Recognizing the maternal health crisis among indigenous women in the United States, which includes American Indian, Alaska Native, and Native Hawaiian women, recognizing the importance of reducing mortality and morbidity among indigenous women, and calling for urgent Federal funding changes to ensure comprehensive, high-quality, and culturally competent maternal health and family planning services are available.

IV 116TH CONGRESS 1ST SESSION H. RES. 735 Recognizing the maternal health crisis among indigenous women in the United States, which includes American Indian, Alaska Native, and Native Ha- waiian women, recognizing the importance of reducing mortality and morbidity among indigenous women, and calling for urgent Federal fund- ing changes to ensure comprehensive, high-quality, and culturally com- petent maternal health and family planning services are available. IN THE HOUSE OF REPRESENTATIVES NOVEMBER 26, 2019 Ms. HAALAND (for herself, Ms. ADAMS, Mr. AGUILAR, Mr. COLE, Ms. DAVIDS of Kansas, Ms. ESCOBAR, Mr. ESPAILLAT, Ms. GABBARD, Mr. GALLEGO, Mr. GRIJALVA, Ms. NORTON, Mrs. KIRKPATRICK, Mr. LARSEN of Wash- ington, Ms. LEE of California, Mr. LUJA´N, Ms. MCCOLLUM, Ms. MOORE, Mrs. NAPOLITANO, Mr. O’HALLERAN, Ms. OCASIO-CORTEZ, Ms. ROYBAL- ALLARD, Mr. SMITH of Washington, Ms. SPEIER, Ms. TLAIB, and Ms. UNDERWOOD) submitted the following resolution; which was referred to the Committee on Natural Resources, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall with- in the jurisdiction of the committee concerned RESOLUTION Recognizing the maternal health crisis among indigenous women in the United States, which includes American Indian, Alaska Native, and Native Hawaiian women, rec- ognizing the importance of reducing mortality and mor- bidity among indigenous women, and calling for urgent Federal funding changes to ensure comprehensive, high- VerDate Sep 11 2014 21:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\HR735.IH HR735 pamtmann on DSKBC07HB2PROD with BILLS 2 •HRES 735 IH quality, and culturally competent maternal health and family planning services are available. Whereas American Indian, Alaska Native, and Native Hawai- ian women in the United States suffer from life-threat- ening pregnancy complications, known as ‘‘severe mater- nal morbidities’’, twice as often as non-Hispanic White women; Whereas American Indian and Alaska Native women in the United States are more than twice as likely to die from pregnancy-related causes as non-Hispanic White women; Whereas American Indian, Alaska Native, and Native Hawai- ian women are more than twice as likely to receive late or no prenatal care compared to non-Hispanic White women; Whereas American Indian and Alaska Native women in the United States experience high rates of births by Cesarean section which exposes them to additional risk of devel- oping complications; Whereas the rate of poverty among American Indian and Alaska Native women is nearly double the national aver- age for all people; Whereas the Federal Government is required to provide health care services to American Indians and Alaska Na- tives as a result of promises made in hundreds of treaties with the Indian Tribes, authorized by the Constitution, and reaffirmed by United States Supreme Court deci- sions, Federal legislation, Executive orders, and Federal regulations; Whereas the aforementioned body of authority makes up the foundation of Federal Indian law and explicitly defines VerDate Sep 11 2014 21:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6300 E:\BILLS\HR735.IH HR735 pamtmann on DSKBC07HB2PROD with BILLS 3 •HRES 735 IH the Federal trust responsibility owed American Indians and Alaska Natives based on their political status; Whereas Federal Indian law makes clear that Indian Tribes, American Indians, and Alaska Natives hold a political status, and are not a racial group; Whereas American Indians and Alaska Natives receive health care services, in partial fulfilment of the Federal Govern- ment’s trust responsibility to the Indian Tribes, through health programs administered through the Indian Health Service (IHS) and Tribes and Urban Indian Organiza- tions (UIOs), collectively known as the ‘‘ITU’’ or ‘‘IHS/ Tribal/Urban’’; Whereas indigenous women benefit from increased resources and access to community-based health care facilities, in- cluding indigenous