Indigenous women, facing tougher abortion restrictions post-Roe, want Congress to step in

April Matson was a single mother of two on a six-hour interstate quest to find a legal abortion.

Matson loved being a parent, but the 25-year-old Native American couldn’t afford another child on a small salary as a food co-op manager. So, in 2016, Matson and a friend set out from Rapid City, South Dakota, for the long drive to Fort Collins, Colorado, for a $650 abortion. To save money, Matson spent two nights after the procedure recovering in a tent at a campsite.

"We sat in camp chairs and had to use the Porta Potty that was there and sleep in a sleeping bag on the ground…I think I had to get up in the middle of the night to use the bathroom because of the bleeding,” said Matson, now 33. Unable to afford prescription medication, they popped ibuprofen for the pain. “It was part of the struggle of that whole situation.”

That wasn’t Matson’s last involvement with an out-of-state abortion.

If anything, things are worse now for Native American women seeking abortion and maternal care following the Supreme Court’s 2022 bombshell decision overturning Roe v. Wade and the constitutional right to an abortion, health experts and advocates say.

In one sign of the rising financial and legal barriers to care, abortion rights organizations say more Native American women are seeking outside help in paying for the procedure and driving farther to find legal care.

“You have an unwanted pregnancy and limited funds,” said Dr. Antoinette Martinez, an obstetrician at the United Indian Health Service in northern California, told USA TODAY. “Then, to go farther away to go to a facility that provides abortion care can be near to impossible.”

Reproductive healthcare access more limited after Roe v. Wade

Indigenous Women Rising, a nonprofit organization that runs the only abortion fund catering to Native and Indigenous women, reported a 116% jump in the number of clients seeking financial help for the procedure, from 277 in 2021 to 600 in 2022, according to evidence submitted to the New Mexico state legislature. The group funded 220 abortions between January and August of this year, and also supports midwifery and doula services.

A 2022 study by researchers at Boston Children’s Hospital, Harvard Medical School, and other institutions found that the number of American Indians and Alaska Natives living more than an hour’s drive from a legal abortion increased 20.4% in the year since Roe v. Wade was overturned.

Dr. Corrine Sanchez, executive director of Tewa Women United, in Española, New Mexico, called last year's abortion ruling, known as Dobbs vs. Jackson, a “soul shattering experience to live through.”

And, even as many states have moved to ban abortion after the ruling, federal funding for abortion has been restricted for decades.

More than 2.2 million Native Americans rely on the federal Indian Health Service for free and low-cost healthcare. But a law known as the Hyde Amendment bans the use of federal dollars for abortion care.

The amendment, which went into effect 1980, contains exceptions for pregnancies resulting from rape and incest — or if the pregnancy endangers the mother’s life.

But, while Native women suffer high rates of sexual assault, they are often reluctant to disclose it to doctors when seekingcare, said Charon Asetoyer, a 72-year-old member of the Comanche Nation and founder of the Native American Community Board in Lake Andes, South Dakota.

A 2022 report by Amnesty International found that 56% of American Indian or Alaska Native women have experienced sexual violence, and that they are more than twice as likely to be raped than non-Hispanic white women. (According to a 2016 study by the National Institute of Justice, 96% of female Native American sexual assault victims reported their assailant was a non-native.)

After the Dobbs decision last year, states with high indigenous populations enacted even stricter abortion bans. Both Oklahoma, where Native Americans are 13% of the population, and South Dakota, where they are 10%, banned abortion except in life-threatening cases.

And so it was that, eight years after that difficult journey to Colorado, Matson was once again on the interstate in search of an abortion. This time, Matson was making a 14-hour round-trip to support a pregnant friend. This time, they stayed in a hotel.

“To see this actually happening, like in practice, where you don't have the option to go within the state that you live in – that was really eye opening and shocking,” Matson said.

Two targets for Native Americans: Hyde Amendment and Indian Health Service

In 2021, Lael Echo Hawk, a Washington, D.C.-based tribal lawyer, and Lauren Van Schilfgaarde, a federal Indian law expert at the University of California, Los Angeles, filed an amicus brief in the Dobbs case asserting that the Hyde Amendment, coupled with anemic Indian Health Service Funding had “resulted in a de facto ban on abortion services for victims of sexual assault.”

“Native women are forced to rely on private providers for abortion care, the banning of which would further decimate Native women’s access to this critical component of reproductive health and self-determination,” they wrote.

The authors also cited high rates of sexual assault, and of infant and maternal mortality among indigenous people, along with “attendant mental, physical, and socioeconomic trauma” in calling for more health funding and access.

Though there’s little comprehensive data on how many abortions have been conducted within the Hyde Amendment’s exceptions, Alia Hoss, an Indian health law expert at Indiana University, said it’s been “very few in terms of the research that epidemiologists and researchers have been able to do.”

A 2002 survey conducted by the Native American Women’s Health Education Resource Center found that 85% of Indian Health Service units failed to provide abortion services even in cases that were compliant with the Hyde Amendment. In 62% of these centers, employees told researchers they knew of cases where a woman whose life was endangered by her pregnancy was still unable to get an abortion.

“Women like myself and other indigenous women and other women of color have been impacted by things like the Hyde Amendment for not the last year, not the last two years, but the last 30 years,” said Abigail Echo Hawk, executive vice president of the Seattle Indian Health Board.

'It will come down to electoral politics next year'

Advocates looking to overturn the Hyde Amendment are pinning their hopes on the Democratic party retaking control of the House of Representatives next November – though it would be much more difficult to reverse in the Senate.

“We want to keep this legislation on the table. We want to remind people that not only are so many women suffering right now, because of the Dobbs decision, but lots of women have been suffering for a long time,” Rep. Diana DeGette, D-Colo, told USA TODAY.

Rep. Melanie Stansbury, D-N.M., said the biggest challenge to Native American health care right now is the Republican-led Congress and proposed budget cuts to the Indian Health Service.

“Frankly, it will come down to electoral politics next year and making sure that we regain the majority and it’s not just a Democratic majority, but a majority that cares about indigenous rights that cares about indigenous sovereignty and cares about indigenous lives,” she said.

Gabriel Sanchez, a political science professor at the University of New Mexico, said he expects Native people, particularly women and young voters, to be more energized to vote in 2024 after the Dobbs decision.

A 2022 Midterm Voter Election Poll conducted by the African American Research Collaborative found that, after inflation and gas price, 27% of Native American voters wanted Congress and the president to address women’s reproductive rights.

And 40% of Native American voters said in the survey that abortion was their primary motivation to vote in 2022.

Asetoyer expects strong turnout in 2024. “When it comes to health care, Indian women are very, very strong about not having the diminishment of our health services,” she said.

This article originally appeared on USA TODAY: Indigenous women facing tougher abortion restrictions call for action