The Intersection of MMIR and Abortion Access

TRIGGER WARNING: Mentions and discusses violence, medical malpractice, human trafficking, and many other related subjects.

I scrapped what I originally wrote for this article. 

I’ll be vulnerable. I’m immunocompromised due to numerous accidents and injuries and I’ve been very sick, very frequently this year. In the time I was originally writing this zine and now, too much has happened. The Trump administration and ICE and other legislators have attacked so much of our rights and our lands and our people. It’s really hard not to be consumed with dread and anxiety. 

My mother became a full citizen after becoming an adult. Half of my family came here after fighting on the side of the US in the Vietnam War. We had the luxury of coming here legally, with special permission from at-the-time President, Jimmy Carter, (my grandmother still has the letter in one of her china cabinets). My family has been here for decades. We have the privilege that our immigration story doesn’t come with the same scorn and stigma as if we were Latino. I have been frantic with fear that ICE might come for me, my friends, my family and have been repeatedly told, by well meaning friends, that I’m not likely to get deported. That everything will be fine for me, because I live in the north, in a safe state, and ICE isn’t pointed at Asians right now– unless you count exchange students, like Dogukan Gunaydin of the University of Minnesota. As if I don’t share a similar story to the people who ARE being deported. As if the government isn’t also deporting legal full citizens who were born here (like me), without due process. 

The other half of my family is indigenous. It’s really up in the air whether or not some of us are Hispanic (my brother and I are dakota, ojibwe, and pueblo, our last name is Espinosa, and we have a bunch of spanish-speaking extended family in New Mexico). I often get mistaken for being Latina, which makes sense. Indigenous peoples exist throughout both American continents and we share a lot besides our recent history of colonization. My dad has been accused of being everything brown under the sun– we’re very used to it. Some Dine folks in the southwest have been getting stopped and arrested by ICE. When I heard about it earlier in the year, I immediately freaked out, because it was further proof that indigenous people are never exempt from the police brutality and cruelty and racism Hispanic and Latino people and other migrants face in the U.S. Again, I was assured, by well meaning friends, that I’ll probably be fine. I’m a citizen, I have proof of citizenship readily available, and I live in a safe state. As though it’s not eminently clear that there are atrocious things that are happening to people who look like me. As though ICE cares to check that I’m actually someone they’re looking for and not just a brown person on the street they can deport without consequence.

This article was originally supposed to be about intersectionality, and how the MMIR crisis and the fight for reproductive liberation are the same for indigenous people. As a genderfluid, bisexual, Indigenous, Laotian American second generation immigrant, I know all too well how systemic issues are not limited to one group of people. How people at the intersection of all these minorities and disenfranchised groups suffer because we treat these issues symptomatically. As though houselessness, substance abuse, police brutality, abortion access, gender affirming care access, bigotry, racism, sexism, domestic violence, violence against femme folks, transphobia, and more don’t go hand in hand among each other. As if a person stops being oppressed for their trans-ness because they’re also black, or a woman stops deserving access to reproductive care because she’s houseless or gay or trans. As though the right to housing is actually a trophy that is only awarded to sober persons, and not a basic human necessity. I don’t have the luxury of not worrying about how these issues affect other people because they affect me too.

The point I’m trying to impress upon you with this zine series, dear reader, is that there are a lot more similarities than differences between all of us, as I think the recent No Kings marches have shown us. That these big systemic problems are– surprise, surprise– systemic, and impact more than just one group of people. In the same way, individuals are being impacted by more than just one systemic issue.

I’m still going to give you the statistics and the indigenous history and the resources and tell you to get involved. Before I do that, we need to make one thing clear: You are already involved. The president and his supporters are attacking immigrants, and lgbtqia+ folks, and poor people, and middle class people, and farmers, and forestry, and food safety, and houseless folks. They have been stirring up more and more racism and bigotry and keeping you angry and divided. Your silence, confusion, and complacency are all tools for the oppressor. It’s naive to ask everyone to unite as one, but I implore you to look out for more than just “your people”. There are people in your community who need your advocacy, your time, your resistance. You share more with the strangers in your community than you think.

With Love and Power

Tobias-Ana, of the GPAS Team

Written in June/July 2025

Intersectionality

Intersectionality is difficult to define concisely. A google search will give you a dozen definitions full of buzz words, but I have long favored Dictionary.com for their simplicity. Intersectionality’s definition reads: “the theory that the overlap of various social identities, as race, gender, sexuality, and class, contributes to the specific type of systemic oppression and discrimination experienced by an individual” or “the oppression and discrimination resulting from the overlap of an individual’s various social identities”. 

