(This piece was originally written for Chicago-based In These Times magazine (www.inthesetimes.com) Reprinted with permission.)

When it comes to their health, American Indian women face extraordinary barriers – from high disease risks to increased incidents of sexual violence. They now face another obstacle, rooted in the political battleground of abortion.

The Senate’s recent passage of the Indian Health Care Improvement Act was a breakthrough for advocacy groups that have long pushed for the bill’s provisions – new programs, improved facilities and funding for the Indian Health Services (IHS) system, which serves about 1.9 million people nationwide.

But the victory is dampened by a poison pill provision slipped in by Sen. David Vitter (R-La.) that explicitly restricts abortions under IHS programs. The amendment was approved along with the bill in February. As In These Times went to press, it was unclear whether the House would vote on companion legislation carrying a similar amendment.

Speaking at a Right to Life rally in January, Vitter boasted that

his amendment put “clear, strong, pro-life language in that Indian

healthcare bill.”

In fact, the amendment mostly replicates an

older, more general ban on abortion funding under federal health

programs, known as the Hyde Amendment. IHS is already subject to those

restrictions, which allow federal financing for abortion only in cases

of rape, incest or endangerment of the pregnant woman’s life.

Still,

Vitter’s initiative entrenches Hyde’s strictures more firmly by

directly changing IHS’s long-term governing statute. Enacted in the

late 1970s, Hyde is subject to annual revision when renewed through the

appropriations process. It mainly applies to Medicaid, but

anti-abortion groups have lobbied to expand its reach in other areas,

such as the military and federal prison health systems.

Opponents

say Vitter has tethered crucial health programs to an anti-abortion

agenda and brazenly targeted Native women’s reproductive rights.

“It’s

a race-based amendment, because it’s trying to reduce our right to

access abortion more than any other race of women in this country,”

says Charon Asetoyer of the Native American Women’s Health Education

Resource Center (NAWHERC), a research and advocacy organization.

Critics

point to slight differences in the wording of the Vitter amendment that

could tighten existing restrictions – for instance, the limitation of

the incest exception to women under 18.

Although some states

offer separate funding for abortions deemed medically necessary for

overall health, Hyde has generally succeeded in raising barriers to

abortion for poor women. By making abortion prohibitively costly, the

funding restrictions have historically led many women to have abortions

later, at greater medical risk, or not at all, according to a study by

the Guttmacher Institute, a reproductive-health policy group.

The

consequences of abortion funding restrictions are uniquely dire in

Native communities, where women are disproportionately poor, more

likely to be sexually assaulted, and acutely limited in their options

for dealing with unplanned pregnancy.

“Native women are so much

more vulnerable on so many levels,” says Sarah Deer, a Minnesota-based

victim advocacy legal specialist with the Tribal Law & Policy

Institute, “from health problems, to being victims of violence, to

housing. We’re the ones suffering the most on a lot of different

issues.”

According to research by NAWHERC, IHS facilities

performed only a handful of abortions over a two-decade period. But the

Center has also found that IHS staff routinely failed to properly

enforce the Hyde Amendment’s protections for assault survivors.

Meanwhile, state health records indicate that Native women in North and

South Dakota and Alaska are over-represented among abortion cases

compared to their overall state populations, suggesting that many are

resorting to private abortion providers.

This isn’t the first

time the abortion issue has ensnared Indian Country. In South Dakota,

which has an especially high Native population, Asetoyer and other

activists campaigned successfully in 2006 against a proposal for a

statewide ban on abortions. A similar initiative is up for a referendum

vote this November.

But since the Vitter amendment would not

dramatically change current abortion policies at IHS, the bigger

concern is that it will sink the Native health bill altogether, killing

prospects for a much needed funding infusion.That would still be a

victory for Vitter, who voted against the bill even with his amendment.

To

Kitty Marx, legislative director of the National Indian Health Board,

an advocacy group representing Native communities, the health of nearly

2 million American Indians and Alaskan Natives is being subsumed in a

political proxy battle.

“[This] is an Indian healthcare bill –

written by Indians for Indians,” she says. “If Congress wants to have a

national debate on abortion, then have it on a national bill.”

Asetoyer

says Vitter’s initiative creates a cruel dilemma for activists focused

on the intersection between reproductive rights and Native health

issues. She continues to support the bill despite the amendment: “We

just may have to eat this one, because we cannot use this to stop the

bill from going through. Otherwise, we’d end up with no healthcare at

all.”