Periodic report of the united states of america to the united nations committee on the elimination of racial discrimination


Recent and ongoing agency consultations and other outreach to tribes include



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173. Recent and ongoing agency consultations and other outreach to tribes include:


  • At the direction of the Secretary of Agriculture, between July 2010 and April 2011, the USDA Office of Tribal Relations and the Forest Service engaged in listening sessions in more than 50 locations. Hundreds of tribal elected officials and tribal culture keepers provided recommendations to improve the Forest Service’s protection of sacred sites. In December 2012, the Secretary of Agriculture released the resulting report on Indian Sacred Sites and joined the Departments of Defense, Energy and Interior in signing an MOU for access to and protection of sacred sites under a plan of action.

  • In May 2011, EPA published its Policy on Consultation and Coordination with Indian Tribes.

  • As part of the reissuance of the Cook Inlet National Pollutant Discharge Elimination System Wastewater General Permit for Oil and Gas facilities, EPA, through a contractor, collected traditional ecological knowledge from local tribes, leading to development of two new study requirements for the permit – additional ambient monitoring requirements and no discharge zones. The same template has been used to collect traditional knowledge from North Slope and Northwest Arctic communities regarding permits for discharge of wastewater associated with oil and gas exploration in the Chukchi and Beaufort Seas.
  • In July 2010, the World Heritage Committee inscribed the Papahānaumokuākea Marine National Monument as the first mixed (natural and cultural) World Heritage Site in the United States. This was the result of active consultation with the Native Hawaiian community for whom this development has significant importance.

  • The DOI Fish and Wildlife Service and DOJ are working with tribes to facilitate eagle feather possession for cultural and traditional uses and to promote coordination in wildlife investigations and enforcement efforts to protect golden and bald eagles. In October 2012, DOJ announced a new policy on this issue. In FY 2012, DOI awarded $8.95 million to support historic preservation for Indian tribes, Alaska Natives, and Native Hawaiian organizations. The National Park Service is also conducting tribal consultations in its consideration of a regulatory change that would allow gathering of plants and minerals on Park lands by members of federally recognized tribes for traditional uses.

  • The federal government consults formally and informally with the Northwest Treaty Tribes when considering designation of critical habitat for endangered species, including salmon, to ensure that agencies are informed of relevant tribal science and any potential impacts on the tribes, including tribal treaty fishing rights.

  • Since April 2010, ED has held 25 informal and formal regional consultations with tribal officials regarding reauthorization of the ESEA and implementation of Executive Order 13592, covering in particular the importance of preserving Native languages and the strengthening of tribes to participate meaningfully in the education of AI/AN public school children. Drawing from input received at these consultations, the Administration has proposed changes to the ESEA that support, inter alia, flexibility in the use of federal education funds to allow funding for Native language immersion and restoration, and expanded authority for tribal education agencies.

  • The DHS Tribal Consultation and Coordination Plan of March 2010 expands the Department’s commitment to close coordination with tribal partners across the nation on security initiatives, and continues to ensure direct involvement of tribes in developing regulatory policies, recommending grant procedures, and advising on key issues. Every component and office in the Department has identified a dedicated tribal liaison or point of contact. Further, DHS has formalized agreements with the Tohono O’odham Nation of Arizona, the Seneca Nation of Indians, the Kootenai Tribe of Idaho, and the Pascua Yaqui of Arizona to develop Western Hemisphere Travel Initiative compliant Enhanced Tribal Cards, which verify identity, tribal membership, and citizenship for the purpose of entering the United States by land or sea. This enhances safety and security at U.S. borders while facilitating legitimate travel and trade. CBP is continues to work with other tribes across the country on this initiative.


  • Based on tribal consultations and public comment and the passage of the Helping Expedite and Advance Responsible Tribal Homeownership Act (HEARTH Act) in 2012, DOI issued regulations that will streamline the leasing process on Indian lands, spurring increased home ownership and expediting business and commercial development, including renewable energy projects.  Two tribal governments have already taken advantage of the new law and regulations and many others are anticipated to follow their example.

