In a recent speech given at the United Nations, Eve Espey, MD, chair of the Department of Obstetrics and Gynecology of the University of New Mexico School of Medicine, spoke out about health care disparities faced by American Indian women. She was accompanied by Brian Thompson, MD, assistant dean of SUNY Upstate Medical University and member of the committee on American Indian/Alaska Native Women’s Health. In her address to the United Nations Commission on Status of Women, Dr. Espey focused on “the narrative of violence against these women” perpetuated by a difficult history of “Western imperialism, exploitation, and abuse.”
Coercion and Violence
Dr. Espey provided a moving account of her time with the Indian Health Service helping staff a teen clinic at Fort Wingate High School in New Mexico. There, she provided service to a 15-year-old patient who wanted birth control, but also expressed that she was suffering from abdominal pain. After performing a gynecological exam on the patient, Dr. Espey immediately moved the patient to the hospital and, soon after, delivered a full-term baby girl. After speaking with the American Indian hospital social worker, Dr. Espey learned that the teen had a coercive, controlling boyfriend who was opposed to any form of contraceptive methods. In recounting this story, Dr. Espey expressed how disheartened she was to see young women “disempowered through violence and reproductive coercion.”
Dr. Espey noted that “It’s difficult to determine the actual prevalence of violence against women in American Indian country—unfortunately, statistics are not routinely gathered and violence is greatly under-reported and acted on.”
But, we do have some information on the plight of American Indian women:
- Almost half of American Indian women report lifetime intimate partner violence; one third of these women reported violence in the last year
- American Indian women suffer 2-3 times more instances of rape and intimate partner violence than U.S. women in general
- American Indian women suffer a higher unintended pregnancy and teen pregnancy rate than U.S. women in general
- American Indian/Alaska Native populations have the highest rate of poverty of all racial/ethnic groups in the U.S.
- Interracial violence is common. According to the U.S. Department of Justice, 86 percent of American Indian women are assaulted or raped by non-Native, mostly white men
Providing the appropriate level of care and resources can be exceptionally difficult. Dr. Espey says, “Access to care for Native American victims of violence is inconsistent…about 40 percent of American Indian women live in rural/reservation settings where treaties dictate that tribes and the Indian Health Service operate clinics and hospitals…but over 60 percent live in urban areas.”
Dr. Espey encouraged the members of the United Nations to engage at every level. She called for an international recommitment to the Beijing Declaration which bolsters the elimination of all forms of violence against women and girls. On a national level, she asked United Nations members to pass legislation similar to the U.S. “Violence against Women Act” (VAWA). The VAWA now “extends tribal jurisdiction over non-American Indians who commit crimes of violence against Native women.” But, the VAWA reauthorization did not contain this extension of jurisdiction for those native women residing in Alaska.
Additionally, lawmakers can also promote advocacy campaigns such as "Futures Without Violence" and institute policies that reduce poverty, empower women, and create affordable, permanent housing. Dr. Espey noted that ACOG endorses the "Futures Without Violence" campaign. In the words of the campaign:
“Violence against women is not part of our traditions. Harmony relies on our ability to respect, honor and nurture all our relatives. We must teach the boys in our life early and often that this is what it means to be a warrior and that violence never equals strength.”
What You Can Do
On a local level, health care settings are ideal opportunities for screenings and interventions. You can open up conversations with your patients about reducing harm, preventing intimate partner violence, and connect them with appropriate resources. For those who serve American Indian/Alaska Native women, “culturally relevant approaches can be used to honor women’s specific traditions and values.”
Together with Futures Without Violence, ACOG has created the Reproductive Health Safety Card, which you can provide to patients in waiting rooms. To learn more about ACOG and Futures Without Violence, visit the ACOG webpage on Health Care for Underserved Women.
Also, check the ACOG Committee Opinion on Health Care for Urban American Indian and Alaska Native Women.
In closing, Dr. Espey remarked, “We have a long way to go to achieve equality for women…ending violence against Indigenous women is critical to the goal of equality…American Indian traditions tell us that women are sacred. ACOG stands with the United Nations and Indigenous women to end violence.”
In addition to her University of New Mexico chair role, Dr. Espey has held leadership roles with ACOG, including former chair of the Health Care for Underserved Women Committee, the Association of Professors of Gynecology and Obstetrics, the Society of Family Planning, and the National Campaign to Prevent Teen and Unplanned Pregnancy.
Epsey, Eve. “UN Remarks—Violence against Indigenous Women in the U.S.” United Nations. New York, New York. 10 March 2015. Featured Address for the UN Commission on Status of Women.