Photo: A still from Young Lakota, a documentary about women's activism in South Dakota.
“Every other race of women in this country has access to emergency contraceptives as an over-the-counter, except for native women,” says Charon Asetoyer, executive director of the Native American Women’s Health Education Resource Center who is fighting to change that reality. Most press coverage celebrating recent changes to federal law around Plan B have left at least one group behind: Native Americans. That's why Native American activists are still pushing the slow-moving bureaucracy at the Indian Health Service to make Plan B available over-the-counter for women of all ages. And while progress is being made, challenges to accessing emergency contraception remain in Native communities, where high rates of sexual assault make the need particularly dire.
In collaboration with the radio journalists at Making Contact, I put together a 10-minute audio story about Native women pushing for emergency contraception access. The story will be featured in our podcast coming out later this week, but you can listen to it now or read the transcript below.
[Audio: Walking through a drug store]
Sarah Mirk: This is Sarah Mirk. I’m in the Walgreens on the corner of 33rd and Killingsworth in Northeast Portland, and I’m looking for Plan B One-Step, which is supposed to be available over-the-counter. And I’m in the aisle that has lots of condoms and lube and Vagisil and somewhere around here should be Plan B. There it is, right there. It’s on the top of the aisle in a purple box. Plan B One-Step emergency contraception: $51.99. You can just take the box to the counter. That was easy.
My visit to Walgreens in Portland, Oregon was how getting Plan B is supposed to go. In June 2013, the Food and Drug Administration approved the brand-name emergency contraceptive to be stocked on pharmacy shelves across the country for women of all ages. No prescription needed, no asking someone to get it from behind the counter. No age limits. Just grab it like some aspirin, and be on your way.
But for some women, getting emergency contraception is not so simple….
[Audio: Pow-wow drumming]
SM: This is the Dancing in the Square pow-wow, an annual Native American gathering put on by the Northwest Portland area Indian Health Board. It’s a celebration that brings together local tribes. But it’s also a chance to raise awareness about important issues facing Indians living in Oregon and connect them to healthcare resources. For many Native women, getting emergency contraception isn’t always as easy as walking into Walgreens.
Jessica Leston: People don’t know the difference between emergency contraception and medical abortion, and there is a lot of non-education around the subject.
SM: That misunderstanding is the first problem, says Jessica Leston. She’s the clinical programs manager at the Northwest Portland area Indian Health Board, the group that helps put on the pow-wow. Plan B and other types of emergency contraception, actually prevent pregnancy from happening if taken within three to five days of unprotected sex. They do that by delaying or disrupting ovulation, which means they’ve helped millions of women avoid accidental pregnancies.
In Native American communities, access to Plan B is crucial, says Charon Asetoyer, executive director of the Native American Women's Health Education Resource Center, based in South Dakota.
Charon Asetoyer: There is an extremely high rate of sexual assaults that occur on reservations in this country. And one in three Native women will be sexually assaulted at least once in her life. And it’s important that women know that these services are available. I’ve always said that emergency contraceptives help to reduce the residual effects of sexual assault, one being an unwanted or unplanned pregnancy from the sexual assault. So, it reduces the trauma, the added trauma that can result from sexual assault.
SM: But despite that need, access to emergency contraception lags in Native communities. Native Americans receive free healthcare through the Indian Health Services (HIS), a federal agency that runs clinics all over the country. And although federally managed facilities must follow FDA regulations, the reality doesn’t always live up to the law. While the FDA ruled in 2009 that Plan B should be available over-the-counter to women over age 17, Indian Health Services did not work that change into its policies until this year, under pressure from Native women and the ACLU. However, they have still not caught up to the recent all-ages ruling and, meanwhile, Indian health centers managed independently by tribes have the authority to decide what products they carry.
All of this means that Native women have unequal access to emergency contraception—whether or not they can easily get the legal drug depends in part on where they live.
CA: Every other race of women in this country has access to emergency contraception as an OTC except for Native women within our health care system.
SM: Research conducted by Asetoyer and others found that many Indian Health Services’ pharmacies did not carry any emergency contraception, nor did they not offer it over-the-counter. A 2012 survey from the Native American Women’s Health Education Resource Center found that 43 percent of the clinics serving Native American women did not carry any emergency contraception at all. Only 11 percent of the pharmacies surveyed carried emergency contraception over-the-counter.
