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 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 

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 Washington, Ms. LEE of California, Mr. LUJA ́N, Ms. MCCOLLUM, Ms. MOORE, 

Mrs. NAPOLITANO, Mr. O’HALLERAN, Ms. OCASIO-CORTEZ, Ms. ROYBALALLARD, 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 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, highVerDate Sep 11 2014 21:45 Nov 26, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\HR735.IH HR735

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•HRES 735 IH 

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 


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•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 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 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 

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•HRES 735 IH 

vided 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 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 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 and Alaska Natives 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 


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American Indian and Alaska Native women at IHS, 

UIOs, and non-IHS facilities: Now, therefore, be it 

1 Resolved, That the House of Representatives— 

2 (1) acknowledges the unacceptable maternal 

3 health crisis that indigenous women disproportion4 ately experience resulting in the exceedingly high 

5 rates of maternal mortality and morbidity in the 

6 United States; 

7 (2) calls for urgent Federal funding increases 

8 for the Indian Health Service (IHS), Tribally Oper9 ated Health Centers, Urban Indian Organizations, 

10 and Native Hawaiian health care programs to en11 sure American Indians, Alaska Natives, and Native 

12 Hawaiians have access to comprehensive, high-qual13 ity, and culturally competent maternal health, pre14 natal care, and comprehensive family planning serv15 ices; 

16 (3) recognizes the Federal Government’s failure 

17 to uphold Tribal treaty rights as it pertains to pro18 viding adequate health care services to American In19 dians and Alaska Natives; and 

20 (4) calls upon the Department of Health and 

21 Human Services, IHS, and the Health Resources 

22 and Services Administration (HRSA) to prioritize 

23 policy for American Indian, Alaska Native, and Na24 tive Hawaiian women to reduce long-standing and 


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•HRES 735 IH 

1 well-known barriers to access culturally competent 

2 maternal health and comprehensive family planning 

3 services. 

Æ 


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