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Reproductive Justice

Reproductive Justice: The Politics of Health Care for Native American Women

Copyright Date: 2015
Published by: Rutgers University Press
Pages: 216
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  • Book Info
    Reproductive Justice
    Book Description:

    InReproductive Justice, sociologist Barbara Gurr provides the first analysis of Native American women's reproductive healthcare and offers a sustained consideration of the movement for reproductive justice in the United States.

    The book examines the reproductive healthcare experiences on Pine Ridge Reservation, home of the Oglala Lakota Nation in South Dakota-where Gurr herself lived for more than a year. Gurr paints an insightful portrait of the Indian Health Service (IHS)-the federal agency tasked with providing culturally appropriate, adequate healthcare to Native Americans-shedding much-needed light on Native American women's efforts to obtain prenatal care, access to contraception, abortion services, and access to care after sexual assault.Reproductive Justicegoes beyond this local story to look more broadly at how race, gender, sex, sexuality, class, and nation inform the ways in which the government understands reproductive healthcare and organizes the delivery of this care. It reveals why the basic experience of reproductive healthcare for most Americans is so different-and better-than for Native American women in general, and women in reservation communities particularly. Finally, Gurr outlines the strengths that these communities can bring to the creation of their own reproductive justice, and considers the role of IHS in fostering these strengths as it moves forward in partnership with Native nations.

    Reproductive Justiceoffers a respectful and informed analysis of the stories Native American women have to tell about their bodies, their lives, and their communities.

    eISBN: 978-0-8135-6470-8
    Subjects: Sociology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-x)
  4. Commonly Used Acronyms
    (pp. xi-xii)
  5. Part I Introductions:: The Stories We Tell and Why

    • 1 Introducing Our Relatives and Introducing the Story
      (pp. 1-10)

      InLako’l wicoh’an(the Lakota way of being in the world), important things—prayers, ceremonies, the telling of stories, and the sharing of lessons—are marked with the phrasemitakuye oyasin.This phrase, which is commonly translated in English as “all my relations” or “we are all related,” carries profound significance for Lakota and other Native people, reminding those who are gathered that all things are in relationship, and that our relationships define who we are and what our purposes might be. Our relationships carry responsibilities, sometimes joyful, sometimes challenging, sometimes tedious. Our relationships contour our lives in a thousand...

    • 2 Stories from Indian Country
      (pp. 11-25)

      On the wall of my office I have two maps, both of which are titled “Indian Country.” One shows the contiguous United States, Hawai’i, and Alaska, with the locations of all reservations marked in red. The other shows the entirety of North America and Hawai’i, and the entire map is colored a solid red. Which one is correct? Both. Indian Country is complicated.

      The Lakota people emerged from the womb of Unci Maka (Grandmother Earth) long, long ago. No one knows when, exactly. Before they emerged they were spirit, and some of their ancestors who chose not to climb to...

    • 3 Whose Rights? Whose Justice?: Reproductive Oppression, Reproductive Justice, and the Reproductive Body
      (pp. 26-36)

      In the United States we rely on a liberal ideology that locates responsibility for health and wellness in individual choices. Similarly, the language of “rights” and “justice” tends to promote a legalistic, objective standard that protects the individual. When mainstream conceptualizations of objectivity are coupled with this individualist ethos, the social environment is potentially neglected. As medical sociologists and others recognize, however, health is profoundly social. The fundamental role of race, class, sex, and gender inequalities in contemporary societies, and the histories from which these inequalities derive, necessitate the careful and deliberate consideration of social relations in any effort to...

  6. Part II Tracing the Ruling Relations:: Health Care, the Reproductive Body, and Native America

    • 4 The Ruling Relations of Reproductive Health Care
      (pp. 39-50)

      The biomedical model of reproductive health care in the United States today has developed over the last two centuries from heteropatriarchal assumptions about women as reproducers, assumptions that centralize and privilege the experiences of economically advantaged and white women. The practice of mainstream medicine continues to rely on a narrow construction of health care in which women of color, women who are economically disadvantaged, differently abled women, and women who do not identify publicly and/or privately as heterosexual may not be able to access the care that they need, or may be required to negotiate health-care structures that do not...

