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Native Americans’ abortion hurdles
Post-Roe state laws only add to barriers in place for years
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 to get the procedure.
The trip brought back difficult memories of Matson’s own abortion at the same clinic in 2016. The former grocery store worker and parent of two couldn’t afford a hotel and slept in a tent near a horse pasture — bleeding and in pain.
Getting an abortion has long been extremely difficult for Native Americans like Matson. It has become even tougher since the Supreme Court overturned Roe v. Wade last June.
New, restrictive state laws add to existing hurdles: a decades-old ban on most abortions at clinics and hospitals run by the federal Indian Health Service, fewer nearby health centers offering abortions, vast rural expanses for many to travel, and poverty afflicting more than a quarter of the Native population.
“That’s a lot of barriers,” said Matson, who lives in Sioux Falls and is Sicangu Lakota. “We’re already an oppressed community, and then we have this oppression on top of that oppression.”
Among the six states with the highest proportion of Native American and Alaska Native residents, four — South Dakota, Oklahoma, Montana and North Dakota — have moved or are poised 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.
“Native people are having to cross massive, massive distances and absorb all of the travel costs and child care,” she said.
Experts say the issue should be seen within the larger context of the tortured history between Indigenous people and white society that began with the taking of Native lands and includes coerced sterilization of Native women lasting into the 1970s. Native Americans on both sides of the abortion debate invoke this history — some arguing the procedure reduces the number of potential citizens in a population that has been threatened for centuries, and others saying new restrictions are another attack on Native women’s rights.
Many advocates worry that reduced abortion access will make things even worse for women already facing maternal death rates twice as high as their white peers, teen birth rates more than twice as high as whites, and the worst rates of sexual violence.
“Indigenous women don’t have access to reproductive justice in any form, 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 limitation on our health care and any limitation on abortion is going to impact our health and well-being.”
For centuries, experts said, Indigenous people had their own systems of health care, which in some cases included natural abortive practices.
Today, the main source of care for many is the Indian Health Service, which serves 2.6 million American Indians and Alaska Natives who belong to 574 federally recognized tribes in 37 states. Its clinics and hospitals operate under the Hyde Amendment, which bars them from using federal funds for abortions except in cases of rape, incest or threats to a mother’s life.
Even when an IHS patient falls under one of those exceptions, many facilities “don’t have the materials or staff or the expertise to provide that abortion care,” van Schilfgaarde said.
Matson, who lived in Rapid City at the time, said IHS staff didn’t discuss abortion as an option for unplanned pregnancy. After getting the procedure at 13 weeks in Colorado, Matson felt uncomfortable returning to IHS despite ongoing bleeding.
While IHS staff can refer people to places that provide abortions, federal funds can only be used for “Hyde-permitted” procedures and related patient travel, agency officials said in a statement. And a federal report shows nearly 1 in 5 American Indians and Alaska Natives are uninsured.
Also, there are often no abortion providers nearby. One reason is the proportion of Catholic health systems, which generally prohibit abortion, has grown significantly. A 2020 report by Community Catalyst, a nonprofit health advocacy organization, found that 1 in 6 acute care hospital beds in the U.S. is in a Catholic system. The share is 40% in South Dakota and 32% in Oklahoma.
After Roe fell, restrictive “trigger” laws took effect in more than a dozen states, including South Dakota and Oklahoma, which already had stopped providing most abortions. North Dakota’s abortion ban has been blocked in court.