174. The federal government has also cooperated with tribes to protect tribal lands and resources, including cooperative resource protection activities with the Sac and Fox Tribe on the Iowa River, restoration of the Klamath River through possible dam removal in partnership with the Klamath River Basin tribes, and assistance to the Great Lakes Indian Fish and Wildlife Commission to assess the impact of land use and climate change on wetlands; a grant of $37.3 million in Recovery Act funds to tribes for wild land fire management and improvement of habitat and watersheds, plus grants of $213 million in Recovery Act funds by the Forest Service to benefit tribes and tribal lands; grants of more than $50 million in the past eight years for 400 conservation projects administered by 162 federally recognized tribes to benefit fish and wildlife resources and habitat; and many other grants and joint projects. In addition, 188 notices of decisions to repatriate human remains and cultural items were published in FY 2012. The Forest Service is also exercising its authority to assist tribes in reburial of over 3,000 sets of human remains and associated cultural items earlier removed from National Forests.

175. Many federal agencies continue to raise awareness of Indian law and policy. One example, “Working Effectively with Tribal Governments,” is available to the public and state and local governments online at http://tribal.golearnportal.org/ .


176. Regarding the recommendation in paragraph 29 of the Committee’s Concluding Observations, the United States, in announcing its support for the United Nations Declaration on the Rights of Indigenous Peoples, went to great lengths to describe its position on various issues raised by the Declaration, http://www.state.gov/documents/organization/153223.pdf. Concerning the Committee’s recommendation that the Declaration be used as a guide to interpret CERD treaty obligations, the United States does not consider that the Declaration – a non-legally binding, aspirational instrument that was not negotiated for the purpose of interpreting or applying the CERD – should be used to reinterpret parties’ obligations under the treaty.  Nevertheless, as stated in the United States announcement on the Declaration, the United States underlines its support for the Declaration’s recognition in the preamble that indigenous individuals are entitled without discrimination to all human rights recognized in international law, and that indigenous peoples possess certain additional, collective rights.

177. In response to paragraph 30 of the Committee’s Concluding Observations, the United States strongly supports accountability for corporate wrongdoing regardless of who is affected, and implements that commitment through its domestic legal and regulatory regime, as well as its deep and ongoing engagement with governments, businesses, and NGOs in initiatives to address these concerns globally. The United States is a strong supporter of the business and human rights agenda, particularly regarding extractive industries whose operations can so dramatically affect the living conditions of indigenous peoples. In the context of extractive industries, one way we work to promote better business practices is through participation in the Voluntary Principles on Security and Human Rights Initiative (VPI), a multi-stakeholder initiative that promotes implementation of a set of principles that guides extractive companies on providing security for their operations in a manner that respects human rights.  The Voluntary Principles discuss, inter alia, consultations with local communities, respect for human rights, and appropriate handling of allegations of human rights abuses in the context of maintaining the safety and security of business operations. The U.S. government has devoted significant resources to ensuring that the VPI has stable foundations to focus more effectively on implementation and outreach efforts. Working with other participants, the United States has helped develop an institutional framework to increase the efficiency and efficacy of VPI. Additionally, in the annual Country Reports on Human Rights Practices, the State Department has in recent years increased efforts to highlight the impacts and the lack of accountability surrounding the extraction of natural resources, including with regard to indigenous peoples. 


178. Paragraph 19 of the Committee’s Concluding Observations concerns Decision 1 (68) related to the Western Shoshone. The United States respectfully refers the Committee to its 2007 Report and accompanying Annex II for a description of the history of this matter, http://www.state.gov/j/drl/rls/cerd_report/83406.htm. In 2004, Congress passed a law (the Western Shoshone Land Claims Distribution Act) that authorized distribution of $145 million to qualifying Western Shoshone individuals. Distribution of the funds was completed on September 30, 2012. A total of 5,362 persons were determined eligible to participate in the Judgment, 902 appeals were filed, and final decisions were made by the Assistant Secretary for Indian Affairs. The Western Shoshone Judgment Act also established a Western Shoshone Scholarship, for which rules for eligibility are being drawn up. A total of 45 reports detailing the steps leading to completion of the fund distribution can be found at the IA website, http://www.bia.gov/WhoWeAre/RegionalOffices/Western/WeAre/WSC/index.htm.