    • 5 Producing the Double Discourse: The History and Politics of Native-US Relations and Imperialist Medicine
      (pp. 51-67)

      As numerous historians and other scholars assert (see, e.g., Deloria 1970; Smith 2006; Veracini 2010; Wolfe 2011), conquest does not happen in a teleological or totalizing way. Colonizers who seek to settle “new worlds” must first and continually manage the preexisting inhabitants, addressing multiple forms of resistance and the stubborn persistence of sheer existence. Tactics of control, negotiation, assimilation, resistance, and management evolve on all sides. The complexities of Indian Country and Native-US relations today did not develop through a natural course of social evolution; they were produced through a labyrinthine and unfinished history of treaty negotiations, local and national...

    • 6 “To Uphold the Federal Government’s Obligations . . . and to Honor and Protect”: The Double Discourse of the Indian Health Service
      (pp. 68-88)

      The fragmented nature of Indian policy creation and implementation is clearly reflected in the organization and structural challenges of the Indian Health Service. Historically IHS follows a fairly linear trajectory of development. However, its increasing institutionalization has progressed during a period when State-produced concepts of self-determination, coupled with social movements for community control, encourage locally oriented service. As a result, its structural integration into the bureaucracy of the United States produces convoluted and multiple locations of authority and complicates IHS’s unique mission and its emphasis on comprehensive community-based care.

      The management of IHS operations and resources is accomplished through a...

  7. Part III Consequences of the Double Discourse:: Native Women’s Experiences with the Indian Health Service

    • 7 Resistance and Accommodation: Negotiating Prenatal Care and Childbirth
      (pp. 91-104)

      As shown in Chapter 4, close examination of the historical development of reproductive health care reveals the longue durée of ruling relations that organize all women’s reproductive health-care experiences, though in different ways. Not only health-care modalities, but even knowledge about the body reflect the influence of these ruling relations. Because IHS is located squarely in the State’s ruling apparatuses and relies on an evidence-based model of care that further reflects the strong hand of these ruling relations, it provides a fulcrum through which State goals may be imposed on Native communities, but through which Native people can also exert...

    • 8 One in Three: Violence against Native Women
      (pp. 105-118)

      When I taught at a high school on Pine Ridge Reservation, one of my students, a junior, became pregnant. Amelia was a good student and a star cheerleader; the reaction from teachers and her cheerleading coaches was one of dismay and disappointment, punctuated by comments such as “What were you thinking?” and “Why would you let this happen?” Other teachers at the school would simply shake their heads or opine, “happens all the time” (and in fact, it does; see Chapter 9). Just before I left the reservation to give birth to my own first child in Connecticut, Amelia came...

    • 9 Genocidal Consequences: Contraception, Sterilization, and Abortion in the Fourth-World Context
      (pp. 119-134)

      The organization of reproductive health care, even outside of IHS, is often shaped by ideologies of race, class, gender, and citizenship status. However, the IHS system is particularly vulnerable to the shifting political and social intersections of gender, race, class, sexuality, and citizenship because of its reliance on multiple points of authority, including Congress and the president, regional states, and Tribal governments as well as social edicts from religion, tradition-oriented cultural practices and beliefs (which themselves are often influenced by patriarchal colonization), and local and national public opinion. The links between access to contraception, unintended pregnancies (including but not limited...

  8. Part IV Reproductive Justice for Native Women

    • 10 Community Knowledge, Community Capital, and Cultural Safety
      (pp. 137-151)

      As this study reveals, the organization of certain resources contributes to Native women’s health disparities and even their behavior in seeking health care. Lack of ready transportation and financial resources, for example, combine with the evidence-based paradigms that organize mainstream medical care and the political economy that determines IHS’s inadequate staffing and outdated facilities to produce particular subjective experiences that, I argue, are marked by expressions of restriction, acquiescence, negotiation, and resistance. However, focusing on the ruling relations—the structures that shape these experiences—tells only a partial story. Although the technologies of settler colonialism organize Native peoples’ lives to...

    • 11 Conclusions: Native Women in the Center
      (pp. 152-158)

      As this study reveals, the ruling relations that organize reproductive health care for Native women emerge from multiple locations and reflect the intersections of race, class, gender, sex, and citizenship ideologies in the settler State. The stories that drove my research bring to light how these ideologies combine with State interests to impose a complex organizing force on the experiences of Native women seeking reproductive health care and reveal the links between Native women’s embodied experiences of reproductive health care and the multiple locations from which these experiences are organized.

      For example, the role of Congress and the executive branch...

  9. Appendix A: Methods and Methodologies
    (pp. 159-170)
  10. Appendix B: A Brief Chronology of Federal Actions Affecting Native Health Care
    (pp. 171-174)
  11. References
    (pp. 175-192)
  12. Index
    (pp. 193-200)
  13. Back Matter
    (pp. 201-202)