Insane Bureaucracy Blocks Native American Women’s Access to Plan B

Given that one in three Native American women will be raped in their lifetime, activists are asking that the federal Indian Health Service provide emergency contraception over-the-counter and on demand. They're getting radio silence in return.

By Akiba Solomon Jun 20, 2012

When I see an opinion piece, Facebook post or tweet berating folks for not being outraged enough about a Very Important Issue, a nasty little inner voice retorts, "Make it hot, and the people will come!" Then I end up in a justice-centered shame spiral, feeling pissy at the people who are trying to make me do something good about something bad happening in the world.

I hate shame spirals.

So I’m not going to demand that you display outrage about how poor rural and reservation-based Native American women who receive medical care from the federal Indian Health Service still don’t have easy access to Plan B emergency contraception. Even if you know that one in three indigenous women will be sexually assaulted in her lifetime–due in large part to jurisdictional red tape and legal loopholes that allow predators to go unchecked–you might not understand why over-the-counter emergency contraception should be an option for those 17 and up.

After all, this important issue hasn’t gotten the same burn as, say, the Republican-fueled controversy over Elizabeth Warren’s faux Native American identity.

In a must-read report released in the spring, activist Charon Asetyoer made the case:

"I’ve heard women ask for information about emergency contraceptives so they can talk to their daughters about what to do when they are sexually assaulted–not if they are sexually assaulted, but when."

Imagine having that talk with your daughter in the hope of removing abortion or adoption from her post-rape to-do list.

Not if, but when.

That kind of tragic pragmatism should stay on our collective radar.

In Search of a Response

Last week, I called and emailed various IHS sources to find out if and how the agency is addressing anecdotal evidence that rural and reservation-based Native American women who request Plan B are being told they need to travel long distances and/or obtain a prescription from health centers that are often short-staffed and closed over the weekend. (Note that to be effective, Plan B has to be taken within 72 hours.)

I figured that in the four months since the NAWHERC report dropped and Asetoyer name-checked IHS director Dr. Yvette Roubideaux all up and through the media, the agency had come up with a targeted policy or at least some talking points.

Bizarrely, they hadn’t.

This is particularly weird given that more than 99,000 people have signed an online petition, demanding that Roubideaux mandate (not suggest) that all IHS facilities stock Plan B and distribute it according to FDA guidelines–to women 17 and up without a prescription. Every single time someone signs that petition, Roubideaux’s office gets an email.

But instead of owning up to why the agency can’t or won’t create a systemwide Plan B policy, the IHS spokesperson told me Roubideaux wasn’t available and directed me to this broad blog post that doesn’t mention emergency contraception. An excerpt:

The DOJ, working with the IHS as well as the Bureau of Indian Affairs and other agencies, has responded to the call for equal justice in Indian Country with substantial action. At the start of this Administration, Attorney General Eric Holder established a Department-wide initiative on tribal public safety, and issued a clear directive to every U.S. Attorney serving Indian Country: Meet with the Tribes in your district and develop operational plans to improve public safety. Plans are now in place and guiding our efforts to reduce crime through aggressive law enforcement, as well as focused prevention and intervention efforts.

Finally, on Friday afternoon, I got this statement:

"IHS is in the process of standardizing our procedures to ensure patients have access to the medicines they need."


Trying to Get Plan B in Real Time

In March, 26-year-old Oglala Sioux park ranger and online activist Sunny Clifford launched the above-mentioned petition after she called the Kyle, South Dakota, IHS clinic and asked for Plan B. In an interview she explained what happened:

"I called and told the receptionist that I needed Plan B. She said, ‘Hold on, I’ll try to get you in.’ But after a few minutes she told me that I would need a prescription from the [clinic’s] midwife who wasn’t there at the moment."

Clifford asked for additional options and was directed to the two other IHS centers in the area–Wanblee which is about 50 miles from Kyle and Pine Ridge, which is about 60 miles away. She, like many of her peers, doesn’t have a car. "Just seeing what I had to go through, thank God I didn’t need it when I called," she said.

Last Thursday I repeated Clifford’s experiment. I cold called Kyle clinic and asked if they had Plan B in stock. The receptionist transferred me to the pharmacy line, which rang incessantly before disconnecting me. I called back and at least made it through to the pharmacist’s outgoing message. The voice of a clearly overworked gentleman asks callers to leave their name, chart number, date of birth, and reason for calling, tells them that due to high demand the pharmacy can’t always respond immediately and ensures that they’ll receive a response within about two hours. (I didn’t leave a message because I think it’s unethical to create another task for an overtaxed health provider.)

Next, I called the Wanblee clinic and made the same request. The receptionist patched me through to a dial tone. I called back and made it to a voicemail that required an extension of the person I wanted to speak with. During a pregnancy scare, particularly one produced by sexual violence, the last thing a woman needs is to navigate an interoffice directory.

Finally, I called Pine Ridge, the largest and best resourced branch of IHS in the area. I asked for Plan B and, after I identified myself as a reporter, I was transferred to Becky Anton, the certified nurse midwife who oversees gynecological care there.

Antone explained that Plan B was in stock but only available only through a prescription from a midwife or pharmacist. She also told me that she’d just received a policy draft from regional headquarters in Aberdeen instructing providers to distribute this emergency contraceptive without a prescription. After receiving feedback from IHS branches, this policy would go to "the director" for his or her signoff. Anton, who has been working at Pine Ridge for six months, couldn’t tell me if this policy is riding on Roubideaux’s signature or the Aberdeen Area director’s.

My intention here isn’t to call out overextended cogs in a bureaucratic wheel. But it’s pretty clear that IHS needs outrage, more calls, more emails, more media scrutiny to speed up this process.

Paging Dr. Roubideaux.