179. On March 1, 2011, the U.S. District Court for the District of Columbia granted a motion to dismiss in a case challenging the Western Shoshone Claims Distribution Act, Timbisha Shoshone Tribe v. Salazar, 766 F. Supp. 2d 175 (D.D.C. 2011). In this case, a number of individual members of the Timbisha Shoshone Tribe sued in the tribe’s name claiming that the Distribution Act unlawfully takes tribal property by distributing the fund to individuals instead of to the Western Shoshone Tribes, and violates the Equal Protection Clause of the U.S. Constitution because it impermissibly discriminates on the basis of race by distributing the fund to a group of descendants rather than to tribal members. The Court upheld the Distribution Act under a rational basis standard, finding that the classification was not a racial classification. The plaintiff appealed and, on May 15, 2012, the U.S. Court of Appeals for the D.C. Circuit concluded that the individuals who brought the suit (the Kennedy faction) had no standing to bring the case after the federal government recognized the Gholson faction, based on tribal election results, 678 F.3d 935 (D.C. Cir. 2012). The case was remanded with instructions to dismiss the complaint for lack of jurisdiction. The United States believes that it should not interfere in the internal dispute among the Western Shoshone, and that they have been properly compensated for the land at issue.

180. San Francisco Peaks. With regard to concerns that have been raised by the Committee concerning the decision of the United States Forest Service to grant the request of the operator of the Arizona Snowbowl ski area to make artificial snow from reclaimed waste water purchased from the City of Flagstaff, Arizona, the United States offers the following. This issue relates to a modification of a permit for operation of the Snowbowl ski area that has existed since 1937. In considering the modification, the Forest Service engaged in extensive consultations with interested and affected tribes, including the Acoma, Apache, Havasupai, Hopi, Hualapai, Navajo, Southern Paiute, Yavapai, and Zuni. In all, the Forest Service held approximately 41 meetings with tribal representatives, made more than 200 calls to tribal officials, and exchanged 245 letters with tribes as part of the consultation process. These consultations resulted in modifications to the permit to meet specific tribal concerns. In addition, in its decision the Forest Service committed itself to ensuring that the tribes continue to have access to the area for ceremonies and to harvest traditionally used forest products. The Forest Service also noted that, with the support of the tribes, it had previously worked to obtain wilderness status for the Kachina Peaks Wilderness, an 18,960-acre area of the mountain around Snowbowl, and also to remove 74,380 acres encompassing the San Francisco Peaks from mineral entry – all to preserve and protect those areas from future development. The Forest Service continues to seek frequent input of tribes pursuant to a Memorandum of Agreement in which the Forest Service committed, inter alia, to continue to allow the tribes access to the Peaks and to work with them periodically to inspect the condition of the religious and cultural sites on the Peaks and ensure that the tribes’ religious activities on the Peaks are uninterrupted.

181. Several tribes objected to the Forest Service’s decision and sued in federal courts under the Religious Freedom Restoration Act. Both the U.S. District Court for the District of Arizona and the U.S. Court of Appeals for the Ninth Circuit, however, found that the tribes’ rights under the law did not preclude the federal government from authorizing this otherwise permissible activity on federal lands. The Court of Appeals noted that no plants, springs, natural resources, shrines with religious significance, or religious ceremonies would be physically affected by the artificial snow, and that the tribes would continue to have virtually unlimited access to the mountain, including the ski area, for religious and cultural purposes. A second suit, filed in 2009, was also dismissed at the district court level, a decision upheld by the Ninth Circuit Court of Appeals in February 2012. For further discussion of this matter, as well as an overall review of U.S. law and policy concerning consultations with tribes and U.S. legal protection of religious freedom, we respectfully refer the Committee to the discussions in this Report, as well as to the U.S. Response, dated November 17, 2011, to the Office of the High Commissioner for Human Rights and the Special Rapporteur on the Rights of Indigenous Peoples, https://spdb.ohchr.org/hrdb/19th/USA_17.11.11_(10.2011).pdf.

