Reproductive Rights Denied: The Hyde Amendment and Access to Abortion for Native American Women Using Indian Health Service Facilities

Restrictions on the use of federal funds to provide abortions have limited the access to abortion services for Native American women receiving care at Indian Health Service facilities. Current data suggest that the vast majority of Indian Health Service facilities are unequipped to provide abortions under any circumstances. Native American women experience disproportionately high rates of sexual assault and unintended pregnancy. Hyde Amendment restrictions systematically infringe on the reproductive rights of Native American women and present a pressing public health policy concern.Unlike many cultures in which access to abortion is limited, gender norms in Native American cultures traditionally support and respect women’s autonomy with regard to reproductive health decisions. In more recent times, federal regulation and deepening social problems have largely usurped Native American women’s control over their reproductive health.Active colonization of Native American communities and lands has not only marginalized traditional healing practices and resulted in devastating poverty but also disrupted traditional family structures and matriarchal gender norms, leading to high rates of sexual assault, intimate partner violence, and unintended pregnancy.1For many Native American women living in the United States, Indian Health Service (IHS) facilities are the primary source of reproductive health care.2 Made possible by the 1921 Snyder Act,2 federal funds are used to provide free health services for 1.9 million American Indians and Alaska Natives (AI/ANs) belonging to 564 federally recognized tribes in 35 states.3 Because it receives federal dollars, however, the IHS is subject to congressional regulation of the provision of abortion services, as stipulated under the Hyde Amendment.2,4,5Passed in 1976 and amended in 1993, the Hyde Amendment bans the use of federal funds for abortion services, except in cases of pregnancies resulting from rape or incest or those that pose a threat to the mother’s life.4,6 IHS regulations codified Hyde Amendment restrictions in 1982 and were then updated in 1996 to match the current amendment.7 Because the IHS is often the sole provider of reproductive health services for Native populations, Hyde Amendment restrictions effectively deny Native American women access to full-scope women’s health care that includes access to abortion.