Domestic violence in American Indian and Alaska Native populations: a new framework for policy change and addressing the structural determinants of health

Summary

There are 574 federally recognized Tribes in the United States. Tribes have experienced increased rates of domestic violence (DV) due to structural determinants like gender violence, loss of control, discrimination, marginalization, oppression, and political violence. American Indian and Alaska Native girls and women experience the highest rates of DV and abuse in the US, yet policy change, funding, and advocacy has been slow to address high DV rates. In this commentary, we comprehensively review the structural determinants of DV in American Indian and Alaska Native populations. We review policies and the complexities of criminal jurisdiction in Tribal nations and provide key recommendations to build a new framework that addresses DV in American Indian Alaska Native women in the future. Less than half of federally recognized Tribes receive funding through the Family Violence Prevention and Services Act. Structural determinants explain why housing and funding are advocacy issues, where unequal access and differential effects lead to increased risk for DV. We advocate for future work that addresses the interplay of multiple structural determinants while advocating for funding and culturally safe research and support to address DV in American Indian Alaska Native populations.

Introduction

Domestic violence (DV) is a pervasive, insidious, and life-threatening crime.¹ DV is a public health crisis that often involves intergenerational transmission and negative social, legal, and economic consequences.^2,3 DV is defined herein as physical, verbal, sexual, emotional, psychological, and gender violence within a family or relationship. While DV happens across all gender identities, American Indian and Alaska Native girls and women experience the highest rates of DV and abuse in the US. More than 84 percent of American Indian and Alaska Native women experience some form of violence in their lifetime.⁴ Homicide rates for American Indian and Alaska Native women are more than ten times the national average in some counties and overall, 2.8 times that of White women.⁴ The vast majority of perpetrators, 96 percent, are non-American Indian and Alaska Native. American Indian Alaska Native women experiencing violence are more likely than White women to be physically injured, miss work or school, and be less likely to have access to needed services.⁵ Two-spirit (American Indian and Alaska Native LGBTQ+) communities are at high risk for DV.⁶ Lehavot et al. report that 85 percent of American Indian and Alaska Native lesbian, bisexual, and Two-Spirit women experience sexual assault, and 78 percent experience physical assault.⁷ The current magnitude of violence and abuse against American Indian and Alaska Native women stems from unresolved effects of colonisation that intentionally disrupted Tribal ways of life, traditions, relationships, and kinship systems, and subsequent laws and policies that continue to reinforce the trauma of colonisation.⁸ This viewpoint aims to comprehensively describe structural determinants of DV and articulate necessary policy change in the United States and among the 574 federally recognized Tribes.

Structural determinants of Domestic violence

Framing issues of American Indian and Alaska Native women's high prevalence of DV within a multi-level context that includes structural racism confronts a long history of genocidal policies and historically poor treatment of American Indian and Alaska Natives by the United States government. Power and control at the individual and system levels create conditions of exclusion, racism, oppression, discrimination, loss of control, gender violence, and political violence. The perpetuation of trauma on American Indian and Alaska Native girls and women diminishes their prospects for healthy childbearing by the unresolved grief of intergenerational experiences with persistent “historical-cultural erasure” and forced relocation; racist policies that control mothering, such as forced sterilisation and limited birth control access; and racial profiling among child welfare policies.⁹ DV policy and advocacy must be viewed within a structural determinants framework where the effects of colonisation are apparent in broken systems, failed federal policies, and laws.

Historical trauma theory reveals the linkages between colonisation and DV.¹⁰ The framework and constructs are: 1) the historical trauma experience, e.g., colonisation, broken treaties, genocide, subsequent Federal Indian Law and Policies that continue to reinforce outcomes of colonisation, 2) the historical trauma response, e.g., risk factors for DV and abuse due to unequal access and differential effects of the social determinants of health (SDOH), and 3) the intergenerational transmission of historical trauma, e.g., continuing external abuse by non-Native perpetrators, structural racism and discrimination, lack of culturally informed interventions for unresolved grief.⁸ One observation (anonymous), states that American Indian and Alaska Natives are the United States’ First Peoples who are being treated as second-class citizens and forced to live in third-world conditions.⁸ The unconscious uptake of that lived experience in the form of intergenerational trauma increases the risk for depression, post-traumatic stress disorder, and deaths of despair from suicide and the effects of alcohol and drug use (Fig. 1).

Fig. 1.

Structural determinants and Domestic violence.