182. Border Fence. In response to the Committee’s March 2013 letter concerning the effects of the border fence on indigenous communities, in particular the Kickapoo Tribe of Texas, the Ysleta Del Sur Pueblo (Tigua) and the Lipan Apache (Nde), the U.S. government recognizes the potential impact that physical security barriers may have on local communities and landowners. More than 200 meetings and consultations have been held, including extensive consultations with American Indian tribes. For example, the government has consulted with the Ysleta Del Sur regarding access to cultural sites that may be affected by the fence. During the deployment of the fence, the DHS/CBP El Paso Sector Program Management Office met with representatives of the Ysleta Del Sur Pueblo and the construction company to ensure that native vegetation, especially the vegetation required for tribal ceremonies, was reseeded once the construction was completed.  The Ysleta Del Sur Pueblo and the El Paso Sector also agreed to allow tribal access to the river and flood plain area for religious ceremonies.  The Pueblo and the Sector have had a Memorandum of Agreement in place since March 14, 2005 to make allowances for the tribe’s cultural and religious practices. In addition, DHS/CBP’s Del Rio Sector staff meets with the Kickapoo tribe a few times each year to discuss issues related to tribal lands and border security, and to plan community events. CBP has not conducted outreach specifically related to the border fence with the Kickapoo; their land is close to thirty miles away from the fence. CBP has not conducted outreach activities with the Lipan Apache tribe.

183. CBP trains its agents and officers in the cultural sensitivities involved in screening, inspection, and patrolling on tribal lands or with travelers transiting areas of operation near tribal artifacts.  CBP is aware of the cultural and historic importance of the environments in which it works. CBP outreach encompasses training to respect and preserve the land and its history. An example is the discovery and preservation of two significant Tohono O’odham tribal archeological areas in 2012. The cultural awareness of CBP to not disturb, but rather document the locations and notify the proper authorities, demonstrates a balance between conducting necessary law enforcement activities and preserving cultural heritage.

184. With regard to litigation, we are not aware of any instance in which lands held by any federally recognized tribe were acquired through eminent domain proceedings for the purposes of constructing the border fence and related infrastructure. The Ysleta del Sur Pueblo joined a number of non-tribal entities in challenging the portions of a U. S. law providing for the waiver of other U. S. laws (and related state and tribal laws) to facilitate construction of the border fence.  Although the court rejected the legal position that such a waiver violated the U. S. Constitution, the court did fully consider the arguments. See County of El Paso, Texas v. Chertoff, No. 08-CA-196, 2008 WL 4372693 (W.D. Tex. Aug. 29, 2008), cert. denied, 129 S. Ct. 2789 (2009).

185. Minorities and descent-based communities. As noted in the Common Core Document and throughout this Report, despite the existence, implementation, and enforcement of myriad laws, policies, and programs designed to ensure equality for all, some members of racial and ethnic minorities, in particular Blacks/African Americans, Hispanics/Latinos, and Native Americans, continue to experience disproportionate levels of poverty, lower educational attainment, and other problems. Significant progress has been made in these areas, including as a result of the laws, policies and programs described throughout this Report, but we recognize that we still have a great distance to go before we reach our goal.

186. Women. Committee guidelines request a description of factors affecting and difficulties experienced in ensuring the equal enjoyment by women, free from racial discrimination, of rights under the Convention. Discrimination based on sex, gender and race or ethnicity can take different forms, including race/ethnic-and gender-based violence, higher poverty rates for women of disadvantaged racial and ethnic groups, differences in educational attainment, and discrimination in the labor market, health care, and other areas. Minority women have made strides in a number of areas; for example, as noted in paragraph 13 of the Common Core Document, in 2009 Hispanic/Latino women were more likely than Hispanic/Latino men to have college degrees or higher – a change from prior years back to 1970. From 1970 to 2009, the percentage of Black/African American women with college degrees also grew faster than that for Black/African American men.19 Despite gains, however, problems remain for women in general, including minority women – in particular with respect to discrimination in salary and promotions and harassment in employment; discrimination in sale and rental of housing; and violence against women. This section discusses gender related dimensions of race/ethnic discrimination with regard to two particular areas of concern expressed by the Committee – sexual violence and women’s health issues.

