3 Decolonizing Indigenous Reproductive Healthcare and Politics: Indigenous Feminist Perspectives and Practices

Introduction

In recent years, reproductive healthcare policies and reproductive justice advocacy have been an important part of popular discourse. Since the overturn of Roe V. Wade, abortion and reproductive rights have been a major point of contention, and the state’s consistent inability to provide adequate healthcare has negatively affected many people with uteruses. The evolution of reproductive politics in the United States is intimately interwoven with the colonization of Indigenous peoples and the ownership of land and bodies. This paper aims to provide a comprehensive and critical analysis of the history of Indigenous reproductive healthcare and politics in the United States, with an emphasis on the efforts of Indigenous feminists to achieve reproductive justice.

As the history of Indigenous reproductive politics is assessed, the main lens through which this paper aims to contextualize Indigenous reproduction is through the impacts and legacy of colonization. Where and how do the pervasive impacts of colonization influence the past and present of Indigenous reproductive healthcare and politics? Indigenous author Luhui Whitebear notes that “Indigenous feminisms ask us to recognize…how [different systems of coloniality] impact us both historically and in the present while also imagining futures in which we are liberated from these violences” (Whitebear, 2). Carmela Roybal, Executive Director of the Native American Budget and Policy Institute of New Mexico, emphasizes the importance of this radical contextualization centered in many Indigenous feminisms’ efforts to achieve a decolonial horizon, specifically a future of reproductive justice. Radically contextualizing the multifaceted histories, relationships, and resistance efforts within Indigenous reproductive healthcare and politics requires an expansive and inclusive analysis, knowing that there are innumerable considerations across the social, political, and cultural landscape of Indigeneity in the West.

Theoretical Framework: Contextualizing Indigenous Reproductive Politics within the Legacy of Colonization

These manifestations of coloniality in Indigenous reproductive healthcare and politics have served as the launchpad for transcultural-decolonial efforts that are continuously developing and enacted by Indigenous and other transnational feminists. As described by Mignolo and Walsh, decoloniality “is rooted in the praxis of living and in the idea of theory-and-as-praxis and praxis-and-as-theory, and in the interdependence and continuous flow of movement of both…. Decoloniality, in this sense, is wrapped up with re-existence” (Mignolo & Walsh 2018, 7). There is no singular way in which decolonization is enacted, and arguably needs to be intentionally cultivated across a range of social and political structures using a variety of tools and practices. For instance, a range of decolonial theories and practices are continuously adapting from the efforts of Indigenous feminists in their process of imagining and implementing a state of reproductive justice.

As is further demonstrated, Indigenous feminists and frameworks center this relationship between modernity/coloniality and futurity/decoloniality^[1] in order to understand and envision the past, present, and future of Indigenous reproductive politics and healthcare. Decolonial efforts founded in an energy of love, care, and cooperation are being cultivated by Indigenous feminists and communities through modes of remembering and reclaiming Indigenous knowledge and practices, connecting and healing through embodied and community connection, and preserving and maintaining land and natural resources. These efforts are combating manifestations of coloniality across a range of socio-political institutions impacted by intersectional systems of oppression, the coloniality of knowledge, and the codependent relationship between colonized land and bodies.

In an effort to achieve religious, gendered, and racialized hegemony in the Americas, colonizers constituted intersectional systems of oppression that embody white supremacist and patrarichal-heternormative ideals. Professor and author of sociology Barbara Gurr explores the impact of intersectional systems of oppression (race, gender, sexuality, class, etc.) on Indigenous reproductive healthcare and politics: “Racial boundaries are also sexual boundaries…These boundaries may be spatial…legal or political…[or through the] inclusion or exclusion of certain people based on racial/ethnic/nationalist identity [i.e…IHS eligibility criteria].” Gurr expands on the implications of these boundaries noting that they enforce “a racial, [gender, class, and sexual] barrier of exclusion by differentiating Native people legally and politically from other US citizens, reflecting the diversion of resources that simultaneously produce and negate Native identity” (Gurr 2015, 27-28). These barriers imposed by such intersecting systems of oppression are important considerations to understand and address with decoloniality as a mode of achieving a state of reproductive justice. Re-centering Indigenous knowledge and practices regarding family and gender structures, and medicine and caretaking is a powerful tool of decolonization that assists in the deconstruction of racialized, gendered, and classed hierarchies in the US.

