Reproductive health of urban American Indian and Alaska Native women: Results from the National Survey of Family Growth

Background: Current literature on reproductive health among urban American Indians/Alaska Natives (AI/AN) is severely lacking. When available, literature shows high rates of unintended pregnancy, sexual violence and risky sexual behavior among AI/AN nationally and among those in urban areas. This is the first analysis to examine AI/AN using National Survey of Family Growth (NSFG) data to describe disparities in reproductive health. Methods: Results among urban AI/AN and non-Hispanic (NH-) white women participating in Cycle 6 (2002) of NSFG were analyzed to examine sexual history and behavior, contraceptive use, non-voluntary sexual intercourse, and unintended pregnancies.

Results: Many risk areas of the reproductive health topics examined showed disproportionately higher rates among urban AI/AN compared with NH-whites: urban AI/AN had higher rates of unintended and mistimed pregnancies, were more likely to have had three or more pregnancies and births, and were more than twice as likely to have experienced non-voluntary first sex than NH-whites. Additionally, young AI/AN women reported more unprotected first sex and much older first sex partners, and a lower proportion of urban AI/AN teens reported using contraception overall. Rates of Depo-Provera and female sterilization use were significantly higher among AI/AN.

Conclusions: The study provides baseline data and serves as a model for further surveillance on the reproductive health of urban AI/AN women. The information offers guidance for programming priorities. The context in which reproductive health outcomes, especially sexual violence, occurs for urban AI/AN communities needs to be further examined to learn how to promote justice and address underlying issues.