The blog of the Urban Institute
May 30, 2014

The barriers American Indian women face in accessing sexual assault exams and services

May 30, 2014

Among American women of all races, American Indian women report the highest rates of sexual violence. According to the Department of Justice, one in three are raped during their lifetime—more than double the rate of American women across all racial groups.

Although a significant number of American Indian women have experienced sexual assault, American Indian victims face a number of unique challenges after the sexual assault has taken place. These go beyond who pays for the sexual assault medical forensic exam, and include accessing the exam, acquiring medical services, and receiving an adequate response from the criminal justice system.

Here’s what our research revealed:

  • Tribal jurisdictions don’t have access to trained Sexual Assault Nurse Examiners (SANEs).  For American Indian women, getting access to critical 24-hour emergency services, health clinics, and trained SANEs can be difficult. In one state, we visited multiple tribal reservations and found that only one reservation had a SANE. Even when cases were forwarded to Indian Health Services, facilities lacked these practitioners. As a consequence, victims had to travel off the reservation in order to receive an exam, which presents additional challenges. Victims may not have access to transportation, or familiarity with—or trust in—the local non-Native community. They may not even be aware that free exams and victim services are available to them.
  • Some American Indian victims don’t seek services due to past experiences with racism. All of the direct services providers we spoke with that worked with Native American communities reported witnessing racism from other providers when working with American Indian victims. They described a 911 call that went unanswered by the local counties that had jurisdiction over the tribe, a SANE who told a woman who came to the hospital that it wasn’t a “pill shop,” and several examples of law enforcement agencies’ differential treatment of American Indian victims. Service providers reported that victims are rarely believed by law enforcement agencies, and cases are rarely prosecuted. These experiences make some victims reluctant to seek services, the exam, or assistance from law enforcement.
  • Cultural barriers prevent some victims from seeking services and using the justice system.  Due to cultural norms, the shame and stigma surrounding sexual assault are more prevalent in American Indian communities. These factors, coupled with the fear of retaliation, which can even include excommunication from the tribe, prevent some sexual assault victims from making a report. When the perpetrator and victim belong to the same Native community, there is sometimes a lack of support for victims.  
  • American Indian communities may distrust justice and service systems due to historical trauma and mistreatment. Service providers in these communities said that the historical mistreatment of American Indians is responsible for much of the inherent distrust that victims have of the system. This sad history includes the atrocious nonconsensual sterilization of American Indian women by Indian Health Services from 1970-76, during which an estimated 25 to 50 percent of Native American women were sterilized. This is underscored by current practices that often make victims feel like second-class citizens.

All of these barriers can prevent American Indian victims from accessing important services and using the criminal justice system to hold perpetrators accountable. That’s why it’s critical to make trained examiners and suitable facilities available for victims in tribal and rural jurisdictions, and to train first responders on how to provide culturally competent social services to American Indian communities.

Tuba City, Ariz., in the Navajo Nation, is home to the Tuba City Regional Health Care Corp. (AP Photo/Ross D. Franklin)


As an organization, the Urban Institute does not take positions on issues. Experts are independent and empowered to share their evidence-based views and recommendations shaped by research.


It is time for our tribal leaders, federal and state partners, community and civic leaders, and elders to declare a state of emergency to address sexual violence in the entire Native community! Our Native women, men and Two-Spirit (LGBT Natives) are under assault – it is time for action! Although your reporting was focused on the sexual violence that our Native women experience, this issue is way more pervasive. According to the HHS’ National Intimate Partner and Sexual Violence Survey (NISVS, the Native community experiences higher rates of rape, physical violence and/or stalking by an intimate partner during their lifetime when compared to other ethnicities: 27% of our Native women experience rape at some point in their life and 23% report being stalked during their lifetimes. The report goes to state that 44% of American Indian women and 46.0% of Alaskan Native women have experienced rape, physical violence and/or stalking by an intimate partner in their lifetime. What is even more surprising is that nearly half (45%) of our Native men experience rape, physical violence and/or stalking by an intimate partner during their lifetime. That is almost one out of every other Native man and woman! In NISVS report on 2010 Findings on Victimization by Sexual Orientation detailed that lesbian women and gay men reported levels of intimate partner violence and sexual violence equal to or higher than those of heterosexuals. Although there is (of course) no data on our Two-Spirit (LGBT Native) community, this community stands in the intersection of being Native and being LGBT identified, it stands to reason that there are elevated risks for this community when it comes to sexual violence. This state of emergency should call for the development of trainings for Native service providers, law enforcement, mainstream service providers regarding the sexual violence and all of these trainings must include the two-Spirit community.
I cannot believe that our country has put idians on the back burner and act like they are trash. Blacks are now treated equal well so should tge idians. Idians were here before us we took their land. Give them the help they need. This country is totally messed up. If a woman was raped she should be treated with dignity and respect help her out regardless of race.