The Failing State of Native American Women’s Health: Interview with Charon Asetoyer

Silence is a dangerous thing to fall victim to. Women living on American Indian reservations know this. To this day, the stories of Native American women often remain untold. Geographic isolation and racial segregation have created a world of silence around the problems these women face.

Limited access to health care is one of the most daunting of these problems, according to Charon Asetoyer, Founder and Executive Director of the Native American Women’s Health Education Resource Center. The Center is a grassroots women’s health institute on the Yankton Nakota Indian Reservation in South Dakota. Asetoyer spoke with the Center for American Progress this week about the failures of our federal government to keep women on reservations safe and healthy.

The Indian Health Service, the federal agency responsible for providing health care on all reservations, is failing Native American women on many fronts, says Asetoyer. Native American women do not have access to reproductive health services such as abortion, emergency contraception, and sometimes even condoms. The gravity of this situation is magnified by the high number of rapes and sexual assaults that occur on reservations.

One in three Native American women will be sexually assaulted or raped in her lifetime—a rate 3.5 times higher than all other racial groups. Yet victims of sexual violence often do not receive the treatment and care they need from IHS hospitals. Victims sometimes have to travel hundreds of miles just to receive a rape kit and screening for sexually transmitted infections.

These are human rights violations, Asetoyer says. She discussed with CAP the problems surrounding reproductive health, sexual violence, and environmental health concerns in addition to what she and the Native American Women’s Health Education Resource Center are doing about these problems.

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Center for American Progress: Could you start off by talking about the goals upon which you founded the Native American Women’s Health Education Resource Center? 

Charon Asetoyer: The purpose of organizing the resource center was to be able to bring services that didn’t exist into our community.

CAP: What makes the Center’s approach so unique? 

CA: Because it’s based on the needs of indigenous women and it’s developed and run by indigenous women, and so the perspective that we share here and that we promote is that of an indigenous woman’s perspective.

CAP: What do you think are the most pressing reproductive health issues for Native American women? 

CA: The access to reproductive health services that the mainstream has access to. Our reproductive choices are decided for us by the federal government through the Health and Human Services—the Indian Health Service. And it’s up to them as to whether or not they want to provide various services. For instance, we cannot access EC, Emergency Contraceptive, for the purpose of wanting it as a morning-after pill—they’ll give you the old fashioned cocktail combination if there’s been a sexual assault, but if you want to just be able to access it for other purposes than a sexual assault, then you can’t get it. They’re supposed to provide us with a full venue of reproductive choices.

When it comes to contraceptives, for instance, they promote the use of Depo Provera because it’s convenient for the health care provider, regardless of whether we are poor candidates for it or not. We suffer from a lot of the contraindications that make us poor candidates for Depo Provera—everything from obesity, high blood pressure, to depression—and it’s still used by Indian Health Service and promoted among that population. So, that is not providing us with much option, so we work to be able to change that. 

Also, another big issue is violence against women and sexual assault, and it’s definitely a reproductive health issue, because of rape. We go to an Indian Health Service emergency room for services; in that area, we’re working very hard to get Indian Health Service to have standardized policies and protocols for women who have been sexually assaulted when they appear in the Emergency Room. Currently, the Indian Health Service does not have standardized sexual assault policies and protocols for victims of sexual assault, so there’s no guarantee that a woman would get offered EC or that you would get the prophylactic that reduces your chances of getting HIV if your perpetrator was HIV positive.

Also, there’s no guarantee that you would get other sexually transmitted disease screening, and a rape kit. Without a rape kit being done, there is no evidence, and without evidence, that perpetrator is free to strike again in the community and often does. So we have a very difficult situation that we’re facing and it’s the government’s failure to provide equal protection under the law, not only through its judicial system but also through its health care. 