The shameful history of mistreatment of American Indian and Alaska Natives from contact to the present is one of extreme violence and abuse in every sphere of individual and communal life. Nowhere is that more evident than in the continuing lack of access to quality health care and safety. The trust doctrine between the United States government and Tribes obligates the Federal government to provide for the well-being of Tribes.² To that point, in 1890, the government value placed on the lives of people being served by the Armed Forces and the Indian Health Service was roughly estimated to be “$21.91 per soldier, $48.10 per sailor, and $1.25 per Indian”.¹¹ Little has changed. Recent per capita healthcare expenditures by the federal government include $13,185 for Medicare, $8019 for Medicaid, $10,692 for Veterans Health Administration, and $3332 for the Indian Health Service, which is approximately one-third of the national per capita healthcare expenditure of $9207. Per capita health care expenditure for inmates of the Federal Bureau of Prisons is $8,602, more than twice that for American Indian and Alaska Natives.¹² As one Tribal leader in the Southwest stated, “My people would have better health care if I constructed a barbed wire fence around our pueblo and called it a prison”.⁸

The ongoing abuse and violence toward American Indian and Alaska Natives include the intentional underfunding of persistent health disparities, particularly those classified as mental and behavioural health conditions. These disparities lead to the lowest life expectancy of any racial or ethnic group in the US, 65.2 years, 10 years less than the general population.¹³ Without adequate, sustained interventions, it is projected that between 2017 and 2030, American Indian and Alaska Natives will experience a 10% increase in all-cause premature deaths.¹⁴

Even in environments of economic upturn and access to higher education, the benefits of these social determinants of health (SDOH) to American Indian and Alaska Native girls and women produce differential effects due to the impacts of chronic stress related to systemic/structural racism, similar to the weathering effects on the Black population, and colonisation.¹⁵ In addition, without safeguards for economic booms that can increase access to alcohol and drugs and spur increases in local employment, the benefits of improved economic conditions may be offset for American Indian and Alaska Native girls and women by the increase in human trafficking and sexual violence with downstream outcomes of deaths from drug and alcohol use.¹⁵ These dynamics may also be at play in the Missing and Murdered Indigenous People (MMIP) epidemic.

DV policy trends and challenges

Understanding DV policy trends unique to Tribal populations and acknowledging the intergenerational transmission of negative social, legal, and economic consequences is the first step in addressing structural conditions and policy change. Law and policy impact how individuals access services, the quality of those services and supports, and what the Federal government's trust responsibility should be to Tribal nations and members.¹⁶ The Federal government has taken on a greater role in recent years to address public safety and DV in Tribal populations. The Victims of Crime Act established in 1984 provided federal funding for crime victims, but VOCA excluded Tribes. The Violence Against Women Act (VAWA) established in 1994 excluded Tribes; in 2013, it was reauthorised to include Tribes. Federal funding initially neglected Tribes, but in the last decade, progress has been made to fund Tribes through the U.S. Department of Justice, Office on Violence Against Women (OVW). Support includes Tribal set-aside funding and specific DV grants. In 2015, the MMIW grassroots movement called attention to violence against American Indian and Alaska Native women, calling for greater accountability. Congress enacted the Not Invisible Act of 2019 to increase coordination between Tribal, Federal, and State agencies. Increases in funding and policy change are due to the grassroots efforts of Tribes to hold the federal government accountable (Fig. 2).

Fig. 2.

Timeline of key federal policies.

While policies have been developed and laws have been enacted to address DV in American Indian and Alaska Native populations, the complexity of criminal jurisdiction in Indian country poses a significant barrier to the implementation of effective solutions.¹ Three sovereign entities—Tribal nations, the United States, and state governments— may assert, often overlapping, criminal jurisdiction in Indian country. A given offense may be prosecuted by one or more Tribal, Federal, or State law enforcement authorities depending on multiple factors, including the crime committed, the status of the perpetrator, the status of the victim, and where the crime occurred in Indian country. This jurisdictional quagmire can hamper investigations, slow response times, and may even result in disputes between jurisdictions as to the proper prosecuting authority.

An additional impediment to effective DV solutions in Indian country is the severe restraints placed on the exercise of Tribal nations' criminal jurisdiction over non-Indian defendants.² This massive jurisdictional gap means that Tribal nations often lack the legal authority to prosecute abusers of American Indian and Alaska Native individuals. While it is possible for Tribal nations to acquire the necessary criminal jurisdiction to prosecute non-Indian offenders, the tradeoffs are often steep and require the relinquishment of some level of tribal sovereignty. For example, Tribal nations may enter into deputation agreements with state or federal law enforcement authorities to exercise criminal jurisdiction over non-Indians. Such agreements, however, come at the cost of subjugating a Tribal nation's authority to an external sovereign because deputation agreements often require compliance with federal or state standards, regulations, or laws that would otherwise not apply to a Tribal nation (Table 1).