Applied in real life, that means someone who is houseless is impacted by more than just issues directly related to being houseless. If that person is a woman, they also must deal with avoiding violence enacted against them. If that person also has a chemical dependency, they must also either battle or live with their addiction while having no safe space. If that person is also 2slgbtqia+, they must also deal with hate crimes and anti-lgbt stigma and barriers to healthcare. 

In my previous article, “Missing and Murdered: An Introductory History of the MMIR Crisis”, I explored a few reasons why many indigenous people are disenfranchised, including struggling with houselessness, after the US government stopped their more overt efforts to genocide us. It’s very tempting to retread that ground, but to save us all paper, please just read that zine/article. While houselessness is an issue that is on the rise across ALL demographics –there was over a 12% increase between 2022 and 2023 and statistics from the National Alliance to End Homelessness show that this continues to be true every year despite more and more people finding permanent housing every year– Indigenous peoples have long faced much higher rates of disenfranchisement despite making up the smallest racial group in the country.

*these figures are per every 10,000 people.

This overlap is intersectionality: Indigenous peoples have large overlap with houseless populations because such a disproportionate amount of us are houseless. Houselessness has massive overlap with victims of human trafficking, assault and violence. People who struggle with substance abuse also have similarly large overlap with human trafficking, assault and violence. There is historic overlap between indigenous people and substance abuse. Both Indigenous peoples and houseless populations have the most difficult time receiving reproductive care– where doctors and advocates who do the front line work of connecting human trafficking and abuse victims are able to offer resources and help. 

The people caught in the overlap of all of these already disenfranchised groups are among the most vulnerable and hardest to reach because their situations are so complicated. Therefore, the solutions and pathways to better lives for these people, needs to be equally comprehensive. It’s easy to say we can just end houselessness with X amount of dollars or more pertinently we can just end violence against women by making a law about it, but the actual execution and, more pressingly, the atmosphere around passing good legislation and operating programs that address these needs comprehensively is much more difficult in practice.

The State of BIPOC Women’s Health

It’s an all too common experience that has been voiced A LOT recently, that it feels like doctors don’t take women and their health issues seriously. Some health professionals on Tik-Tok and Youtube have made entire channels dedicated to validating patient struggles. I, myself, have had my share of medical racism and malpractice. Doctors have insisted that I must have a drug problem when I go to the ER with suicidal ideation. Two paramedics once told me that I just needed an anti-anxiety med when I was suffering from an asthma attack; they wouldn’t give me my inhaler and refused to take me to the hospital just because my vitals were “fine”. A physician's assistant once demanded I get myself onto an examination table when I was having an unknown medical episode. I came in on a wheelchair, disoriented and unable to stand because of the pain I was in across my torso and head. When I could get words out I told him I needed help to get up, and he ignored me. He later ordered me to get off the table unassisted, I fell, and he caught me by the neck and choked me. He later approached my partner and asked if I was on drugs or if I was always like that. These are just MY experiences, in an urban setting with good doctors, great health insurance and within the last 2 years. 

My experiences are unfortunately echoed by many women in my life. One went years without knowing her chronic fatigue and weight gain were related to menopause and could be treated with HRT. My mom struggled for years before doctors found out she had a thyroid problem that could be treated with a single medication. A former coworker lived with endometriosis for 8 years and was constantly having to get third and fourth opinions just to have any medical professional believe her. She was finally able to get a hysterectomy after spending another 2 years proving her endometriosis was bad enough to require one. I have found wonderful doctors and advocates who have put in the work to get me the care I needed when others failed (Native American Community Clinic in Minneapolis is full of the most wonderful doctors, nurses and advocates I could ask for, and Planned Parenthood has bridged so many gaps for me when I didn’t have health insurance) but all of this frustration has made me ask, how much do we even know about women’s health anyway?

Turns out, not a lot, and even less for women of color.

The Association of American Medical Colleges put out an article, entitled “Why We Know So Little About Women’s Health” by Bridget Balch, back in 2024. I highly recommend reading it. The article describes the utter lack of data collected about women until 1993. Until then, most medical studies were conducted exclusively on males, be they human or mouse. The first paragraph reads “Throughout history, doctors have considered women’s bodies atypical and men’s bodies the “norm,” despite women accounting for nearly half the global population and outnumbering men in the United States since 1946. Though policy and social changes in the 1990s have helped turn the tide, women remain underrepresented in research, sometimes grossly so. Many medical researchers even avoid conducting studies on female mice due to greater costs associated with purchasing and housing both sexes and concerns that the fluctuating hormones and reproductive systems of female mice might confound the study results.”