187. In response to paragraph 26 of the Committee’s Concluding Observations concerning sexual violence, individuals of every race, gender, and background face sexual violence; however, some communities are disproportionately affected. The United States believes that the best response to violence against women – the response most likely to empower survivors and hold offenders accountable – is a response driven and defined by the community served. Recognizing this, the United States provides grants to community organizations serving minority women who are survivors of sexual assault.

188. As noted by the Committee, an area of particular concern is violence against American Indian and Alaska Native women. Addressing such violence is an Administration priority. The problem stems at least in part from the fact that under U.S. law, tribal authorities have been prevented from exercising criminal jurisdiction over non-Indians on Indian lands, and are also limited in their criminal sentencing authority. Provisions proposed by DOJ and included in the 2013 reauthorization of VAWA address this situation with regard to certain common domestic abuse cases, as noted below.

189. Title XI of the 2005 reauthorization of VAWA, “The Safety for Indian Women Act,” was designed to strengthen the capacity of Indian tribes and Alaska Natives communities to respond to violent crimes against women. Recognizing that more must be done, in July 2010 President Obama signed the Tribal Law and Order Act, which expands support for BIA and tribal officers; includes new guidelines and training for domestic violence and sex crimes; strengthens tribal courts and police departments; strengthens cooperation among tribal, state, and federal agencies; and enhances programs to combat drug and alcohol abuse and help at-risk youth. In April 2011, the Attorney General approved establishment of a National Coordination Committee to solicit advice about the complex issues surrounding the response to sexual violence in AI/AN communities and to advise DOJ’s Office for Victims of Crime and other DOJ components about the unique cultural issues faced by AI/AN adult and child victims of sexual violence. The Committee, composed of representatives from tribal organizations and federal agencies, is developing recommendations to enhance the ability of federal agencies and tribal communities to address sexual violence against AI/AN adults and children. The 2013 reauthorization of VAWA, signed by President Obama in March of 2013, also significantly improves the safety of Native women and allows federal and tribal law enforcement agencies to hold more perpetrators of domestic violence accountable for their crimes. 20

190. Numerous federal agencies have programs aimed at preventing violence against Native American women. In FY 2012, the DOJ Office on Violence Against Women (OVW) awarded $36 million to more than 67 tribal governments and their designees to enhance the ability of tribes to respond to violent crimes, including sexual assault, domestic violence, dating violence and stalking, against AI/AN women; enhance victim safety; and develop education and prevention strategies. DOJ has also provided funding to establish a national clearinghouse on sexual assault for Native women – a one-stop shop where tribes can request on-site training and technical assistance in developing tribal sexual assault codes, establishing Sexual Assault Response Teams, and accessing tools to gain sexual assault forensic evidence collection certifications. In 2012, DOJ provided funding to four tribes to cross-designate tribal prosecutors to pursue violence against women cases in both tribal and federal courts. The Tribal Special Assistant U.S. Attorney initiative is another step in DOJ’s on-going efforts to increase engagement, coordination, and action on public safety in tribal communities; it involves OVW, the Executive Office of U.S. Attorneys, and the U.S. Attorneys’ Offices in Montana, Nebraska, New Mexico, North Dakota, and South Dakota. Many examples of actions taken to address violence against AI/AN women are listed in the Public Safety section of the December 2012 White House publication, “Continuing the Progress in Tribal Communities,” http://www.whitehouse.gov/sites/default/files/wh_tnc_accomplishments_report_final.pdf.pdf.

191. In FY 2010, HHS awarded $87 million through the Family Violence Prevention and Services Program in support of more than 1,600 tribal and community-based domestic violence prevention and service programs. Annually, these programs respond to more than 2.7 million calls to crisis hotlines, and provide emergency shelter and other services to more than 119,300 victims of domestic violence and 120,900 children. This funding also supports state, territorial, and tribal programs to prevent family violence and to provide immediate shelter and related assistance for victims of family violence and their dependents. Institutions such as the Asian and Pacific Islander Institute on Domestic Violence, the Institute on Domestic Violence in the African American Community, Casa de Esperanza: the National Latina Network of Healthy Families and Communities, and the National Indigenous Women’s Resource Center, Inc. also raise awareness and improve services for minority communities.