The oppression of Indigenous people is further perpetuated by the coloniality of knowledge. The creation of a new knowledge system founded from the proselytization of white hegemonic and patriarchal-heteronormative ideals reorganized Native American communities “economically, culturally, spiritually, linguistically, and socially” (Hoagland 2020, 57). Anibal Quijano’s theory on the coloniality of knowledge ^[2] specifically manifests in the field of reproductive politics, through the medicalization of childbirth, the nuclear construction of the gender binary and family structures, as well as the persecution and erasure of Indigenous midwives and reproductive practices. These manifestations of coloniality are resisted and decolonized by Indigenous feminists through persistent efforts to remember and reclaim knowledge that was oppressed or diminished in the process of colonization. For instance, Indigenous feminist and midwife Katsi Cook emphasizes the importance of remembering Indigenous knowledge, medicine, and connectivity centered on decolonial feminist frameworks of personal and political sovereignty, and embodied and community based healing (Bioneers, 2024). The relationship between stolen lands and stolen bodies further contextualizes the purpose and effectiveness of such Indigenous feminist frameworks of decolonization in achieving a state of reproductive justice.

The inherent connection between the colonization of Indigenous land and Indigenous reproductive people is a site for both understanding the implications of colonization as well as creating feminist cartography of a decolonized state. Scholars Sofia Zaragocin and Martina Angela Caretta unravel “the relationship between land and embodiment by proposing the concept and method of cuerpo-territorio, which stems from Latin American critical geography praxis. Cuerpo-territorio can be conceptually defined as the inseparable ontological relationship between body and territory: What is experienced by the body is simultaneously experienced by territory in a codependent relationship” (Zaragocin & Caretta 2020, 1504). In addition, “Cuerpo-territorio as a concept and a method…[then] becomes a feminist means to diagnose territorial conflicts and to initiate healing of bodies and territory” within community healing spaces, embodied processing practices, and co-created bodies of knowledge (Zaragocin & Caretta 2020, 1508). This Indigenous decolonial feminist framework and method notably reflects ecofeminist ideals of “co-operation, and mutual care and love” to achieve a state of liberation and preservation of all life-forms in their diverse expressions (Mies and Shiva 2014, 6). It is through this framework, that the social, political, and financial barriers negatively affecting Indigenous reproductive practices and healthcare can be unraveled and dismantled, creating the space and opportunity to achieve a future of reproductive justice.

Case Study: Politicization and Medicalization of Childbirth and Reproduction 

The politicization of childbirth and reproduction, and the bio-medicalization of Indigenous childbirth and reproductive healthcare (i.e.… the Indian Health Services) outline the implications and manifestations of colonialism on Indigenous people and their reproductive healthcare. Furthermore, Indigenous scholars, story-tellers, feminists, activists, and community members convey the negative implications of colonialism on Indigenous reproductive healthcare and the social and political networks in Indigenous communities and tribes. In an attempt to center Indigenous and other transnational feminisms, this case study also explores the reactions and resistance efforts of Native Americans in response to the coloniality of Indigenous reproductive health serving as a decolonial cartography towards a state of reproductive justice.

