Wanderlust

I spent yesterday exploring South Dakota and the politics of reproductive health care in this beautiful, contradictory state. South Dakota, as many of you will remember, has a legislature that voted last year to pass a ban on abortion that didn’t include exceptions for the rape, incest, or the health of the woman.  Supporters of reproductive rights gathered more than enough signatures to put the matter to the voters, who effectively overruled the legislature by soundly defeating the abortion ban, 55% No to 44% Yes. While it was certainly a victory for women, as Kate Looby, the Director of Planned Parenthood in Sioux Falls, put it "it still means that 44% of South Dakota voters thought a ban on all abortions was a good idea.  A sobering thought.

South Dakota is an interesting place when it comes to reproductive health care.  Planned Parenthood is the only abortion provider in the state, and it isn’t a Title X funded clinic, which means that it doesn’t get funding for family planning services.  According to the Guttmacher Institute, although South Dakota has 45 Title X funded family planning clinics, it ranks 40th out of 50 states when it comes to availability of contraception.  However, it also ranks 44th in the nation for the rate of teen pregnancy.  Are South Dakota teens using more protection? Having less sex? 

I smell a research project…

I also got the opportunity to talk with Andrea, who manages the clinics in both Sioux Falls and Rapid City. She talked about the challenges they face as a provider – the state legislature has thrown pretty much every law in the book at providers. There are TRAP (Targeted Restrictions of Abortion Providers) laws which mandate that there must be 45 square feet of space for each client in the recovery room, among other ridiculous and arcane restrictions. They’re also waiting for a decision to come down from the appeals court on new informed consent requirements. Currently, a woman seeking an abortion has to hear information from a physician at least 24 hours in advance of the procedure, but it can be done over the phone.

Informed consent laws are onerous for a couple of reasons – one, they create more paperwork and bureaucracy for clinics, taking away time that they could be spending with clients. Two, there is an assumption that without laws mandating informed consent, women would just be having abortions left and right without thoughtfully considering each option and its ramifications.  This assumption that women are incapable of making sound health care decisions for themselves, is present throughout the reproductive health care system. I’ve heard stories of doctors refusing to perform tubal ligations on women because "they might change their minds" and doctors coercing women into using bith control methods like Depo-Provera because they can’t be trusted to remember to take birth control pills. 

The new South Dakota informed consent guidelines will require physicians to present information in person to women seeking abortions at least 2 hours before the procedure, which will present a whole new array of logistical issues.  The women who work at Planned Parenthood clinics, and at family planning clinics across the nation in states where they face laws like this, are to be commended for the work they do in the face of so much opposition. Andrea commented that the staff at the clinic makes her incredibly proud in the ways that they work together and come to work each day committed to their mission. It seems to me that working in states like South Dakota, where there is so much organized opposition to access to reproductive health care, strengthens the commitment and resolve of reproductive health care providers in ways that a less hostile environment doesn’t.

I think a lot about the relative merits and drawbacks of having such a defined enemy to align against.  It certainly galvanizes people who support access to health care, but it also means that it’s harder to provide that care.  While PP in South Dakota doesn’t seem to worry about staff apathy and disinterest like othe PP affiliates do, they also spend a lot of time, energy, and resources defending themselves against attacks.

Speaking of attacks on personal freedom, I drove down yesterday afternoon to visit the Native American Women’s Health Education Resource Center in Lake Andes, on the Yankton Sioux Reservation.  Unfortunately, Charon Asatoyer, who is the director and one of the founders and driving forces behind the center, was out of town, but I had the opportunity to talk with some of the interns and several of the people who work at the Center.

The Center is housed in an unassuming white-paneled house in Lake Andes, a small, dusty town near the Missouri river.  On the front door was a sign that read "NO one will be allowed into the food pantry under the influence of alcohol". That afternoon, there had been a lunch for participants in the Dakota language school and their families. Jermaine, the language school teacher and one of the few fluent Dakota speakers, sat down and talked with me about her work and the language school. The story of the Yankton Sioux is the same story told over and over on reservations across the nation, with small, wicked variations. The forcible removal of children to boarding schools where they weren’t allowed to speak their languages, where they were told that their customs and culture were backwards and heathen. The treaties signed and reneged on, the health services promised and left unfunded, the women forcibly sterilized.

Its sad, but not surprising, that I grew up knowing so little about the ways in which the Native Americans continue to be treated in this country. Sure, we learned about the Trail of Tears, forcible removals and genocidal campaigns in the 18th and 19th centuries, but I don’t remember ever learning about the ways in which the government continues to enact and support policies that have devastating effects on Native populations.  The tangled web of policies and procedures regarding tribal and state jurisdictions and responsibility for law enforcement, health care provision, and more means that many people end up not being able to access the services they need. Life expectancy for Native men in South Dakota is the lowest in the nation. The Washington Post did an article on what life is like on the Pine Ridge reservation, which you should read, especially if you think I’m exagerating or unfairly demonizing the government.  

It amazes me that the women of the Center are able to organize and advocate for themselves in the face of such overwhelming adversity.  They have all kinds of programs in addition to the language school – a domestic violence shelter, an AIDS prevention program, a food pantry, and an information clearinghouse which includes in-depth reports on reproductive health issues facing Native women.

I talked a little with Ellen, one of the interns at the Center who I’d met at the Hampshire Civil Liberties and Public Policy Program office in Amherst, Mass. She’s spent time in Chiapas, Mexico, with the indigenous population that faces discrimination and oppression from the Mexican government. She was struck by how different the two experiences were – in Chiapas, it seemed like there was energy, political momentum, and hope. Here in America there is rarely discussion of the continuing mistreatment of Native Americans, much less a political movement fighting for access to rights and resources.  

I’ve spent a lot of time examining social inequalities in access to health care and education, and there are some places where I can see where pressure can be applied, energy expended to begin to alleviate inequalities and change circumstances. For instance, it seems pretty clear that if I want to facilitate women and girls obtaining the tools and skills to empower themselves to make good decisions about their lives and their bodies, I need to provide access to information and a space to share it. That I can do, and I can see it happening around me, visit people who are doing it and take their successes and lessons learned and build off them.

But there are some problems that seem so big I don’t even know where the edges are, don’t know how to strategize when every expenditure of energy seems laughable in the face of the forces arrayed against it.  How do you bring back a language that only 87 people still speak fluently, most of whom are over 70? How do you bring back a language when the only school that taught the language year round closed due to lack of funding?

I’m immensely glad that the Native American Women’s Health Education Resource Center exists, and I was deeply moved by the efforts of the women who work there to provide resources and education to women who so desperately need them.  As Jermaine put it, they are "trying to recreate our wellness", our ability to live in harmony with the earth and each other.  I challenge myself, and all of us, to work as allies to Native women and do what we can to recreate that wellness in the community and on the reservation.