CAP: On that topic, the U.S. Department of Justice estimates that one in three Native American women will be sexually assaulted or raped in her lifetime—that’s a rate 3.5 times higher than all other racial groups. And just a couple weeks ago, Amnesty International released a report exposing the U.S. government’s failure to address such human rights concerns. First of all, why do you think this number is so high? And second of all, how are clinics on Indian reservations treating victims of sexual violence?

CA: Because reservations are under the jurisdiction of the federal government, it is up to them to be able to provide enough resources, to be able to provide equal protection under the law. Eighty-six percent of these predators are non-Native, and are white. And so there is this whole historical trauma from day one of contact of rape, burn, and pillage, and that has continued throughout history and continues today.  

A lot of times because of the jurisdiction issues, a non-Indian perpetrator cannot be arrested by tribal law enforcement, so it’s up to the FBI to come down to the reservation and do the investigation and arrest that perpetrator. So, if they were to be in hot pursuit, they still could not arrest them—and this needs to change. It needs to change in order to protect us. So there are jurisdictional issues as well as the health issues.

The federal government needs to increase the resources to reservations so that we can have more law enforcement officers. You may have a 62- to 64-square mile area and have only one or two law enforcement officers on duty at the same time, and that’s a huge area to patrol with only that low number of law enforcement officers. So if there’s something going on at one end of the reservation and something happens on the other end, the law enforcement officer has to assess the situation that he can access sooner, so a lot of things don’t get done for hours and hours. And oftentimes it’s a sexual assault that gets neglected.

Not being able to use other jurisdictions to hold or arrest, or even be able to arrest within our own jurisdiction if it’s a non-native perpetrator, makes a pretty difficult situation. So these are things that need to be remedied. We need to be able to have jurisdiction over anyone that’s within our territory, within our boundaries—whether they’re Indian or non-Indian.

CAP: In your extensive work with women on Indian reservations, what are some of the most compelling personal stories you have encountered? 

CA: A few weeks ago, there was a very heinous rape. And it happened in the city of Wagner, which is on the reservation; however, in the township, it’s state jurisdiction, so it means it’s the city police and the sheriff’s department have jurisdiction there. And this happened late on a Thursday night, early Friday morning, and on Monday when I called the chief of police to ask him if they had arrested the perpetrator, he wasn’t even aware that a rape had occurred.

And when I talked to the attending officer, he said, “Well, I was waiting for the victim to call me and give me the name of the perpetrator.” I said, “Excuse me? You happened to have been there. You happened to have been there when the rape kit was being done at the Indian Health Service hospital. You knew that she was staying at our shelter—you could have called us, you could have called the Indian Health Service who would have been able to give it to you off the record because you were there.”  

I said, “If this was your daughter would you have forgotten to write down the name of the rapist?” And he said, “No, well, I made a mistake.” I said, “You not only made a mistake, you failed to contact her when you knew where she was, you failed to contact the Indian Health Service. You have just failed altogether, because it wasn’t important to you.”

These were non-Indian law enforcement officers. And this was a very heinous rape—he bit her all over, he left handprints he held onto her so hard, he left a bruise in the shape of his hand. I mean, this kind of situation occurs. They’re failing to protect us; they’re violating our right to equal protection under the law, and this has got to stop. We cannot continue with this kind of situation. And there’s no recourse when law enforcement doesn’t do anything—when they don’t make an arrest, the whole process of getting a conviction doesn’t even start. Somebody can access our community, commit a crime, and then leave. So these are things that need to change. 

CAP: There’s a movement, particularly among minority communities, toward what’s been termed “reproductive justice.” Do you consider your own work to be within that framework?

CA: Definitely so. We advocate for reproductive justice within our communities. The fact that the Indian Health Service could reduce the number of sexual assaults within our community if they had standardized policies and protocols in place—that is a human rights violation right there. The fact that they are not providing us with the kind of services that would help to get convictions, help to reduce the number of sexual assaults. Very much so, what we do is reproductive justice. 

CAP: Could you explain for us the goals of this movement, and could you also talk about some of the strategies you use in your work toward reproductive justice?