In 1832, “the first treaty that included medical services was signed between the United States and the Winnebago Indians…Congress provided funding for Indian health care in the amount of twelve thousand dollars” (Lawrence 2000, 401). This initial treaty was the beginning of an ever-changing socio-political landscape of Indigenous healthcare and reproduction in the United States that must be contextualized in a history of biological warfare and cultural erasure as colonization practices. Throughout this process, reproductive healthcare continued developing as a site of politicization not just for Indigenous women, but all people with reproductive anatomies. The politicization of childbirth and reproduction is exhibited by a collection of court rulings in the 20th century which “set legal precedents regarding informed consent, [birth control, abortion services,] family planning, and sterilizations” (Lawrence 2000, 403). The politicization of reproduction as presented through these court cases and their proceedings granted the federal government with more control over the future of Indigeneity in the US with power and influence over the state of reproductive healthcare practices in Indigenous communities. While there are many legislations and court rulings that add restrictions to the reproductive practices of Indigenous communities, it is important to note that expansive policies and laws have also increased the financial, medical, and social resources on reservations. For instance, one of the most important and effective programs implemented by the US government is the Indian Health Service (IHS) ^[3].

Additionally, the establishment of the IHS, attached available healthcare services to Indigenous communities to the control of the biomedical-industrial complex. When the IHS was established, Indigenous reproductive healthcare shifted from community based care practices to medicalized and isolated instances of biomedical care in federally funded and managed facilities. While there were benefits to providing Indigenous communities with biomedical services, it is crucial to contextualize the positive impacts as well as the negative impacts within a history of genocide and biological warfare weaponized against the existence of Native Americans. As is further explored, the collection of regulations, policies, and state-run programs implemented over the course of the 20th century illustrate the main attitudes, challenges, and needs of Indigenous reproductive healthcare and politics that are still prevalent in the US today. For instance, sterilization abuse, inadequate healthcare and childbirth services, limited birth control access, and the spread of misinformation have a significantly detrimental impact on the health and wellbeing of Indigenous reproductive people, their children, and surrounding communities (Lawrence, 2000).

Analysis: Implications of the Coloniality of Reproduction on Indigenous communities and healthcare services

Reproductive rights have consistently been a point of contention throughout the United States and the ever-changing socio-political landscape reflects the differing opinions of United States citizens and residents. While legal and medical restrictions imposed on reproductive health care services affect all people with reproductive anatomies, they disproportionately impact Native women due to the underlying implications of colonization, racism, and sexism. One of the primary implications of the politicization of reproduction is restricted access to abortion services. In 2021, the Dobbs v. Jackson Women’s Health Organization court case determined that “The Constitution does not confer a right to abortion; Roe and Casey [were] overruled; and the authority to regulate abortion [was] returned to the people and their elected representatives” (2022, 8-79). However, even before these recent developments in abortion laws, Native women faced restrictions to safe abortion services when the Hyde Amendment of 1976 was passed which imposed “legal restrictions on abortion access for [all women including] Native women of limited income…who rely on state and/or federally funded healthcare, such as medicaid…The House of Representatives [also] sought to further curtail Native women’s access to abortion services and counseling through the Vitter Amendment [of 2008] …restrict[ing] access to abortion counseling and services specifically and solely for Native American women” (Gurr 2011, 78). Additionally, access to appropriate birth control is affected by the financial, social, and political regulations imposed during the process of the politicization of reproduction.

Access to safe and affordable birth control is one of the primary needs of people with reproductive anatomies. A lack of information surrounding birth control options has led many Indigenous women to undergo sterilization as a form of birth control. In addition, use of long term contraceptives, like Depo-Provera and Norplant, have “risen since the mid-1980’s… [and are commonly] used in IHS facilities, despite adverse side effects” and misinformation on the contraceptive’s longevity (Gurr 2011, 76). Other forms of birth control like the Pill and Plan B are hard to access for a number of reasons: “only 12.5% of IHS facilities dispense emergency contraception,….[and on some reservations that do dispense EC, like Pine Ridge in South Dakota, ] Plan B is [only] available for women…who have been raped” (Gurr 2011, 77). Inadequate staffing, limited/irregular hours, and isolated locations of pharmacies and IHS facilities, as seen on Pine Ridge Reservation, also hinder Indigenous women and reproducing beings from accessing the Pill and emergency contraception (Gurr 2011, 75). Condoms, on the other hand, are more easily accessible in pharmacies, IHS facilities, as well as schools and other community centers. However, given the lower efficacy of condoms, and the social/interpersonal barriers surrounding condom use, there must be more effort and resources invested in providing a range of birth control options to Indigenous people. There are many areas to improve the accessibility and quality of birth control accessible to all of those in need.

