,,iv  #aafth ,,congress  #ast ,session  
,h4 ,,res4 #gce  ,,in ,,the ,,house ,,of
 ,,representatives  ,november #bf1      
#bjai,ms4 ,haaland 7for herself1 ,ms4   
,adams1 ,mr4 ,aguilar1 ,mr4 ,cole1 ,ms4 
,davids of ,kansas1 ,ms4 ,escobar1 ,mr4 
,espaillat1 ,ms4 ,gabbard1 ,mr4         
,gallego1 ,mr4 ,grijalva1 ,ms4 ,norton1 
,mrs4 ,kirkpatrick1 ,mr4 ,larsen of     
,washington1 ,ms4 ,lee of ,california1  
,mr4 ,lujn1 ,ms4 ,mc,collum1 ,ms4       
,moore1 ,mrs4 ,napolitano1 ,mr4         
,o',halleran1 ,ms4 ,ocasio-,cortez1 ,ms4
 ,roybal-,allard1 ,mr4 ,smith of        
,washington1 ,ms4 ,speier1 ,ms4 ,tlaib1 
and ,ms4 ,underwood7 submitted the      
following resolution2 which was referred
 to the ,committee on ,natural          
,resources1 and in addition to the      
,committee on ,energy and ,commerce1 for
 a period to be subsequently determined 
by the ,speaker1 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   
,states1 which includes ,american       
,indian1 ,alaska ,native1 and ,native   
,hawaiian women1 recognizing the        
importance of reducing mortality and    
morbidity among indigenous women1 and   
calling for urgent ,federal funding     
changes to ensure comprehensive1        
high-quality1 and culturally competent  
maternal health and family planning     
services are available4  ,whereas       
,american ,indian1 ,alaska ,native1 and 
,native ,hawaiian women in the ,united  
,states suffer from life-threatening    
pregnancy complications1 known as severe
 maternal morbidities1 twice as often as
 non-,hispanic ,white women2 ,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 women2 ,whereas    
,american ,indian1 ,alaska ,native1 and 
,native ,hawaiian women are more than   

twice as likely to receive late or no   
prenatal care compared to non-,hispanic 
,white women2 ,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 complications2 ,whereas the  
rate of poverty among ,american ,indian 
and ,alaska ,native women is nearly     
double the national average for all     
people2 ,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 ,tribes1      
authorized by the ,constitution1 and    
reaffirmed by ,united ,states ,supreme  
,court decisions1 ,federal legislation1 
,executive orders1 and ,federal         
regulations2 ,whereas the aforementioned
 body of authority makes up the         
foundation of ,federal ,indian law and  
explicitly defines the ,federal trust   

responsibility owed ,american ,indians  
and ,alaska ,natives based on their     
political status2 ,whereas ,federal     
,indian law makes clear that ,indian    
,tribes1 ,american ,indians1 and ,alaska
 ,natives hold a political status1 and  
are not a racial group2 ,whereas        
,american ,indians and ,alaska ,natives 
receive health care services1 in partial
 fulfilment of the ,federal             
,government's trust responsibility to   
the ,indian ,tribes1 through health     
programs administered through the       
,indian ,health ,service 7,,ihs7 and    
,tribes and ,urban ,indian              
,organizations 7,u,i,os71 collectively  
known as the ,,itu or                   
,,ihs_/,tribal_/,urban2 ,whereas        
indigenous women benefit from increased 
resources and access to community-based 
health care facilities1 including       
indigenous midwives1 doulas1 and birth  
centers2 ,whereas the ,,ihs1 as part of 
the ,department of ,health and ,human   
,services1 operates health care         

facilities and administers and provides 
funding to health programs1 including   
,,itu facilities for ,american ,indians 
and ,alaska ,natives1 but remains       
severely underfunded and lacks resources
 to provide adequate health care        
services for ,american ,indian and      
,alaska ,native women that are          
culturally competent1 including prenatal
 care1 labor and delivery services1 and 
a full range of culturally informed     
family planning services2 ,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 ,natives2 ,whereas 
the ,united ,states ,commission on      
,civil ,rights found that ,american     
,indian and ,alaska ,native health care 
provided 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
 ,natives2 ,whereas1 in #bjag1 ,,ihs    
health care expenditures per person were
 #c1ccb1 compared to #i1bjg for ,federal
 health care spending nationwide2       
,whereas historical trauma and gender   
oppression1 coupled with the social     
determinants of health inequities       
experienced by indigenous women in the  
,united ,states1 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 rates2 
,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    
outcomes2 ,whereas fully funding the    

,federal ,government's trust and treaty 
health care responsibilities1 especially
 for reproductive health care services  
and maternal health programming1 is     
critical to closing the maternal health 
disparity gap when receiving care at    
,,itu facilities1 and health services   
for indigenous women generally2 and     
,whereas culturally competent models for
 women's health services are needed to  
provide appropriate maternal health1    
family planning1 and child health       
services for ,american ,indian and      
,alaska ,native women at ,,ihs1 ,u,i,os1
 and non-,,ihs facilities3 ,now1        
therefore1 be it  ,that the ,house of   
,representatives-- 7#a7 acknowledges the
 unacceptable maternal health crisis    
that indigenous women disproportionately
 experience resulting in the exceedingly
 high rates of maternal mortality and   
morbidity in the ,united ,states2  7#b7 
calls for urgent ,federal funding       
increases for the ,indian ,health       
,service 7,,ihs71 ,tribally ,operated   

,health ,centers1 ,urban ,indian        
,organizations1 and ,native ,hawaiian   
health care programs to ensure ,american
 ,indians1 ,alaska ,natives1 and ,native
 ,hawaiians have access to              
comprehensive1 high-quality1 and        
culturally competent maternal health1   
prenatal care1 and comprehensive family 
planning services2  7#c7 recognizes the 
,federal ,government's failure to uphold
 ,tribal treaty rights as it pertains to
 providing adequate health care services
 to ,american ,indians and ,alaska      
,natives2 and  7#d7 calls upon the      
,department of ,health and ,human       
,services1 ,,ihs1 and the ,health       
,resources and ,services ,administration
 7,,hrsa7 to prioritize policy for      
,american ,indian1 ,alaska ,native1 and 
,native ,hawaiian women to reduce       
long-standing and well-known barriers to
 access culturally competent maternal   
health and comprehensive family planning
 services4