There is a lack of reproductive health care and accessibility for women on the Crow Reservation, and it’s hard for women to access the resources that are available, according to a report from the Kaiser Family Foundation published Thursday.

On the Crow Reservation medical resources specific to reproductive health care are stretched thin, the report found. Researchers identified the Crow Reservation as one of five “medically underserved” communities because of its rural location, shortage of medical providers, a “declining number of family planning providers,” and high rates of teen pregnancy.

Other places studied were Tulare County, California; Selma, Alabama; Erie, Pennsylvania; and St. Louis.

The study sought to understand how nationwide policy changes and debates may limit access to future reproductive and sexual health services at local levels. 

Montana’s largest reservation by land mass has three sites in the IHS service unit: the Crow-Northern Cheyenne Hospital in Crow Agency, the Lodge Grass Health Clinic and Pryor Health Station.

All three offer onsite STI testing and treatments and insertion of implanted birth controls and IUDs. Abortion or sterilization are not provided in any of the three locations — requiring women to travel to Billings to seek out those procedures.

But, for the population of about 3,600 women on the reservation, there is only one OB-GYN and one midwife.

Additionally, the hospital cannot provide labor and delivery services, so women are referred to hospitals in Billings after 30 weeks gestation.

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It can be challenging to keep up with appointments for women who lack reliable transportation, especially if referred to Billings, the report states.

Another concern among women interviewed during the study was a lack of confidentiality and trust in health care providers. Confidentiality was especially concerning for those seeking STI treatment or tests, or family planning services in the rural community.

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But, the Crow-Northern Cheyenne Hospital is working to bring more resources to the reservation, according to Brocade Stops Black Eagle, a maternal child care coordinator at the hospital. Stops Black Eagle spoke during a presentation Thursday in Washington, D.C.

“We are currently trying to reopen the labor and delivery center,” Stops Black Eagle Said. “(IHS) has bought all new equipment, and remodeled all the birthing centers.”

The hospital is also trying to hire and retain additional OB-GYNs and nurses, she said. According to the report, IHS is in the process of building employee housing across the service unit to attract medical professionals. Calls to the hospital to confirm those plans were not returned Friday.

This year the IHS also partnered with RiverStone Health to host a women’s health fair, and offered staff training in trauma-informed care.

Cultural barriers to seeking care, like a stigma toward contraceptives or a lack of open sex education, is also declining on the reservation, said Stops Black Eagle. 

“We’re making some pretty big strides,” Stops Black Eagle said.