CA: For indigenous women, it means being able to have equal access, and being the individual that makes those decisions over your reproductive health. Being able to access pregnancy termination services if you so choose, being able to make decisions on what kind of contraceptives you’re going to have, being able to access them, being able to decide the size of your family—if you want to have children, if you don’t want to have children—and not having that done for you.  

Reproductive health is a form of health care, and the decisions need to be made by us as individuals. So it’s also respecting our right to decide for ourselves—whether or not it’s something that you would decide or not is irrelevant, it’s what I would decide. It’s being free from oppression, it’s being free from rape, it’s being free from violence—there are just so many things that make up reproductive justice, and we’ve for years worked very hard on trying to have equal access to health care that would improve the quality of health, and it starts with reproductive health, it starts with the kind of access to services you have. Can you afford them? They should always be affordable. They should always be accessible. If you do not have access to the same kinds of health care that your neighbor has merely because of the difference of the color of your skin, there’s a problem. And we face that every day.

CAP: What are some victories you’ve had in your work? 

CA: We’ve been able to get improved informed consent for Depo Provera. We have been able to get policies in place within our Indian Health Services. It looks like we’re going to have a big victory with being able to get these standardized policies and procedures in place for victims of sexual assault. I think with all of the interest that has been generated from the Amnesty International report—we helped to put that report together, and helped in the development of the recommendations—I think that we’re going to see a major victory here. We have been able to bring a lot of awareness to the women in the community. Knowledge is power, and whenever a woman becomes knowledgeable about her own health care, then she can be her own advocate. And that’s very powerful, to be in that position. So we do a lot of community education and organizing around issues, so that women can become their own advocates—and advocate for each other.

We were able to get Indian Health Service—and this is how oppressive they are—to provide condoms on request. [Before,] every time you’d go up to the pharmacy to request them, they’d pull your chart and document, “They gave Mary Smith two dozen condoms.” So we’ve been able to get [condoms] on request, so that a lot of our youth don’t have to deal with the embarrassment of having to go up and ask for them, and have it put down on their chart. And that was to prevent the spread of HIV. We’ve been able to do quite a bit over the years. 

CAP: Let’s talk a little bit about the Hyde Amendment, which, as you know, forbids federal funding for abortions except in cases of rape, incest, or danger to the life of the woman. How does the Hyde Amendment pose a disproportionate threat to Native American women?

CA: Well, we’re the only race in the country that is denied access to abortion merely because of our race. Indian Health Service is a provision of our treaties, for land seized. In exchange for the land that was taken, or seized, from us, there were certain stipulations in our treaties, and health care was one. So, we access health care through the federal government.  

What happens, because of the Hyde Amendment, is that we cannot access abortion unless it’s rape or life endangerment. It shouldn’t have to be that way. We should be able to access abortion when we decide that we want to have an abortion, like anybody else. They’re not providing that service, so they are restricting it. And it is a provision of our treaty.

Based on our race, we are denied that access. And we’ve done a lot of work around that; in fact, that’s what has taken us to the place that we’re in today, working on these sexual assault policies and protocols. We were working on the Hyde Amendment and it was brought to our attention that Indian Health Service doesn’t have any standardized policies and protocols in place, and that’s a very serious situation. And so we’re still working on the Hyde Amendment.  

CAP: The Indian Health Service has been highly criticized for its treatment of women over the years. In past decades, for example, the IHS actually carried out forced and coerced sterilization of women. Could you talk about this history?

CA: That came out of the whole eugenics movement—the sterilization—and it also came out of a way to commit genocide. If enough of us were sterilized then the population rate would dramatically go down. And if that occurred, then we wouldn’t pose a threat to those who want our land, our natural resources. So the whole sterilization of Native women comes from the desire of those that want our resources. After the sterilization surfaced in the ‘60s, Indian Health Service was then caught again for the misuse of Depo Provera on incarcerated and incapacitated women. Senator James Abourezk from South Dakota—when he was in office he convened Senate Committee hearings on that very issue. So it continues within our community—the misuse and abusive use of contraceptives.  