The article goes on to say that women are still underrepresented in modern medical knowledge, which causes many drugs and medical devices to fail much more often in women’s bodies. The information we do have about women’s health is also predominantly white centric. From the same article, “The picture is even more bleak for women of color. The MRCT Center published an article in 2022 pointing out that often clinical trial data do not report the intersection of biological sex and race, and that some systematic reviews of clinical trials that report such information show significant underrepresentation of women of color.”

For indigenous people, bridging this gap in medical knowledge is made more complicated by the amount of distrust we have for western medicine. I have already touched on the lack of access to abortions and reproductive care indigenous peoples specifically have to deal with in our article, “Abortion Access and Indigenous People”, but I will reiterate how deep seated indigenous people’s distrust of western doctors is. On reservations, if there is any health care access at all, it comes in the form of the Indian Health Service (IHS). In the IHS’s history, they have been consistently understaffed, lack reproductive care services, and have historically been the instrument with which much medical malpractice was conducted against indigenous people on reservations. In addition to uninformed forced sterilizations, indigenous peoples have been subject to human experimentation both in Canada and the US. For those curious, Canada’s Food Guide was developed through government conducted nutritional experiments on Indigenous children in residential schools, while here in the US, University of Minnesota researchers took advantage of a kidney disease epidemic happening on tribal lands to experiment on children of the Red Lake nation.

These “incidents” happened on and off for decades, sowing so much hate and distrust for western medicine that continues to persist today. For indigenous people, especially those who still remember or were victims of sterilization, it's really difficult to trust doctors to give us safe, informed, and consensual care. 

This is not a uniquely indigenous issue. Latino communities had forced sterilization campaigns of their own to deal with throughout the 20th century. Black women were historically experimented on in order to develop the modern tools of gynecology starting back in the 1840s. These women were operated on with said experimental tools, completely unnecessarily and without anesthesia by white slave owners. Puerto Rican women were also experimented on by French researchers developing the birth control pill back in 1956. 1500 women participated in the clinical trials, uninformed about the experimental nature of the drug, and were exposed to a WIDE variety of side effects due to the high dosage (20x the current dosage). These side effects went largely ignored and when 3 different women died during the clinical trial, there was no investigation to find the cause of death. These are just three relevant examples. 

Given the current relationship between BIPOC peoples and American health care, the bans on abortion access only adds more hurdles in bridging the  gap. Our executive director wrote an op-ed back in 2019 that’s still incredibly relevant almost 6 years later, entitled “What I want you to know about these abortion bans, as an indigenous woman” on Bustle. In it she describes how the other crises indigenous people face increase the need for abortions while access to reproductive health resources has always been scarce. Her warnings, that white Christian nationalists are trying to take us back to colonizing ideals, are playing out with domestic violence related deaths literally doubling since the Supreme Court overturned Roe v Wade. 

That statistic comes from the National Domestic Violence Hotline (NDVH). At around the same time, it was found that homicide is a leading cause of death for pregnant women in U.S. It is not that much of a leap to say that the legislative backing by the Supreme Court emboldened violent men who were already harming women. To me, looking at these statistics and stories, it's as if their violence is validated and they take the lack of protections for women as permission. In our efforts to end the MMIR crisis, we 

From Harvard TH Chan's article "Homicide Leading Cause of Death for Pregnant Women in the U.S.": “The U.S. has a higher prevalence of intimate partner violence than comparable countries, such violence is often fatal, and it frequently involves guns, Lawn and Koenen noted. They cited one study that found that, from 2009–2019, 68% of pregnancy-related homicides involved firearms. That study also found that Black women face substantially higher risk of being killed than white or Hispanic women.” The study they describe in the article is not linked, but this study published in the National Library of Medicine describes similar findings, though they do not extensively track homicides victims sorted by race among their publicly available data.

Additionally, the same researchers from the Harvard article, Rebecca Lawn and Karestan Koenan, corresponded with CNN and went on to say “‘Women are likely to have multiple visits with healthcare professionals during pregnancy, providing opportunities to identify and help women at risk of violence and potentially prevent pregnancy-associated homicides,’ ... ‘However, recent legislation in the US to restrict women’s access to reproductive care and abortion reduces these potential opportunities to help and could place women at further risk of violence.’”

