As Roe faces being overturned, Indigenous communities say it was always impossible for them to access abortion services

• The Indian Health Service (IHS) is a healthcare program for members of tribal nations.
• Because IHS is federally funded, the program cannot use federal dollars toward abortion services.

On May 2, the Supreme Court's majority-draft opinion was leaked to the public, showing that the Court had voted to overturn Roe v. Wade, potentially further restricting abortion access for women across the US. For those in Indigenous communities, accessing abortion services was already near impossible.

The Indian Health Service (IHS) is a healthcare program for members of tribal nations. But because IHS is federally funded, the program cannot use federal dollars toward abortion services, except in cases of rape or incest. And coverage varies from state to state, depending on state law.

"There is this uproar, but we never had it anyway," said Dr. Corrine Sanchez, the executive director of Tewa Women United, an Indigenous women-led nonprofit that helps Indigenous women with health services. "The threats to our community are huge. When you talk about accessing abortion services or accessing services like sexual assault nurse examiners, most IHS programs do not have that because they're so underfunded that they can't even provide basic healthcare, much less these much-needed specialty areas."

IHS has a history of mistreating Indigenous women.

IHS first began in 1955 to provide healthcare coverage to tribal nations as part of Article I, Section 8, Clause 3 of the Constitution that gives Congress the power "to regulate commerce with foreign nations, and among the several states, and with the Indian tribes." Initially, the federal government provided some health services to tribal nations under the Department of War, but once the Department of Indian Affairs was created, health coverage was taken over by that department and was further expanded.

However, IHS has had a horrible history of mistreating Indigenous women. In the 1960s and 1970s, thousands of Native women were tested and sterilized without their knowledge. The underfunding of health services has also often resulted in a severe lack of doctors and nurses under the healthcare coverage. Sanchez said she sees the latest chapter of abortion rights as yet another way of trying to control women's bodies.

The sterilization of Indigenous people was employed as a form of eugenics. Some researchers believe that an estimated 25-50% Native women may have been sterilized during this period. At the time, these populations had no ability to seek legal recourse for what was done to them, Sanchez said.

"So that is the continued legacy," Sanchez said. "You're targeting people and populations who are defenseless."

The Hyde Amendment bans abortions for those under IHS coverage.

Indigenous women are two to three times more likely to suffer a pregnancy-related death than white women, according to the Centers for Disease Control and Prevention.

Sanchez said the biggest question moving forward is asking why abortion services are not considered healthcare. This is especially critical as Indigenous communities experience disproportionate rates of maternal mortality and miscarriage, which can be tied to environmental factors such as the contamination of their lands.

"Women still have to travel long distances in order to get an exam. You know, if we had people trained in every hospital, that would be different," Sanchez said.

In October 2021, a Native American woman in Oklahoma was convicted of manslaughter for having a miscarriage.

Sanchez said regardless of how you feel about abortion, people will have to access "abortion services" because of the maternity health crisis in the US. If a woman has a miscarriage, she will have to get her uterus vacuumed out if the fetus is not completely expelled.

Before IHS, Native women had home births and invested in midwife services.

Before IHS was created in 1955, Sanchez said Native women used to have at-home births with a midwife.

Now that her area doesn't have an OBGYN under IHS coverage, she said Tewa Women United is bringing back that dynamic. They are working with tribal communities in Northern New Mexico to provide pregnancy planning, doula and midwife services.

Sanchez said she'd like to see the federal government fully fund IHS women's healthcare, which goes beyond abortion access. She said there should be specialty services for women who are sexually assaulted.

According to the US Department of Justice, 56% of Indigenous women are sexually assaulted in their lifetime, which is the highest of any racial demographic in the country.

"The federal government owes Native people this," Sanchez said. "It's not like a luxury. It's not like, 'Oh, you're Native, so you get this special thing.' It's because you stole our land and displaced our people, this is what you are supposed to do."