American Indian and Alaska Native women are more than twice as likely to be sexually assaulted than U.S. women of other races and ethnicities, according to the human rights organization Amnesty International. Yet many Indian Health Service (IHS) facilities have no nurses on staff who have been trained to provide emergency care to rape victims.

In its report Maze of Injustice: The Failure to Protect Indigenous Women from Sexual Violence in the USA, Amnesty International notes that “health service providers have a key role to play both in providing survivors with any medical attention they may need and in documenting sexual violence. Sexual assault forensic examinations can provide crucial evidence for a successful prosecution. However, [our] research suggests that the quality of provision of such basic services to American Indian and Alaska Native women varies considerably from place to place. Often this is the result of the U.S. government’s severe underfunding of the IHS. [But] in some instances inadequate training on how to respond to survivors of sexual violence and how to do so in a culturally appropriate manner also means that health facilities fail to provide women with the treatment and support they need.”

Amnesty International’s research–which focused on Alaska, Oklahoma and the Standing Rock Sioux Reservation in North and South Dakota–found that nearly half (44%) of IHS facilities in these three locations lacked personnel trained to provide emergency services to victims of sexual assault.

According to the report, “sexual assault nurse examiners (SANEs)–registered nurses with advanced education and clinical preparation in forensic examination of victims of sexual violence–are a new nursing [specialization] and their availability varies from one [facility] to another. Our research suggests that there are no SANE programs at IHS facilities in Oklahoma, [while] Alaska faces a critical shortage of SANEs in hospitals and clinics and a high turnover of health professionals in IHS hospitals.”

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The American Nurse

Amnesty International recommends that “law enforcement agencies and health service providers should ensure that all indigenous women survivors of sexual violence have access to adequate and timely sexual assault forensic examinations without charge to the survivor and at a facility [located] within a reasonable distance.”

The complete Maze of Injustice report, which also examines the complex social, historical, law enforcement and state/federal/tribal jurisdictional issues that contribute to disproportionately high rates of sexual violence against women in Indian communities, is available online at

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