[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H. Res. 846 Introduced in House (IH)]

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117th CONGRESS
  1st Session
H. RES. 846

 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.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 13, 2021

    Ms. Craig (for herself, Mr. Aguilar, Ms. Davids of Kansas, Mr. 
 Grijalva, Mrs. Kirkpatrick, Ms. McCollum, Mr. O'Halleran, Ms. Roybal-
    Allard, Ms. Underwood, and Mr. Kahele) 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 within 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, 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.

Whereas American Indian, Alaska Native, and Native Hawaiian women in the United 
        States suffer from life-threatening pregnancy complications, known as 
        ``severe maternal 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 Hawaiian 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 developing complications;
Whereas the rate of poverty among American Indian and Alaska Native women is 
        nearly double the national average for all people;
Whereas the Federal Government is required to provide health care services to 
        American Indians and Alaska Natives 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 decisions, 
        Federal legislation, Executive orders, and Federal regulations;
Whereas the aforementioned body of authority makes up the foundation of Federal 
        Indian law and explicitly defines the Federal trust responsibility owed 
        American Indians, Alaska Natives, and Native Hawaiians based on their 
        political status;
Whereas Federal Indian law makes clear that Indian Tribes, American Indians, 
        Alaska Natives, and Native Hawaiians 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 Government's trust responsibility to 
        the Indian Tribes, through health programs administered through the 
        Indian Health Service (IHS) and Tribes and Urban Indian Organizations 
        (UIOs), collectively known as the ``ITU'' or ``IHS/Tribal/Urban'';
Whereas the Native Hawaiian Health Care Act of 1988 recognizes the special 
        responsibilities and legal obligations to Native Hawaiians resulting 
        from the unique history between the United States and Native Hawaiians;
Whereas Native Hawaiians receive health care services, in partial fulfillment of 
        the Federal Government's trust responsibility to the Native Hawaiian 
        community, through health programs administered through Papa Ola Lokahi 
        and the Native Hawaiian health care systems;
Whereas indigenous women benefit from increased resources and access to 
        community-based health care facilities, including indigenous midwives, 
        doulas, and birth centers;
Whereas the IHS, as part of the Department of Health and Human Services, 
        operates health care facilities and administers and provides funding to 
        health programs, including ITU facilities for American Indians and 
        Alaska Natives, but remains severely underfunded and lacks resources to 
        provide adequate health care services for American Indian and Alaska 
        Native women that are culturally competent, including prenatal care, 
        labor and delivery 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 services 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 provided through IHS is inequitable and 
        unequal with Federal 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 2019, IHS health care expenditures per person were $4,078, compared 
        to $9,726 for Federal health care spending nationwide;
Whereas historical trauma and gender oppression, coupled with the social 
        determinants of health inequities experienced by indigenous women in the 
        United States, is further 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 discrimination perpetuated 
        by the Federal Government's failure to uphold the trust responsibility 
        by adequately funding health care services for American Indians, Alaska 
        Natives, and Native Hawaiians 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 reproductive health care services and 
        maternal health programming, 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 American Indian, Alaska Native, and Native Hawaiian women 
        at IHS, UIOs, non-IHS facilities, and Native Hawaiian health care 
        systems: Now, therefore, be it
    Resolved, That the House of Representatives--
            (1) acknowledges the unacceptable maternal health crisis 
        that indigenous women disproportionately experience resulting 
        in the exceedingly high rates of maternal mortality and 
        morbidity in the United States;
            (2) calls for urgent Federal funding increases for the 
        Indian Health Service (IHS), Tribally Operated Health Centers, 
        Urban Indian Organizations, and Native Hawaiian health care 
        programs to ensure American Indians, Alaska Natives, and Native 
        Hawaiians have access to comprehensive, high-quality, and 
        culturally competent maternal health, prenatal care, and 
        comprehensive family planning services;
            (3) recognizes the Federal Government's failure to uphold 
        Tribal treaty rights as it pertains to providing adequate 
        health care services to American Indians and Alaska Natives; 
        and
            (4) calls upon the Department of Health and Human Services, 
        IHS, and the Health Resources and Services Administration 
        (HRSA) to prioritize policy for American Indian, Alaska Native, 
        and Native Hawaiian women to reduce long-standing and well-
        known barriers to access culturally competent maternal health 
        and comprehensive family planning services.
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