‘Uncomfortable’ but necessary conversations: How AZ abortion laws affect Indigenous women

Indivisible Tohono Cofounder April Ignacio (right), Tohono O’odham Nation Health Care Chief Medical Officer Dr. William Mills Chief (center), and Tohono O’odham Assistant Attorney General Rebecca Cohen talk about how Arizona abortion bans may impact Indigenous women on the Tohono O’odham Nation during a community forum held on April 25, 2024. Photo by Shondiin Silversmith | Arizona Mirror

April Ignacio wanted to be able to create a safe space for people in her community to come together and get information about the laws in Arizona that are impacting Indigenous women’s bodily autonomy, especially after the Arizona Supreme Court ruled that a near-total abortion ban from 1864 could once again be enforced.

“Health care is being weaponized against women, and as an Indigenous woman, I know how unfair health care access is already, and then my bodily autonomy is now being impacted by the government,” Ignacio said.

Ignacio is the co-founder of Indivisible Tohono, a grassroots group that organizes and educates on issues impacting the Tohono O’odham Nation. 

When the near-total abortion ban was upheld, Ignacio said their group wanted to provide much-needed resources to people living on the Tohono O’odham Nation. 

“It’s important that our people feel like they know enough about an issue that they can make their own assessment on what they stand for,” Ignacio said. 

Ignacio is Tohono O’odham and lives on the reservation. She understands that not many people within Indigenous communities hold these types of public discussions surrounding reproductive health care for Indigenous women.

“We recognize that it’s a very uncomfortable topic,” she said, explaining that’s why Indigenous people must have access to safe spaces to talk about health care access, including the most intimate and private discussions on something like abortion.

“Even though those are uncomfortable conversations, we still need to have them,” Ignacio said.  The result was Indivisible Tohono hosting a community forum to discuss how Arizona’s abortion ban would impact Indigenous women on the Tohono O’odham Nation.

During the panel, Ignacio touched on how Indigenous people have a uniquely fraught history with Western health care, which oftentimes means accessing it becomes an afterthought for Indigenous people. 

For instance, she said, Indigenous women in the 1960s and 1970s were forcibly sterilized by Indian Health Service hospitals and Phoenix Indian Medical Center was one of the facilities that participated in the sterilizations. 

“We have medical centers who have admitted that they perpetuated this forced sterilization on Native women without their consent and their knowledge,” Ignacio said. It is one of those topics that is rarely discussed in a public and open setting.

A 1976 report from the U.S. Government Accountability Office identified that IHS records show that 3,406 sterilization procedures were performed on Indigenous women in four facilities, including Phoenix, from 1973 to 1976.

And now, reproductive health care is being determined by state lawmakers. 

“These laws do affect our potential to live the life we want, and I think that’s the frustrating part for a lot of women who don’t or have very little access to reproductive health services,” she added.

The community forum, held at the Tohono O’odham council chambers on April 25, featured a discussion with Ignacio, Tohono O’odham Assistant Attorney General Rebecca Cohen and Tohono O’odham Nation Health Care Chief Medical Officer Dr. William Mills Chief.

Ignacio said hosting a public discussion on abortion and how it may impact the women on the Tohono O’odham Nation is the first of its kind for the tribe. 

When planning the community forum, Indivisible Tohono understood how sensitive the topic could be. Ignacio said that if five people showed up, those five people could impact the way others feel or maybe talk about health care.

Ultimately, more than a dozen people showed up to listen to the discussion and ask questions about abortion rights and healthcare access.

Arizona has been at the center of abortion debates when the Arizona Supreme Court ruled to make abortion virtually entirely illegal in early April by reinstating a 160-year-old law that forbids all procedures except those to save a woman’s life.

The Arizona Senate repealed the law on May 1, over the objections of all but two Republicans, and the repeal was quickly signed into law on May 2 by Gov. Katie Hobbs.

But that does not remove other restrictions on abortions in Arizona. Even with the repeal of the Civil War-era ban, there is a 2022 law banning abortions after 15 weeks that will be the law of the land once the repeal is implemented. 

That law prohibits abortions beyond its gestational deadline unless a woman faces permanent injury or life-threatening medical complications. Doctors who violate its provisions are subject to a class 6 felony and revoked licenses. There are no exceptions for rape or incest.

The 1864 law is now set to be repealed, but that won’t officially happen until 90 days after the legislature’s annual session ends. That means the repeal likely won’t go into effect until months after the Supreme Court ruled the near-total ban can be enforced on June 27. 

