•HRES 846 IH 
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 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 the Native Hawaiian Health Care Act of 1988 rec-
ognizes the special responsibilities and legal obligations to 
Native Hawaiians resulting from the unique history be-
tween the United States and Native Hawaiians; 
Whereas Native Hawaiians receive health care services, in 
partial fulfillment of the Federal Government’s trust re-
sponsibility 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, 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-
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•HRES 846 IH 
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-
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 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 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, Alaska Na-
tives, and Native Hawaiians continues to play a con-
sequential role in their health care experiences and out-
comes; 
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•HRES 846 IH 
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 
American Indian, Alaska Native, and Native Hawaiian 
women at IHS, UIOs, non-IHS facilities, and Native Ha-
waiian health care systems: Now, therefore, be it 
Resolved, That the House of Representatives— 
(1) acknowledges the unacceptable maternal 
health crisis that indigenous women disproportion-
ately 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 Oper-
ated Health Centers, Urban Indian Organizations, 
and Native Hawaiian health care programs to en-
sure American Indians, Alaska Natives, and Native 
Hawaiians have access to comprehensive, high-qual-
ity, and culturally competent maternal health, pre-
natal care, and comprehensive family planning serv-
ices; 
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•HRES 846 IH 
(3) recognizes the Federal Government’s failure 
to uphold Tribal treaty rights as it pertains to pro-
viding adequate health care services to American In-
dians 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 Na-
tive Hawaiian women to reduce long-standing and 
well-known barriers to access culturally competent 
maternal health and comprehensive family planning 
services. 
Æ 
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