Sterilization abuse in IHS facilities has left a profound legacy of trauma and injustice on Indigenous women and their communities. In the 1970’s, it was estimated that 15% to 25% of reproductive-aged Indigenous women were forced or coerced into sterilization (Gurr 2011, 73). These rates are likely higher due to a lack of official documentation from medical providers. Instances of forced or coerced sterilization existed as a “failure to provide women with necessary information regarding sterilization; improper consent forms; [and a] lack of an appropriate waiting period (at least seventy-two hours) between the signing of a consent form and the surgical procedure” (Lawrence 2000, 400). In Pinkerton-Uri’s study, it was also discovered that “women generally agreed to sterilization when they were threatened with the loss of their children and/or their welfare benefits… [and] gave their consent when they were heavily sedated… [or] in a great deal of pain during labor” (Lawrence 2000, 411-412). Other accounts describe instances of going in for routine procedures and being unknowingly sterilized or being sterilized as ‘treatment’ for other reproductive issues.

Despite the violation of their reproductive rights, many victims were unable to seek legal recourse due to societal stigmatization and the formidable challenges of the healthcare industry. Sterilization abuse arguably led to increased rates of “marital problems, alcoholism, drug abuse, psychological difficulties, shame, and guilt” in Indigenous women; these impacts both resulted from and perpetuated the societal stigmatization surrounding sterilizations (Lawrence 2000, 410). The devastating repercussions of these practices extended far beyond the individuals directly affected, going as far as rupturing families, communities, and cultural bonds; for instance, “A tribal community that suffers a great number of sterilizations can lose the respect of other tribal communities because of its inability to protect its women” (Lawrence 2000, 411). This had a large impact on the political makeup of tribal networks.

Indigenous Feminisms: A Social Movement Working Towards a Future of Reproductive Justice 

Despite such an extensive list outlining the negative implications of colonialism on Indigenous reproductive healthcare and politics, years of committed organizations, activists, and community members have made significant strides in the fight for reproductive justice. The work of Indigenous midwife Katsi Cook, the Organization of Women of All Red Nation (WARN), as well as a handful of other radical transnational feminist organizations and movements have acted as pioneers in this fight. As is further explored, some of the main efforts being implemented by these activists include establishing personal and political sovereignty, the reclamation of Indigenous medical knowledge and practices, as well as the community based embodied healing.

The organization of WARN has reached a wide range of community members and has made some of the most impactful contributions to the fight for reproductive justice through decolonial feminist efforts. WARN was established in 1974 and focuses on the preservation of Native cultures and traditions specifically in regard to reproductive rights. WARN members understood Indigenous “reproductive agendas to be rooted in their historical and ongoing experiences as targets of colonialism” and understand the interreliance of reproductive justice with environmental and spiritual liberation (Theobald 2019, 148). Therefore, much of the work that WARN members focus on revolves around raising awareness of the impacts of colonialism on Indigenous women such as sterilization abuse (Theobald 2019, 162). Additionally, Indigenous activist and midwife Katsi Cook called “for a return in native midwifery, while [other activists]…. pursued a vision of reproductive control that demanded new types of practitioners, a change in their own attitudes about reproduction, and/or greater authority in clinics and birthing rooms” (Theobald 2019, 148). One of the foundational decolonial feminist frameworks guiding the work of these activists is the fight to reclaim political and personal sovereignty.