“We recognize that the power in this country is at the ballot box,” Ignacio said, and the forum was an opportunity for Indivisible Tohono to ensure their people stay civically engaged.

Jessica Miguel, from New Fields, on the Tohono O’odham Nation, attended the community forum because she has been following the news surrounding the abortion ban and wanted to learn more about how it would impact women living on the reservation because she has two young daughters.

Miguel said their family gets all their services from Tohono O’odham Health Care facilities, and the discussion at the forum informed her that having the ban in effect in Arizona does not drastically impact her or her daughters living on the Tohono O’odham Nation.

Cohen said that the Tohono O’odham Nation has not taken a position on the issue. However, she has done research within the tribal court system and found one case that can put into context how the tribe stands on unborn children. 

She said that the case is not about abortion. In the 1999 case, Tohono O’odham Nation vs. Reseda Pancho, the Tohono O’odham Nation Judicial Court decided on the status of an unborn child — and ruled fetuses have the same rights as people.

Cohen said the information is minimal, but the court findings from that case have a legal holding on the Tohono O’odham Nation.

Reading from the case, Cohen said that in O’odham’s oratory history, pregnant women are cautioned against being around certain situations.

Details on what type of situations were not provided, but Cohen said caution against those situations is to prevent harm or suffering to the child once the child is born, and because of that, the court ruled that an unborn child is a person.

“The law in the Tohono O’odham Nations courts right now, because of this 1999 decision, is that unborn children have personhood, according to the court,” Cohen said. “I can’t speculate beyond that about how that would be interpreted in the context of abortion.”

Cohen said that even though these abortion bans apply to all women in Arizona, there is still a disproportionate impact on Indigenous women who live off the reservation. Some 70% of Tohono O’odham people live off the reservation.

“Indigenous women are disproportionately impacted and will be, continue to be, disproportionately impacted by this ban,” Cohen said, because Indigenous women, in general, face more restrictions, obstacles, and hurdles when it comes to getting reproductive health care.

A majority of Indigenous women living on or off tribal land rely on Indian Health Services (IHS) for care, which is a federally funded service. 

IHS does not manage the Tohono O’odham Health Care facilities. Instead, the tribe has a contract with the IHS, in which the tribe oversees health services for its citizens and any funding received by the hospitals. 

Federal funding can not be used to pay for abortion services unless a pregnancy is a result of rape, incest, or it endangers the life of the person.

Chief said the bans are not a huge concern for the healthcare facilities in the Tohono O’odham nation because they do not do any abortions.

“We have to send them off the nation to do that, and the moment they cross off the nation, they’re subject to everything that the State of Arizona says,” he said. “So, we’re kind of stuck that way.”

Chief said there are several methods the Tohono O’odham Nation recommends for prevention, including contraceptive prescriptions, which include IUDs, birth control, and Plan B.

Indigenous women who seek health care at any federally funded IHS facility, whether on tribal land or not, have minimal options when it comes to abortion services, especially in Arizona. 

Even if they get referred to a different health care provider in Arizona, the bans are almost certain to make it harder and require them to go to another state with few restrictions, like California or New Mexico, adding more unnecessary burdens to the individual. 

Even though it may not change how they access health care, Miguel said she is grateful for Ignacio bringing this conversation to the community because she understands how difficult it is.

“It is a hard conversation to have, and I am sure people have questions but don’t know how to bring them to the forefront,” she added.

Miguel said she hopes more tribes will follow suit and provide a space for their people to have these difficult discussions so they won’t be seen as taboo.

Ignacio said it may be difficult for Indigenous communities to have these conversations publicly because few people want to organize them and ensure that their people have the most up-to-date information. 

“There aren’t very many platforms to be given to people in our community to openly talk about these topics,” she added, and it’s essential to have a space where people do not feel judged for talking about reproductive health care and whatever that looks like.

Having over a dozen people attend the forum was a really good feeling for Ignacio. She said it indicates that people are interested in these conversations, topics, and ideas. I

“We have to do a better job of creating safe spaces to have these difficult conversations, especially if these decisions are being made for us,” she added.

Sunshine Hendricks appreciated the space to talk about these issues close to home. 

“It’s just really important that we start getting comfortable talking about these issues because, as we can see, they’re becoming more and more apparent,” Hendricks said. 

Hendricks, 27, is Tohono O’odham and lives in Sells on tribal land. She said she hopes to share the information she learned from the forum with people in her life. 

“It’s really important for the conversations to continue outside of here,” she added, and she hopes that with the information she shares, they’ll be able to “form their own opinions and come to their own conclusions from what I’ve given them.”

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