192. With regard to educational institutions, in April 2011, Vice President Biden and Secretary of Education Duncan announced ED’s issuance of guidance to make clear that under Title IX of the Education Amendments of 1972 discrimination can include sexual violence, and thus any school, college or university receiving federal funds is obligated to respond promptly and effectively to sexual violence. The guidance also provides practical enforcement strategies. In addition, ED’s Office of Safe and Healthy Students uses the Internet, listservs, and trainings to elevate the awareness of educators, parents, and students about trafficking of children and to increase identification of trafficked children in schools. A toolkit on trafficking in persons, which will help school personnel better identify and serve students who are vulnerable to trafficking recruitment and students who have been victimized by trafficking, is expected to be available in late 2013. With regard to housing, DOJ and HUD actively enforce the Fair Housing Act’s provisions against sexual harassment in housing, including pursuing many cases that involve minority women survivors of such harassment. HUD also issued guidance in 2011 to clarify that residents who are denied or evicted from housing as a result of domestic violence may have the basis to file discrimination complaints under the federal Fair Housing Act.

193. Through its Federal Law Enforcement Training Center (FLETC) and the ICE Victim Assistance Program (VAP), and with the assistance of non-government organizations, DHS actively trains its law enforcement personnel concerning issues related to violence against women in its immigration and law enforcement activities. All VAP providers must adhere to the DOJ Attorney General Guidelines for Victim and Witness Assistance 2011 Edition (rev. May 2012). VAP responds to victims’ issues in crimes, including human trafficking, child pornography, child sex tourism, white collar crime, and human rights abuses; and DHS/CRCL’s Compliance Branch investigates allegations of sexual assault, harassment, or abuse occurring in DHS detention facilities. DHS is also actively pursuing its “Blue Campaign” to combat human trafficking through enhanced public awareness and law enforcement training.

194. The BJS publication, “Criminal Victimization, 2011,” indicates that the overall rate of violent crime declined from 32.1 to 22.5 victimizations per 1,000 persons age 12 and older from 2002 to 2011. This continues a long-term decline from 79.8 victimizations per 1,000 in 1993. Likewise, the rape/sexual assault rate fell from 1.5 per 1,000 persons in 2002 to 1.0 per 1,000 persons in 2010 and 0.9 per 1,000 persons in 2011. The study showed that violence against males and persons 24 and younger occurred at higher or somewhat higher rates than rates of violence against females and persons 25 and older. In 2011, no differences were detected in the rate of violence committed against Blacks/African Americans, Whites, or Hispanics/Latinos. However, the rate of serious violence (rape, sexual assault, robbery, and aggravated assault) for Blacks/African Americans was higher than the rate for Whites and Hispanics/Latinos. About half (49%) of all violent crimes were reported to the police, with violent crimes against females more likely to be reported (58%) than those against males (42%). http://bjs.gov/content/pub/pdf/cv11.pdf and http://www.bjs.gov/index.cfm?ty=nvat. In January 2012, the Attorney General announced revisions to the Uniform Crime Report’s definition of rape, which will lead to a more comprehensive statistical reporting of rape, http://www.justice.gov/opa/pr/2012/January/12-ag-018.html.

195. That violence against women is decreasing overall does not negate the serious problems experienced by women who are survivors of violence or the particular intensity of the problem for AI/AN women. The BJS National Crime Victimization Survey for 2011 indicates that the overall rate of violence for Native Americans is 45 per 1,000, with Native American males having a rate of 44 per 1,000 and Native American females with rates of 47 per 1,000, http://www.bjs.gov/content/pub/pdf/cv11.pdf and http://www.bjs.gov/index.cfm?ty=nvat.

196. With regard to paragraph 33 of the Committee’s Concluding Observations, the United States recognizes that more can be done to increase women’s access to health care, reduce unintended pregnancies, and support maternal and child health. As President Obama noted in his May 2009 speech at the University of Notre Dame, we must begin “reducing unintended pregnancies, and making adoptions more available, and providing care and support for women who do carry their child to term.” In part to address these issues, the White House established the White House Council on Women and Girls in 2009. The United States is also increasing women’s access to health care through the ACA which, inter alia, ensures that more women have access to health care services for healthy pregnancies, including screening for harmful conditions and smoking cessation and alcohol counseling programs. 