WARN activist Katsi Cook emphasized the importance of personal and political sovereignty ^[4] as part of the fight for reproductive justice. Cook has worked to expand “conceptions of sovereignty – ‘personal sovereignty’ alongside tribal sovereignty…[specifically calling] on women to exercise sovereignty over our own bodies” as a means to decolonize reproductive healthcare in Indigenous communities (Theobald 2019, 147). In regard to Cook’s activist efforts, this has looked like the reclamation of Indigenous culture and medicinal knowledge through connection and interpersonal knowledge sharing. Additionally, the establishment of organizations within Indigenous communities such as WARN, the American Indian Movement (AIM), and the Northwest Indian Women’s Council “reject the assimilationist pressures [of the United States government and envision] a movement capable of unifying political struggle with cultural resurgence and spiritual rebirth” (Theobald 2019, 160-161). The element of ‘cultural resurgence’ as a means of personal and political sovereignty applies to not just the re-existence of Indigenous medicinal knowledge, but also to the spiritual, social, and cultural practices related to Indigenous reproduction.

In response to so much of the medical violence induced by the federal government through the IHS, activists like Katsi Cook advocate for the remembrance and reclamation of Indigenous medical practices. As was noted by a member of the Pine Ridge Reservation in an Interview with Barbara Gurr, Reproductive medicine and healthcare knowledge was passed on from mothers and grandmothers to their daughters in “‘The stories, in the songs and in the ceremonies. Colonization broke up all these things, and now we need to rebuild them. We need …to bring back the traditional ways, too, because those are the right ways for us as Lakota people’” (Rosemary) (Gurr 2015, 143). Spreading knowledge through community action can strengthen culture and connection which aids in the development of tribal and individual sovereignty. Gurr’s research on the Pine Ridge reservation, as well as accounts from the Crow Nation, describe traditional medicine as a combination of herbal and diet based remedies, community care practices, and spirituality. Indigenous communities were able to address a wide range of reproductive health concerns with ancient medicinal knowledge, such as abortion, childbirth, and birth control (Theobald, 2019). Through the remembrance and reclamation of Indigenous knowledge, people with reproductive anatomy can rely more and more on themselves and their communities for their reproductive healthcare needs rather than resorting to harmful and neglectful biomedical services. Another element of decolonizing reproductive healthcare is related to the traditional roles and responsibilities of women and gender expansive people in Indigenous tribes.

As a patriarchal nation, the colonization of Indigenous communities was significantly influenced by political and social hierarchies of gender roles and relations. Reinscribing traditionally upheld political and social roles of women in Indigenous tribes can contribute to tribal sovereignty and reduce the gender based discrimination of reproductive healthcare services. In political spheres, “Native women held positions of esteem…and were thought to be born with certain dispositions toward spiritual guidance” (Ralsit-Lewis 2005, 73). Furthermore, “Women’s labor in the realm of reproduction – as life givers, mothers , and midwives – garnered them status and a role in public and ceremonial life” (Theobald 2019, 25). Relearning such attitudes and beliefs about women and instilling decolonial practices of transformative and restorative justice may contribute to the overall goal of Indigenous feminists in achieving a state of reproductive justice. Another decolonial Indigenous feminist methodology helping Indigenous communities heal from a history of colonization is El Cuerpo-Territorio.

Fundamental to the healing processes implemented by Indigenous feminists is the relationship between the land and bodies. As previously explored, the colonization of Indigenous land goes hand in hand with the exploitation, abuse, and control of Indigenous people with reproductive bodies. Embodied healing work is a powerful tool in addressing the link between physical violence against Indigenous women [and] the extractive industries contamination of ancestral land, which also had negative consequences in terms of the health of Indigenous women’s bodies” (1508). Cuerpo-territorio as a feminist body mapping healing modality encourages the creation of “collective knowledge grounded in the participants’ lived experiences of contamination and oppression” (Zaragocin & Caretta, 1508). This Latin based framework has been instilled in a number of Indigenous communities through workshops and individually curated practices.

As our nation and broader global community work to ignite a movement of reproductive healing, Indigenous feminists and their methodologies evidently serve as a leader in the fight for reproductive justice. Reproductive justice, as defined by Black feminists, is “‘the complete physical, mental, spiritual, political, social, environmental, and economic well-being of women and girls’ (Sistersong 2006, 5)” (Gurr 2015, 32). While reproductive politics and healthcare primarily affect those with reproductive anatomies, they ultimately impact entire communities. Therefore, a more expansive definition of reproductive justice that builds on Black feminist thought through an Indigenous feminist lens is the complete mental, spiritual, political, social, environmental, and economic wellbeing of those with reproductive anatomies and those in support of and in solidarity with childbearing individuals.

