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.

Forced sterilization.

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 Nebraska):


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 nativewoman@igc.apc.org

written by Jay Heavner, Public Relations Director