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 Ha-
waiian women, recognizing the importance of reducing mortality and 
morbidity among indigenous women, and calling for urgent Federal fund-
ing changes to ensure comprehensive, high-quality, and culturally com-
petent 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 Wash-
ington, Ms. LEE of California, Mr. LUJA´N, Ms. MCCOLLUM, Ms. MOORE, 
Mrs. NAPOLITANO, Mr. O’HALLERAN, Ms. OCASIO-CORTEZ, Ms. ROYBAL- 
ALLARD, 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 with-
in 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, rec-
ognizing the importance of reducing mortality and mor-
bidity among indigenous women, and calling for urgent 
Federal funding changes to ensure comprehensive, high- 
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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 Hawai-
ian women in the United States suffer from life-threat-
ening pregnancy complications, known as ‘‘severe mater-
nal 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 Hawai-
ian 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 devel-
oping complications; 
Whereas the rate of poverty among American Indian and 
Alaska Native women is nearly double the national aver-
age for all people; 
Whereas the Federal Government is required to provide 
health care services to American Indians and Alaska Na-
tives 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 deci-
sions, 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 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 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-
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-
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•HRES 735 IH 
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 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 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 and Alaska Na-
tives 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 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 
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