WITHDRAWN: Reproductive Justice and Barriers to Achieving Reproductive Desires for an Indigenous Gulf Coast Tribe

Background and Purpose:

Reproductive justice is increasingly being utilized as a framework for exploring women’s reproductive health experiences. However, it has infrequently been used to explore barriers related to achieving the reproductive goals of Indigenous women, who are particularly vulnerable to reproductive oppression, and who experience extensive maternal and infant health disparities. Although the sterilization of Indigenous women by the Indian Health Service (IHS) has been well-documented, this topic has not yet been explored among state-recognized tribes who do not utilize the IHS, and little research explores what other factors impact women’s ability to reach their reproductive goals.

Methods:

A qualitative descriptive research methodology, which is culturally congruent with conducting research with Indigenous groups, was used. The PI worked with a community advisory board (CAB) made up of tribal members to ensure the project was culturally appropriate and to explore how to make the end product of the research beneficial for the health of the tribal community. Data were collected through qualitative semi-structured life-history interviews with female tribal members who self-identified as members of the tribe and who were over the age of 18. Interviews were conducted in interviewee homes and at tribal community centers. Women were recruited through the use of fliers, word-of-mouth and snow-ball sampling. Interviews were recorded and took between 1-1 1/2 hours and were then transcribed verbatim and analyzed with NVivo software.

Results:

Several key themes emerged illustrating barriers related to women achieving their reproductive desires. These included: (a) High Prevalence of Hysterectomy or Sterilization; (b) Experiences with Infertility Common; (c); High Frequency of Polycystic Ovary Syndrome (PCOS) or Endometriosis; and (d) Desired Family Size. Findings of this study reveal that central components of reproductive justice, including the ability to have children, are currently being undermined for the Indigenous women in this study. Women discussed their desire for having or not having children, the number of children they hoped for, and challenges in getting and staying pregnant. Some women felt their hysterectomies could have been prevented and expressed regret at not having more children. Several women described struggling with infertility at some point in their life, and although some were able to get medical support, it was usually not covered by insurance. Having a diagnosis of either PCOS or endometriosis was common, and women reported difficulty in getting a diagnosis and adequate treatment. Although the number of children women had, and wanted, varied greatly, women tended to report wanting more children than they had.

Conclusions and Implications:

This study is unique in exploring the family planning desires and goals, and the barriers experienced in achieving these reproductive desires, for women in a Gulf Coast, and a non-federally recognized, Indigenous tribe. Consistent with national literature, women reported experiencing reproductive oppression, such as high rates of sterilizations and hysterectomies, untreated and undiagnosed PCOS and endometriosis, and difficulty in getting treatment for infertility. These results contextualize these national trends and suggest that Indigenous women in this study experience reproductive injustices that harm their ability to achieve their reproductive desires.