New Report Examines Reproductive Health of Urban Native American Women

A new report has been released on the reproductive health of American Indian and Alaska Native women (referred to in the report as AI/AN women, a term I will thus also use here). The full report, Reproductive Health of Urban American Indian and Alaska Native Women, can be found here (pdf) and the executive summary is here (pdf). The report details some disturbing if unsurprising findings about the differences in reproductive health care between AI/AN women and white women in the U.S., including on the subject of sexual violence. Presented below is a hodgepodge look at the report and its key findings.

The section of the report dealing with what is alternately referred to as “non-voluntary sexual intercourse” and “forced sex” begins on page 26 of the report, and presents the following information:

There are two questions about the voluntariness or wantedness of first sexual intercourse. The first one asked how much the first intercourse was wanted with responses as:

• I really didn’t want it to happen at the time,
• I had mixed feelings-part of me wanted it to happen at the time and part of me didn’t,
• I really wanted it to happen at the time.

The second question asked was: “Would you say then that this first vaginal intercourse was voluntary or not voluntary, that is, did you choose to have sex of your own free will or not?”

More than two times the number of urban AI/AN report their first sex was non-voluntary compared to NH-whites (17% vs. 8%; p= 0.00) (See Graph 7).

Respondents who reported having experienced forced sexual intercourse were asked about the type(s) of force used. Women could report more than one type of force and each of seven types were asked as a separate “yes” or “no” question.

• Among urban AI/AN women whose first sex was not voluntary, 85% specified the type(s) of force used.
• The most common reported type of force at first sex for both urban AI/AN and NH-whites was being “pressured into it by his words or actions, but without threats of harm” (63% and 62%).
• The second and third most common types of force were, “Did what he said because he was bigger or grownup, and you were young,” and being “physically held down”.

On the one hand, I have to say that I’m really glad to see that coercion is included among definitions of forced sex (rape). That is absolutely spectacular, and all too rare. Though, at the same time I’m really dismayed and disturbed to see that coerced sex is accepted as somehow different from rape:

In a study of ethnic differences in the impact of sexual abuse on teen pregnancy rates, racial minority teens, including AI, were more likely than whites to have a teenage pregnancy and to have been coerced into having sex, rather than raped, prior to teenage pregnancy (Kenney, 1997).

Something similar is suggested here in the AP report:

The 2002 survey didn’t ask women outright if they had been sexually assaulted in their first encounter or any other time, and researchers say it’s another area that should be examined more closely.

While I have no problem with the wording used in the questions — it’s important, when gathering statistics about sexual violence, to use descriptive language rather than loaded terms like “rape,” since far too few victims realize that their experiences meet that criteria — suggesting that failing to use the term sexual assault therefore means that rates of sexual assault were not tracked is altogether a different beast. And it’s a huge erasure of many women’s experiences, something that is sadly very common, but which I still find unconscionable.

Back to the actual numbers at hand, the statistics presented here are terrifying. Eight percent of women experiencing first sexual intercourse as rape is utterly atrocious. Ideally that number should be zero, but close to 1 in 10 should be astonishingly high by any standard. And again: that’s for white women. American Indian and Alaska Native women are experiencing a 17% rate of experiencing first intercourse as rape. Closer to 1 in 5, than 1 in 10.

The precise reasons why these rates are so much higher among AI/AN women are not determined, nor likely could they have been. Those reasons are almost certainly far too layered and complex for that, though they undoubtedly do hold ties to the continuing consequences of colonization and genocide, such as poverty, lost cultural ties, and ongoing racism. The report also sadly does not seem to contain much information about who the perpetrators of these rapes were. Among AI/AN women generally, a vast majority of perpetrators in reported rapes are non-Native men. How much this holds true for rapes that are not reported, and for rapes that account for a victim’s first experience of intercourse specifically, is currently unknown. But it is important information to have with regards to addressing the problem.

The report does, however, explicitly connect sexual violence to unintended pregnancy and other reproductive health issues, by including a discussion of sexual violence in a report that is explicitly about reproductive health. (And as I adamantly believe that sexual violence is a reproductive health issue, I of course think this was an excellent move.)

The study found that AI/AN women were more likely to have unintended pregnancies than white women and also had more births — though whether and/or how much these two points directly correlate is unclear. After all, a higher number of births may be neutral or even positive, if for whatever reason AI/AN women actually desire more children than white women, or if white women actually desire more children than they have.

More pregnancies and/or more births is not necessarily a problem in the least. Unintended pregnancy, on the other hand, is an issue — because while unintended does not automatically translate to unwanted, most of the unintended pregnancies found in this study were classified as “mistimed” or sooner than the respondents had desired. While many women have and will continue to make mistimed births work, it does also frequently come at a personal and/or economic cost. And for women who are already economically vulnerable, the ability to control one’s fertility can be vital.

The discussion of the reasons behind the differences in rates of unintended pregnancies between AI/AN women and white women is limited, though class and the higher rates of poverty among AI/AN women is implied to likely be a huge factor. With reproductive coercion being generally common among teens and young women, women who endure reproductive coercion frequently being subjected to other forms of abuse, and AI/AN women being particularly likely to have been forced into first sexual intercourse, could reproductive coercion account for at least part of the higher rates of pregnancy? I certainly don’t know, but I do think that it’s a possibility. Other possibilities also abound, including but not limited to contraceptive availability and choices.

Indeed, the study also found that AI/AN women who had never given birth were significantly less likely than white women who had never given birth to use contraceptives. AI/AN women were also significantly less likely to use contraception during first intercourse, quite likely in at least part to the higher rates of non-voluntary intercourse.

Further,  much higher rates of AI/AN women were using Depo-Provera and sterilization as their methods of contraception as compared to white women. And while sterilization, at least, is highly unlikely to result in more unplanned pregnancies, the question of coercive practices regarding contraception is certainly raised — especially since histories of coercive Depo-Provera and sterilization are prevalent for women of color, including AI/AN women, and especially since “a higher percentage of urban AI/AN with public insurance or Medicaid ever used Depo-Provera compared to NH-whites with the same insurance type.” It is far within the realm of possibility, more likely than not, that coercive contraceptive practices against AI/AN women are continuing. And those practices are racist, colonizationalist, a continuation of genocidal efforts, and blatantly unacceptable.

The full report contains many more details. Be sure to check it out, and discuss both those points that I’ve raised and those that I’ve missed in comments.

0 thoughts on “New Report Examines Reproductive Health of Urban Native American Women

  1. Jeannette

    I think your analyses of these reports is so insightful! Thank you for picking them apart. I do wonder about the wording of “forced sex” or “non-voluntary sexual intercourse.” To anyone outside the sexual assault prevention community, this doesn’t really stand out as what it is: rape. I hope that the researchers at least identify it as such, whether or not the study participants would have attached that label to their experiences.


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