197. The HHS Office of Population Affairs oversees the Title X Family Planning Program, which is the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services. This program is designed to provide access to contraceptive services, supplies, and information to all who want and need them. By law, priority is given to persons from low-income families. Title X-supported clinics also provide related preventive health services such as patient education and counseling; breast and cervical cancer screening; sexually transmitted disease (STD) and HIV prevention education, counseling, testing, and referral. In fiscal year 2012, Congress appropriated more than $297 million for family planning activities under Title X, and in calendar year 2012, 98 Title X grantees provided family planning services to approximately 5 million women and men through a network of more than 4,500 community-based clinics, including state and local health departments, tribal organizations, hospitals, university health centers, independent clinics, community health centers, faith-based organizations, and others. Approximately 75% of U.S. counties have at least one clinic that provides Title X services.

198. Through its Personal Responsibility Education Program, HHS awards grants to state agencies to educate young people on both abstinence and contraception to prevent pregnancy and sexually transmitted infections, including HIV/AIDS. The program targets youth ages 10-19 who are homeless, in foster care, live in rural areas or in geographic areas with high teen birth rates, or are members of racial or ethnic minority groups. The program also supports pregnant youth and mothers under the age of 21.  

199. In September 2010, HHS awarded $27 million to support pregnant and parenting teens and women in states and tribes across the country.  Of these funds, $24 million was awarded to 17 states and tribes through the Pregnancy Assistance Fund, created by the ACA. Also in September 2010, the HHS Office of Adolescent Health awarded $100 million in teen pregnancy prevention grants to support programs that have been found effective through rigorous research and to test new models and innovative strategies to prevent teen pregnancy. As of September 2012, a total of $12 million was awarded to 25 tribes, tribal organizations, and urban Indian organizations through the Tribal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Grant Program. This program also serves high risk American Indian and Alaska Natives, Native Hawaiians, Pacific Islanders, African American, Puerto Rican and other Hispanic ethnicities in high-need maternal and child health disparate communities. In FY 2011, MIECHV grants (totalling $250 million) were provided to every state. 

200. To address the complex challenges to safe motherhood, the Maternal and Child Health Services Title V Block Grant Program provided $556 million in federal funds for comprehensive maternal health services, including access to prenatal and postnatal care for low-income and at-risk pregnant women. In 2009, more than 39 million individuals were served, including 2.5 million pregnant women, 4.1 million infants, 27.6 million children, and 1.9 million children with special health care needs. The HHS Health Resources Services Administration (HRSA) has also developed the Bright Futures for Women’s Health and Wellness Initiative to encourage patient- provider relationships and better health among women across their lifespans. One of its target populations is underserved and minority women.

201. In July 2010, the United States issued a National HIV/AIDS Strategy and Federal Implementation Plan to: (1) reduce HIV incidence; (2) increase access to care and optimize health outcomes; and (3) reduce HIV-related health disparities. Also, in March 2012 a working group was established by Presidential Memorandum to look at health-related disparities and the intersection of HIV/AIDS, violence against women and girls, and gender-related health disparities. http://www.whitehouse.gov/the-press-office/2012/03/30/presidential-memorandum-establishing-working-group-intersection-hivaids-. To address disparities in HIV prevention and care involving racial and ethnic minorities and other marginalized populations, the United States is committed to reducing HIV-related mortality in communities at high risk for HIV infection; adopting community-level approaches to reduce HIV infection in high-risk communities; and reducing stigma and discrimination against people living with HIV.

202. The Black/African American infant mortality rate is twice as high as the national average. In May 2007, the HHS Office of Minority Health (OMH) launched A Healthy Baby Begins with You, a national campaign to raise awareness about infant mortality with an emphasis on the Black/African American community, http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid+117. Since 2008, OMH has held more than 60 awareness events (health fairs, community meetings, etc.), conducted media outreach, and launched a successful preconception education effort with colleges and universities, including training for more than 1,000 Preconception Peer Educators in more than 100 schools. In addition, in December 2012, OMH launched “Native Generations,” a campaign to improve birth outcomes and lower infant mortality rates among AI/AN, http://www.uihi.org/projects/native-generations.




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