CAP: As you know, many of the problems that Native American women face are the same obstacles faced by low-income women all over the country. But what concerns are specific to women living on Indian reservations, and why should legislators keep these concerns on their radar?

CA: Because of the geographical isolation. A lot of times, we go unnoticed in the problems that are occurring in our communities and the way the federal government is taking advantage of that situation. That’s how we ended up with the situation we’re in now with so many sexual assaults being unresolved and being so high. It’s because the federal government has chosen to turn its head and look the other way.  

You ought to look at the number of convictions and cases that have even gone to court in the past two years on the reservations. There are over 500 reservations in this country and last year there were less than 25 cases that the federal government actually took to court. And when you look at the statistics of how many sexual assaults and rapes are occurring, versus how many actually get to court, there’s a huge discrepancy. And that is very concerning, and really needs to be examined. And that’s what this report has done—it’s brought it to the attention of the lawmakers.

CAP: And what about environmental problems that disproportionately affect the health of women on reservations? 

CA: Environmental problems are horrendous because of all of the mining, because of the uranium mining and leaving the tailings around, the polluting environmental degradation such as logging, and in our area, the chemical push farming, where everything is herbicides and pesticides. There are regulations and controls, but they’re not enforced on Native land. It’s only after there’s been a disaster that it gets brought to the attention of the powers that be and something gets done about it; and a lot of times nothing is done about it. And so we have high rates of birth defects, cancers, contaminated drinking water, and these contaminations continue and nobody is there to enforce environmental protection policies and stop these from occurring.

CAP: I think among the general public, there is some misconception—or at the very least some ignorance—concerning the cultural responses within Native American communities regarding abortion. In the past, you’ve spoken about the existence of indigenous techniques for preventing unwanted or harmful pregnancies. Could you talk about your understanding of indigenous beliefs on abortion and pregnancy? 

CA: The manners of women were always left up to women, and not for scrutiny within the public arena. It was never seen as it is today when a woman decided that she wanted to terminate her pregnancy. And women had the power and the knowledge to make their period come, so it was seen as maintaining your health—it was not seen as something detrimental.

And also, we have always believed that life does begin at conception, but we also believe that life after death is a reward. It’s that kind of spirituality that’s ingrained in us that would say, okay, in order for me to exist and to continue to exist now in this life, it’s necessary for me to terminate this pregnancy, and that I know that that spirit will go on to a better place. I question the mainstream motive behind this right wing Christian fundamentalist movement because obviously there’s a breakdown in their belief system, because if they truly believe that—they call it heaven, we call it the happy hunting ground—exists, they would not prevent a woman from sending that spirit on.  

CAP: Aside from legislative efforts, what can be done to help improve women’s health in general, and the state of reproductive rights in particular, for Native American women?

CA: We definitely need to look at the Hyde Amendment and to give us an exemption from it. We need to look at the…sexual assault policies and protocols so that they are standardized, so that we have trained sexual assault nurse examiners that can do forensic exams and rape kits.

We need to have the resources to train that staff. Women should not have to travel 200 or 300 miles to have a rape kit done. All of those things need to be, apparently, legislated. We need to be able to access the same kinds of reproductive choices, techniques that the mainstream has access to. We need to be able to determine the size of our families and to be free from any sort of coerced court order forced sterilization, whether they are permanent or intermittent. We need to have improved standards of health care. 

CAP: Is there anything else you’d like to add about reproductive rights and human rights for women living on Indian reservations?

CA: Until the government decides that they’re going to provide equal protection under the law, and equal kinds of health care, our human rights will continue to be violated, and this is something that’s got to change. We’re taking this issue to the [United Nations]; in fact, next week, the Permanent Forum on Indigenous Issues is convening and we’re going to be providing intervention and supporting documentation of these violations. And if necessary, I think it needs to go to a human rights court through the United States government for failure to provide these services to us.