Table 1.

Possible prosecuting authorities for violence against American Indian and Alaska Native populations.17, 18

Location	Suspect	Prosecutor
Indian Country	Non-Indian or non-Alaska Native	Federal and/or State19
Indian Country	American Indian or Alaska Native	Tribal and/or Federal
Indian Country covered by General Crimes Act, 18 U.S.C. § 1152, and the Major Crimes Act, 18 U.S.C. § 1153	American Indian or Alaska Native Non-Indian or non-Alaska Native	Federal
Indian Country where Public Law 280 is applied or Alaska Native villages	Non-Indian or non-Alaska Native	State
Indian Country where Public Law 280 is applied or Alaska Native villages	American Indian or Alaska Native	Tribal and/or State
State land	Non-Indian or non-Alaska Native	State
State land	American Indian or Alaska Native	State

American Indian and Alaska Native women have been systematically targeted by violence with minimal resources and pathways to healing. Recognising necessary policy changes and challenges is the first step in building an advocacy agenda around DV. Geographic isolation, lack of law enforcement, fear of being identified when seeking help, fear of retaliation from the abusive partner or family/community, and lack of trust between victims of abuse and local law enforcement are common barriers that policy and advocacy work must focus on in the future for both reservation and urban areas. The political and legal contexts are structural determinants that must be acknowledged when developing DV policies. Policies that fail to recognise these may not be inclusive of Tribal values and traditions. This barrier was echoed in the U.S. Government Accountability Office (GAO) report to Congress, which calls for improving federal response to MMIP.²⁰

Policy recommendations

To truly address the structural determinants of DV and promote long-term stability and public safety within Tribal communities, Tribal Nations must advocate for greater authority to prosecute all offenders, regardless of American Indian and Alaska Native status. Tribal Nations must lobby Congress to repeal outdated and oppressive laws that grant states criminal jurisdiction in Indian country without the revocable consent of the Tribal Nations in those states. Tribal Nations must also advocate to the President and Congress for long-term policies and legislation that empower Tribal Nations to determine their own approaches to public safety. Finally, Tribal Nations must demand that any legislation passed be backed by funding sufficient to meet the needs of all Tribal Nations. Without real commitments backed by long-term funding, the promises made to Tribal Nations will continue to be broken.

The National Indigenous Women's Resource Centre identified two critical areas for policy change: safe housing and funding. There are 574 federally recognised Tribes and only 55 American Indian and Alaska Native-led DV shelters in the US.⁸ Less than half of federally recognised Tribes receive funding through the Family Violence Prevention and Services Act. Structural determinants explain why housing and funding are advocacy issues, where unequal access and differential effects lead to increased risk for DV.²¹

Building a new framework to address DV

This commentary offers nine key points to help providers, programs, policymakers, and Tribal communities address DV using a structural determinants lens.⁸

• 1.Recognise and address structural determinants of DV first.
• 2.Address the interplay of trauma, ACES, poor mental health, substance abuse, and DV–DV does not occur in isolation from other determinants.
• 3.Address the complex policy and jurisdictional gaps related to DV and MMIW.
• 4.Implement a legal epidemiology approach to study laws and legal practices that contribute to DV in American Indian and Alaska Native people.
• 5.Integrate Tribal protocols on healthy relationships, communication, and rites of passage ceremonies into existing DV prevention and treatment approaches.
• 6.Promote knowledge of health care providers that the core of American Indian and Alaska Native mental health issues cannot be isolated from historical trauma and oppression.
• 7.Support multi-level and grassroots advocacy to promote accountability in actions and choices; movements like MMIW are demanding justice for Tribes and American Indian and Alaska Native families who are diminished by the loss of their female relatives.
• 8.Advocate for equitable funding and programs (IHS, law enforcement, schools, housing, social services) that elevate access to health and well-being resources.
• 9.Conduct culturally safe American Indian and Alaska Native-specific DV research.

Conclusions

The lingering effects of historical trauma and historical oppression are evident in the persistent issues of DV against American Indian and Alaska Native girls and women. The impact of DV on American Indian and Alaska Native children and families can no longer be ignored. Policy efforts that consider the structural determinants of DV and persistent health disparities are necessary to improve conditions and systems where American Indian and Alaska Native girls and women receive the support, advocacy, and treatment they deserve.

Contributors

Tassy Parker: Conceptualization, Writing, Reviewing. Allyson Kelley: Conceptualization, writing, original draft preparation, review, editing. Lee Redeye: Writing, original draft preparation. Marcello A Maviglia: Writing, original draft preparation.

Declaration of interests

There are no conflicts of interest to report.