Here’s a not-so-unusual story from Micha Bitsinnie. She was raised on a Navajo reservation in Arizona, and now lives in New Mexico.
Micha Bitsinnie: Well, I had my first child in 2009. And after having a baby, they ask you, “Do you want to get on birth control?” And if you don’t want a baby right after, you’re going to get on birth control. So I got on birth control—the day-to-day pill. And I was a new mom, forgot pills, and, you know, for, I think maybe, a week, I had forgotten to take my day-to-day pills. So I went into the Indian Health Hospital and asked for an emergency contraceptive, and I learned that they do not offer it over-the-counter, so I had to go see a doctor. And so when I went in to see the doctor, I was treated like I wasn’t supposed to be using emergency contraceptives at all. I was told, “You need to use condoms. You need to take your birth control. It shows on your chart that we issued you birth control—why aren’t you taking it? What are you doing here? What is the purpose of this?”
And on top of that, when I had initially called, I was told, “Well, we don’t have any walk-in appointments. You’ll have to come back tomorrow.” So the 24-hour period was already gone, and I had to get it the next day within that 48-hour period. And as you know, emergency contraception is most effective the sooner you take it. Up to 72 hours.
SM: Bitsinnie also worked as a community health worker and realized her own experience was similar to what many of her clients were facing.
MB: So when I started to do my own research, I decided, well, where best to start than to call my own the clinic where I’m from in Monument Valley? I have nieces who have friends who are sexually active and don’t access birth control because they don’t want their parents to find out. The emergency contraceptive, it’s not a birth control, but it was an option I was talking to my niece about. So I called over to the clinic and I asked them, I want to know if I can get the emergency contraceptive pill. And I was asked, “Who is this?” You know, “What do you need? What do you need this for? Who are your parents? May I ask who’s calling?” And I said, “No, I don’t want anybody to know. I’m just asking can I access it there.” And they, you know, again, “Who is this, who is this?” And I said, “Do you need to know my name?” And he’s like, “Yes.” And I said, “OK, well, when I come into the clinic I will give you my name.” “Well, who is this? Who are your parents?” You know? And so then I just started to realize, whoa, this is a really huge barrier to get access to this Plan B, when it shouldn’t be.
JL: I think that on a very human level, no matter what your race is, it’s hard to talk about sexual health.
SM: Again, Jessica Leston, with the Northwest Portland area Indian Health Board.
JL: And so when you are a Native person in a rural community and the only access to care you have is the IHS or tribal clinic and you go there for care—and you know most people in the clinic, you grew up with them and they’re your aunts or your neighbors, they’re your tribal members—being able to bring up the subject of sex, of your sexual health, of needing to get tested for an STD or about wanting to go on the birth control pill, or anything like that is really embarrassing. It’s uncomfortable.
SM: IHS wouldn’t comment on tape for this story, but in a written statement, said that Plan B is currently available at all federally run facilities from the pharmacy window for women 17 and over, and will be for all ages once FDA labels on the packaging have changed. They noted that a verbal directive has been issued to all IHS pharmacies. But advocates for access say an official policy needs to be put on paper, as a verbal directive can easily be changed. And tribal-run facilities need to evolve as well. Travelling to an off-reservation pharmacy means coming up with transportation, gas money, and having to pay for emergency contraception—whereas it’s free at IHS clinics, if they carry it.
Pam Kingfisher: We feel like this is still step one to make sure that the women are, their human rights are, just as equal as other women who have the access to go to the pharmacy and buy it for 50 dollars.
SM: Pam Kingfisher, who lives within the Cherokee nation of Oklahoma, has been one of the leaders of the campaign for access to emergency contraception. She says its taking time, but things are changing.
PK: We have gotten the IHS to roll over and start providing it. When we went before the National Congress of American Indians last year and got a reservation of support from them, it was like black and white from six or seven years ago where women’s issues were not talked about through the podium.
SM: While Kingfisher, Asetoyer and others keep up they pressure on the bureaucracy, they’re also working to educate women about contraception on a grassroots level by creating thousands of small informational cards that can be distributed at clinics, community centers, and between friends. The most important thing, say advocates, is educating women themselves about Plan B, how it works, and where they can get it.
This story is part of the Reproductive Justice Reporting Project, an initiative of the Media Consortium in partnership with the Association of Alternative Newsmedia, made possible with a grant from the Quixote Foundation. It is jointly published by Bitch, Making Contact, and at Where Is Your Plan B.