Understanding the complex histories of colonization and cultural erasure inflicted upon Indigenous communities in the Americas provides a crucial context to the evolution of reproductive politics and healthcare in the United States. As demonstrated by a host of Indigenous feminists and other transnational reproductive justice advocates, it is through this context that true healing can exist serving as a portal to a future of reproductive justice. Implementing a decolonial praxis across interpersonal relationships, community settings, medical services, and political spheres, collective transformation and a state of reproductive justice can unfold.

Bibliography

Bioneers. “Katsi Cook: Revitalizing Indigenous Knowledge and Medicine, Nurturing Health and Cultural Resilience.” Bioneers, January 16, 2024. https://bioneers.org/katsi-cook-revitalizing-indigenous-knowledge-and-medicine-nurturing-health-and-cultural-resilience-ztvz2401/.

Castells, Manuel. 2010 [1997]. Selection from Chapter 1: “Communal Heavens: Identity and Meaning in the Network Society,” pp. 5-10 in The Information Age. Economy, Society, and Culture. Volume 2: The Power of Identity. West Sussex: Blackwell Publishing (2nd edition)

Gurr, Barbara Anne. “Mothering in the Borderlands: Policing Native American Women’s Reproductive Healthcare.” International Journal of Sociology of the Family, Vol. 37, No. 1. Policing Motherhood (Spring 2011): pp. 69-84. https://www.jstor.org/stable/23029787

Gurr, Barbara Anne. Reproductive justice: The Politics of Health Care for Native American Women. New Brunswick, NJ: Rutgers University Press, 2015.

Hoagland, Sarah Lucia. “Aspects of the Coloniality of Knowledge.” Essay. In Critical Philosophy of Race Vol. 8, 48–60. The Pennsylvania State University Press, 2020.

Lang, Sabine. “Native American Men-Women, Lesbians, Two-Spirits: Contemporary and Historical Perspectives.” Journal of Lesbian Studies 20, no. 3–4 (June 2, 2016): 299–323. https://doi.org/10.1080/10894160.2016.1148966.

Mies, Maria, Vandana Shiva, and Ariel Shah. “Introduction: Why We Wrote This Book Together.” Essay. In Ecofeminism, 1–21. Bloomsbury Academic & Professional, 2014. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/claremont/detail.action?docID=1644031.

Mignolo, Walter D. and Catherine E. Walsh. 2018. “Introduction” in On Decoloniality. Concepts, Analytics, Praxis edited by Mignolo, Walter D. and Catherine E. Walsh. Durham and London: Duke University Press

Ralsit-Lewis, Marie. The Continuing Struggle against Genocide: Indigenous Women’s Reproductive Rights.” Wicazo Sa Review, Vol.20, No. 1. Colonization/Decolonization, II (Spring 2005): pp. 71-95. https://www.jstor.org/stable/4140251

Theobald, Brianna. Reproduction on the Reservation: Pregnancy, Childbirth, and Colonialism in the Long Twentieth Century. Chapel Hill: University of North Carolina Press, 2019.

Whitebear, Luhui. “Disrupting Systems of Oppression by Re-Centering Indigenous Feminisms.” Persistence is Resistance Celebrating 50 Years of Gender Women Sexuality Studies, August 12, 2020. https://uw.pressbooks.pub/happy50thws/chapter/disrupting-systems-of-oppression-by-re-centering-indigenous-feminisms/.

Zaragocin, Sofia, and Martina Angela Caretta. “Cuerpo-Territorio: A Decolonial Feminist Geographical Method for the Study of Embodiment.” Annals of the American Association of Geographers 111, no. 5 (October 16, 2020): 1503–18. https://doi.org/10.1080/24694452.2020.1812370.