2011. Ancient history.
But for one group of women, access to emergency contraception is an urgent and tragically unmet need: the hundreds of thousands of Native American women who live on reservation lands. Their struggle for a better standard of care is the subject of a recent roundtable discussion by the Native American Women's Health Education Resource Center (NAWHERC)
The statistics are stark. More than 1 in 3 Native American women will be sexually assaulted their lifetimes, a rate much higher than the general population. In one study, a stunning 92% of young women reported they had been forced to have sex against their will on a date.
One of the primary fears of any rape victim is an unintended pregnancy. The first line of defense against that possibility is, of course, the prompt administration of emergency contraception.
And this is where things get tricky for many Native women. Most receive their health care from the Indian Health Service and affiliated tribal health centers. Of 157 IHS facilities, only 10% surveyed stock Plan B in their pharmacies, and only 37.5% carried some alternative form of emergency contraception. In the Albuquerque Area, which covers almost all of New Mexico and Utah, only two of its 15 facilities stocked Plan B.
"If you are living on the reservation or on the Pueblos without insurance, or the money to pay for EC or transportation to get you to town, you are out of luck, because you do not have accessibility through our own health care provider," says Charon Asetoyer, a Comanche from Lake Andes, South Dakota and Executive Director of NAWHERC.
And that assumes women even know to ask or find it. "A lot of women in our communities aren't aware that Plan B even exists or they associate it with the abortion pill RU486, they don't realize the difference because the media and the opposition have projected this: it's an abortion pill, when it really is a contraceptive," Asetoyer notes. This was amplified when it became clear that several of the health care workers who participated in the roundtable were themselves unclear about the difference between the two.
The so-called “conscience clause” also comes into play. "We have had rape victims given prescriptions to get EC, but at IHS they wouldn't administer it, because the Pharmacy Director and her staff didn't believe in it, so she wouldn't administer EC," says Lisa Thompson-Heth of the Lower Brule Sioux Tribe in Fort Thompson, South Dakota.
Access to EC is just one part of a systemic failure of the Indian Health Service to provide a consistent standard of care for victims of sexual violence; Asetoyer and others note that IHS staffers find the process of testifying in court so cumbersome that they often fail to collect rape kits in a timely, legally-admissible manner. Attempts to standardize and enforce policies are complicated by dealings with the Federal government and with often male-dominated tribal governments. Female sexuality is still a taboo subject within many tribes, not just because of indigenous beliefs but because many are strongly Catholic or Southern Baptist, lending to a general unwillingness to tackle issues like date rape, incest, domestic violence and contraception itself.
But it’s also one of the easier problems to fix. The roundtable came up with several actionable steps, among time requiring IHS formularies to include Plan B and to buy in generic in bulk to lower the costs; to work with tribes to educate the public about Plan B and to raise awareness of sexual assault; and to promote the adoption of Standardized Sexual Assault Policies (SSAP).
Failure to improve the current system is not just about preventing unintended pregnancy. Native women are being denied full access to health care and legal protections due to them under Federal law and the UN charters governing the rights of indigenous peoples.
"It's not an aspirin; it's not cold tablets,” says Asetoyer. “It's withholding services from a victim.”