Effects of Abortion Bans on MMIR: Direct and Indirect

Abortion bans affect more than just abortions and the people who need them, they attack doctors and advocates who do any kind of reproductive related care, and that includes domestic violence outreach. Lawn and Koenan are not the only people advocating for more and standardized screening for domestic violence victims in healthcare settings. This push for more screening is echoed by advocates supporting human trafficking victims.

According to Preble Street’s article, “Victims of human trafficking going undetected in healthcare settings” by Daniella Cameron, 68% of victims of human trafficking are seen by doctors and healthcare workers while they are being trafficked. This study published in the National Library of Medicine shows the diagnosis codes for victims who were successfully identified by healthcare workers, and some of the medical history before and after their identification. Many victims had been seen for health issues while being trafficked, most for mental health related issues, followed by vaccines, long term drug abuse, and STI screening/treatment and more. Based on this data and Achieve CE’s “Best Strategies To Identify Human Trafficking Victims”, the best places to screen for human trafficking victims and domestic violence victims would be anywhere that treats physical injuries. Many clinics that do abortions also provide other reproductive care like providing contraceptives and, importantly, STI testing and treatment.

Unfortunately, clinics are becoming fewer and further between. In the first 100 days after the Dobbs decision, 66 clinics stopped offering abortion care and of those 66, 26 closed entirely. As of June 17th, 2025, 105 clinics in total have closed– 29 were in states with total abortion bans, 11 in states with 6 week bans, and the other 65 includes clinics that were in states that DIDN’T have bans. In that time only 34 clinics have either opened or moved to states that are less restrictive– nowhere near enough to fill in the rapidly widening gaps in reproductive care availability. 

With the loss of reproductive choice, many victims of domestic abuse or human trafficking lose a doctor’s office where they can find help. It’s really hard to leave someone if you’re pregnant with their child, can’t work, and are physically and financially dependent on them. It’s even harder when you lose the ability to find doctors who are prepared to give you necessary care and resources because the closest one is a 4 hour drive away. Not to mention all the hesitancy to provide necessary and often life saving care in ERs caused by the criminalization of doctors who perform abortions, despite their use to treat miscarriages. This is a rapidly widening hole for advocates and their ability to reach people (especially BIPOC folks) and end MMIR.

This all begs the question: what’s being done about this?

Domestic violence prevention and ending human trafficking are the basis of fighting the Missing and Murdered Indigenous Relative Crisis. As I said before, the people at the intersection of indigeneity and abortion access and MMIR are experiencing complex, systemic problems and thus need comprehensive intentional solutions. We’ll get to my personal theoretical roadmap of How to End the MMIR Crisis in Part 2, but we can’t begin to connect these people to resources in areas where they don’t exist, or expect them to succeed when the resources that are available are incomplete.

That said there is a lot of incredible work being done by organizations nationally. There are actually too many organizations to list if we're speaking broadly about Human Trafficking and Domestic Violence organizations, so I'll stick to MMIR related ones not mentioned in my previous article.For a more comprehensive list of organizations, check out the National Sexual Violence Resource Center’s catalogue.

• Most of our MMIR work at Great Plains Action Society is in advocacy and raising awareness, as well as providing support to MMIR victims and their families.

• The National Indigenous Women's Resource Center (NIWRC) also does a lot of education, awareness and advocacy.

• The Minnesota Indian Women's Resource Center (MIWRC) runs a Domestic Abuse treatment center in Minneapolis.

• Native American Rights Fund (NARF) primarily does legal advocacy across MANY different arenas.

• Minnesota Indian Women's Sexual Assault Coalition (MIWSAC) provides culturally-specific and comprehensive training and technical assistance to Tribal Sexual Assault Services Program grantees and runs Project Beacon.

• Minnesota Coalition Against Sexual Assault (MnCASA) does a lot of work in both training and advocacy, as well as prevention programs.

A lot of work needs to be done to repair the relationship between people of color and western medicine, and even more work needs to be done to include people of color in medical studies in SAFE, ETHICAL WAYS. This requires time, money, resources, and a lot of consideration and education around cultural sensitivity. Even without mentioning the Trump administration’s efforts to defund and consolidate government spending, it has been historically REALLY DIFFICULT just to do any research around women and genderqueer people’s health. This is complicated again by the cultural polarization around abortions, gender, and sexuality, which I will explore in part 2.