midwives, doulas, and birth centers; Whereas the IHS, as part of the Department of Health and Human Services, operates health care facilities and ad- ministers and provides funding to health programs, in- cluding ITU facilities for American Indians and Alaska Natives, but remains severely underfunded and lacks re- sources to provide adequate health care services for American Indian and Alaska Native women that are cul- turally competent, including prenatal care, labor and de- livery services, and a full range of culturally informed family planning services; Whereas the lack of funding and resources at IHS severely limits the ability of the ITU to provide health care serv- ices and administer health programs to American Indians and Alaska Natives; Whereas the United States Commission on Civil Rights found that American Indian and Alaska Native health care pro- VerDate Sep 11 2014 21:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6300 E:\BILLS\HR735.IH HR735 pamtmann on DSKBC07HB2PROD with BILLS 4 •HRES 735 IH vided through IHS is inequitable and unequal with Fed- eral expenditures per capita that remain well below other Federal health care programs and only cover a fraction of the health care needs for American Indians and Alaska Natives; Whereas, in 2017, IHS health care expenditures per person were $3,332, compared to $9,207 for Federal health care spending nationwide; Whereas historical trauma and gender oppression, coupled with the social determinants of health inequities experi- enced by indigenous women in the United States, is fur- ther perpetuated by severe underfunding of ITU facilities that continue to contribute to the disproportionately high rates of American Indian and Alaska Native maternal mortality and morbidity rates; Whereas culturally inadequate and institutionalized discrimi- nation perpetuated by the Federal Government’s failure to uphold the trust responsibility by adequately funding health care services for American Indians and Alaska Na- tives continues to play a consequential role in their health care experiences and outcomes; Whereas fully funding the Federal Government’s trust and treaty health care responsibilities, especially for reproduc- tive health care services and maternal health program- ming, is critical to closing the maternal health disparity gap when receiving care at ITU facilities, and health services for indigenous women generally; and Whereas culturally competent models for women’s health services are needed to provide appropriate maternal health, family planning, and child health services for VerDate Sep 11 2014 21:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6300 E:\BILLS\HR735.IH HR735 pamtmann on DSKBC07HB2PROD with BILLS 5 •HRES 735 IH American Indian and Alaska Native women at IHS, UIOs, and non-IHS facilities: Now, therefore, be it Resolved, That the House of Representatives— 1 (1) acknowledges the unacceptable maternal 2 health crisis that indigenous women disproportion- 3 ately experience resulting in the exceedingly high 4 rates of maternal mortality and morbidity in the 5 United States; 6 (2) calls for urgent Federal funding increases 7 for the Indian Health Service (IHS), Tribally Oper- 8 ated Health Centers, Urban Indian Organizations, 9 and Native Hawaiian health care programs to en- 10 sure American Indians, Alaska Natives, and Native 11 Hawaiians have access to comprehensive, high-qual- 12 ity, and culturally competent maternal health, pre- 13 natal care, and comprehensive family planning serv- 14 ices; 15 (3) recognizes the Federal Government’s failure 16 to uphold Tribal treaty rights as it pertains to pro- 17 viding adequate health care services to American In- 18 dians and Alaska Natives; and 19 (4) calls upon the Department of Health and 20 Human Services, IHS, and the Health Resources 21 and Services Administration (HRSA) to prioritize 22 policy for American Indian, Alaska Native, and Na- 23 tive Hawaiian women to reduce long-standing and 24 VerDate Sep 11 2014 21:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\HR735.IH HR735 pamtmann on DSKBC07HB2PROD with BILLS 6 •HRES 735 IH well-known barriers to access culturally competent 1 maternal health and comprehensive family planning 2 services. 3 Æ VerDate Sep 11 2014 21:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\HR735.IH HR735 pamtmann on DSKBC07HB2PROD with BILLS