Broken Treaties, Empty Promises: An Introduction to
Native American Women's Reproductive Health Issues
by Jay Heavner
For Native Americans living on Native lands, access to basic health care is
often inadequate because of poor funding, high turnover of medical personnel,
bureaucratic abuse and neglect, and geographic isolation. To contemplate
reproductive health care is almost a luxury. Nevertheless, Native American women
are challenging government abuses, examining reproductive health issues, and
making recommendations to help their communities.
A History of Abuse
Native American women perceive current reproductive health issues in the context
of centuries of hostility by the U.S. government. Stories of massacres by
government troops, distribution of blankets contaminated by smallpox, and other
abuses of Native people have been passed down through generations.
Native Americans also point to the role of religious denominations in
undermining Native cultures through the establishment of boarding schools that
removed children from their families, cultures, languages, and communities.
Native American organizations have documented the physical and sexual abuse of
children in boarding schools even into the 1970s.
In the past, the activities and policies of some religious people and
institutions, however well-intentioned, harmed Native peoples. Today non-Native
religious people who wish to be allies should do so in ways that reflect the
needs and priorities of Native people.
Current Reproductive Health Issues
The Native American Women's Health Education Resource Center has documented
abuses carried out by the Indian Health Services (IHS), Job Corps, and other
agencies on which Native American women depend for health care services. Issues
they have identified are forced sterilization, unsafe use of Depo-Provera and
Norplant, and destructive alcohol-related policies.
A study by the Government Accounting Office during the 1970s found widespread
sterilization abuse in four areas served by the IHS. In 1975 alone, some 25,000
Native American women were permanently sterilized--many after being coerced,
misinformed, or threatened. One former IHS nurse reported the use of tubal
ligation on "uncooperative" or "alcoholic" women into the 1990s.
Unsafe use of Depo-Provera and Norplant.
Many Native American women, seeking effective birth control, have requested one
of the long-term contraceptives Depo-Provera and Norplant. Unfortunately, these
drugs have many side effects and contraindications which have not always been
made clear to women requesting information about their use.
Depo-Provera is a long-term injectable contraceptive that lasts up to ten
months. Use of this powerful drug carries serious health risks, including blood
clots, reduced lipid levels, decreased glucose tolerance, weight gain, irregular
and excessive bleeding, and depression. The Food and Drug Administration has
noted "evidence of fetal risk based on human exposure," and medical studies
indicate possible links to cancer and osteoporosis.
Norplant is a long-term contraceptive that is surgically implanted under the
skin in six flexible silicone capsules that slowly release the drug. It is
effective for up to five years and is intended to be removed at the doctor's
discretion or at the woman's request. Side effects of Norplant include irregular
bleeding, weight gain or loss, headaches, and mood swings. The drug is not
recommended for women who smoke or for women who have serious medical conditions
such as diabetes, high blood pressure, or elevated cholesterol. In addition,
Norplant's effectiveness decreases in overweight or obese women.
Native American women express a number of concerns about the use of
Depo-Provera and Norplant in their communities, especially about the coercive
use of these drugs. Both IHS and Job Corps have used Depo-Provera widely in
Native American communities. As early as 1986, IHS administered
Depo-Provera--without informed consent and prior to FDA approval--to Native
American women, including many who were mentally retarded. A recent study by the
Native American Women's Health Education Resource Center found that many more
women were given Depo-Provera and Norplant without adequate informed consent.
Basic health risks are a concern as well. Even when a woman chooses to have
Norplant implanted, having it removed is often difficult. Removal is expensive,
and many doctors are untrained or unwilling. In addition, rates of diabetes,
obesity, and cigarette use--contraindications for the use of both drugs--are
high in Native communities. And neither Depo-Provera nor Norplant prevents
sexually transmitted diseases, such as AIDS or gonorrhea, the rates of which are
increasing in Native American communities.
Cultural issues must be considered also. For example, irregular bleeding
caused by the drugs can prevent Native American women from participating in
traditional practices and ceremonies.
Destructive Alcohol-Related Policies
Like other basic health services, treatment for alcoholism and drug abuse
(including smoking) is often unavailable on Native lands. Pregnant women with
alcohol or drug dependency are often required to turn their children over to
social services for foster care. And alcohol- and drug-dependent women are often
involuntarily incarcerated in tribal law enforcement facilities to prevent fetal
alcohol syndrome/fetal alcohol effect and other injury to the fetus--a possible
violation of their civil rights.
Recommendations from Native American women
Reproductive health is interwoven with a number of other health issues that
affect a woman's reproductive decisions. Following are recommendations by Native
American women in the Aberdeen area (North Dakota, South Dakota, Iowa, and
- End coercive use of contraception and sterilization.
- Conduct better research on the effects of Depo-Provera and Norplant in
Native American communities. Implement tracking of all patients; tell
Norplant recipients when they should have implants removed; remind
Depo-Provera users when their next shot is scheduled.
- Implement informed consent policies at all health care facilities.
- Improve access to quality health care, including mental and emotional
- Develop culturally specific education on reproductive health.
- Educate Native Americans about sexually transmitted diseases and their
effects on fertility.
- Provide access to alternative reproductive options, including artificial
- Implement teen pregnancy prevention programs.
- Reclaim traditional reproductive practices, including ceremonies,
midwifery, and herbal practices. Reestablish family structures.
- Promote positive attitudes about menopause.
- Return to breast-feeding of infants.
- Prevent and treat alcoholism, fetal alcohol syndrome/fetal alcohol
effect, and domestic violence.
- Ensure reproductive rights for women with HIV.
Several publications from the Native American Women's Health Education Resource
Center were used to prepare this publication. They include Dakota
Roundtable II: A Report on the Status of Native American Women in the Aberdeen
Area; A Review of the Use and Effects of Depo-Provera on Native American Women;
The Impact of Norplant in the Native American Community; and A Study of the Use
of Depo-Provera and Norplant by the Indian Health Services.
Thanks to Charon Asetoyer for her assistance. For more information about the
center and its wide range of publications, contact the Native American Women's
Health Education Resource Center, PO Box 572, Lake Andes, SD 57356, telephone
(605) 487-7072, e-mail
written by Jay Heavner, Public Relations Director