By Stephanie Siek, CNN
(CNN) – In most of the United States, a woman 17 years or older who needs Plan B, an emergency contraceptive that can prevent pregnancy up to 72 hours after intercourse, can walk up to a pharmacy counter and request it without a prescription. But for Native American women served by the Indian Health Service, obtaining Plan B might require a drive of hundreds of miles, a wait beyond the pill’s window of effectiveness, and a price beyond what the IHS would charge.
According to a recent report by the Native American Women's Health Education Resource Center (NAWHERC), Native American women living on reservations can face significant barriers when trying to access emergency contraception.
NAWHERC's executive director and co-author of the report, Charon Asetoyer, said that the Indian Health Service, which is administered under the federal Department of Health and Human Services, is not consistently applying its own rules regarding over-the-counter access to Plan B.
According to the roundtable of 50 community workers, women’s advocates and Native American women from South Dakota, Oklahoma, New Mexico and Arizona surveyed by the report, almost all IHS facilities they dealt with require women to see a doctor or get a prescription in order to get Plan B. The medicine is offered without additional cost at IHS pharmacies, but not all pharmacies stock it.
But if a woman happens to need the medication outside of business hours or on the weekend, she has to wait until the facility reopens – which could be up to several days. If she can't wait, she has to try and get it at a non-IHS pharmacy. And she has to pay the full over-the-counter price – which can be a discouraging factor for a population that experiences higher-than-average rates of poverty and unemployment.
"If we want it, we have to leave the reservation, drive to the nearest large city or town that has it, and purchase it for $50," said Asetoyer. "If you’re familiar with the size of some reservations, if you're in the interior, the trip to the nearest pharmacy where they carry it could be 100 miles. So, one, you have to have a car or hire someone to drive you, two, you have to have the time to access it, three you have to have the money to access it. And in small town South Dakota (where the NAWHERC is located), there are some pharmacies that because of what they believe do not have to carry it. So you may have to go even farther, to the nearest large town."
NAWHERC's 2009 survey of IHS pharmacists found that only 10% had Plan B available over the counter, 37.5% offered an older, alternative form of emergency contraception, and the others had no forms of emergency contraception available. Local pharmacy committees had neglected to include Plan B on their lists of approved drugs, some medical staff had simply decided it was unnecessary, and some pharmacies stocked only the older method, which involves several high doses of birth control pills.
Asked about the availability of emergency contraception, the IHS said it required facilities to stock a designated emergency birth control method and have it both over the counter and by prescription.
"IHS is in the process of standardizing our procedures to ensure patients have access to the medicines they need," the IHS said in an e-mailed statement.
Adding to the urgency of the matter is that many women seeking Plan B need it because they have been raped. According to U.S. Department of Justice statistics, one in three Native women will be raped in her lifetime – a figure that’s higher than for any other race. Three in five will be physically assaulted.
Many Native American women are unaware of Plan B's existence, and the information about it isn't always offered proactively, said Maya Torralba, founder and director of the Anadarko Community Esteem Project, which counsels teenage girls in Anadarko, Okla.
"I didn't even know about Plan B until I did this roundtable," said Torralba, a member of the Kiowa, Comanche and Wichita tribes. "I didn't know that was an option, or that we had access to it, and here I am an advocate for young women. Now that I do know this, I am trying to make sure that women are aware of it."
Another problem is that some women were confusing Plan B with RU-486, a prescription pill used to induce an abortion. Both religious leaders and medical staff had sometimes spread misinformation about how Plan B worked, or refused to supply it because it was against their beliefs.
"We have had rape victims given prescriptions to get (emergency contraception), but at IHS they wouldn't administer it, because the Pharmacy Director and her staff didn’t believe in it," said one participant in the roundtable, Lisa Thompson-Heth. Thompson-Heth is a member of the Lower Brule Sioux Tribe in South Dakota.
Micha Bitsinnie, a Native American community health worker for First Nations Community Health Source in Albuquerque, N.M., said that her own experience with trying to get Plan B was less than pleasant.
"I just had a baby girl who's 8 months. And my husband and I weren't ready for another child. And at the time we were really short on money, so I didn’t want to pay the $50 at Walgreens and went to the IHS for a prescription," said Bitsinnie. "When I got there, it was like, 'Why aren't you using condoms, why aren't you taking the pill, why aren't you being more careful?' They put all the blame on me... I was on the pill, but I wanted to be extra sure because we weren't ready for another child."
Now, Bitsinnie said, imagine facing those kind of questions fresh from the trauma of a rape, or sexual abuse, or a beating from an abusive partner.
"The ladies I work with, as it is, they don't trust anybody; they don't want to answer to anybody; they're abused enough," said Bitsinnie. "It’s hard for them to look somebody in the eye and say why they need it. That guilt, that shame, is still there."