FLAGSTAFF, Ariz. (AP) – Micha Bitsinnie and her husband weren’t ready to have another baby just eight months after the birth of their daughter.

So when she forgot to take her birth control pills for a couple of days, she sought emergency contraception

With no extra money, she went to the federal Indian Health Services hospital in Albuquerque, N.M., where she’s eligible for free health care as a Navajo woman. It was there she discovered that the medication is available by prescription only and she would need to speak with a health care provider first.

“I was kind of caught off guard,” Bitsinnie said.

Any woman 17 and older can get emergency contraception from behind the counter at retail pharmacies, but IHS has no retail pharmacies and treats emergency contraception the same as getting aspirin or cough syrup. Women who are enrolled in any federally recognized tribe must visit a clinic, emergency room or urgent care facility and have a consultation before they’re prescribed the medication that is dispensed on site.

Bitsinnie and other Native women say it’s a burden they shouldn’t have to bare and have been pushing for emergency contraception, particularly Plan B, to be available over the counter through IHS facilities. But an IHS official say while getting emergency contraception at the federal facilities may be different than elsewhere, it’s not inaccessible and there are clear benefits to the agency’s methods.

“The benefit of obtaining emergency contraception from an IHS facility would be that it’s available at no cost, that it’s available much more readily in the local community without adding barriers of distance and travel cost, and that it’s part of a larger health care system where information about long-term contraceptive options would also be available,” said Dr. Jean Howe, the IHS’ chief clinical consultant for OBGYN.

Bitsinnie, a community health worker, was one of about 60 women who participated in a round table discussion last year about accessibility to Plan B through IHS. The women’s experiences were documented in a report released last week by the South Dakota-based Native American Women’s Health Education Resource Center. The discussion also touched on tradition and culture, voting rights and the prevalence of domestic abuse and rape of Native women.

One-third of all American Indian and Alaska Native women will be raped in their lifetime and nearly three of five have been assaulted by their partner, the U.S. Department of Justice has said. The IHS released a policy a year ago that sets uniform standards of care for sexual assault victims at its facilities.

Under the policy, the facilities must have staff specifically trained to care for victims of sexual assault and must provide forensic examinations on site or by referral. It also includes requirements for emergency contraceptive options like Plan B and states that sexual assault victims are to be given priority in emergency situations.

But Charon Asetoyer, director of the center, said IHS has not set deadlines for service units to implement that policy or a customized one that incorporates minimum requirements.

Furthermore, she said women shouldn’t have to see a doctor or compete with other patients at urgent care or the emergency room to get emergency contraception, particularly when the effectiveness of the pill lessens over time. Retail pharmacies are often a long drive from reservation communities, and even then, many Native women don’t have transportation or money to pay for it, she said.

“You lose that window of opportunity, that 72-hour window,” Asetoyer said. “It’s a very, very unpleasant situation. It’s very difficult and just puts another layer of control and power over us that is not necessary. We’re being treated differently.”

Bitsinnie said she called the IHS hospital for an appointment to get emergency contraception more than once and was adamant that she needed to be fit in quickly. She said she was made to feel ashamed during her 30-minute consultation and imagined how other Native women might feel if they were questioned on why they needed the medication.

“Imagine not being married, having a few kids or 18 years old and coming in and somebody saying, `Why aren’t you using this, why aren’t you using that?”’ Bitsinnie said. “I felt shameful ... This is not a shameful thing. I’m married. I’m just being cautious.”

Howe pointed to ways in which IHS service units have made it easier for patients to get emergency contraception, through automated drug monitoring machines and expanding the list of people who can dispense it. In Shiprock, N.M., where she works, she said the medication would be available through an OBGYN, emergency room, urgent care and through a health provider’s prescription.

The IHS bases its stock of medication on the national core formulary, a list that includes dedicated emergency contraceptives like Plan B or an equivalent. Wait times depend on the patient volume, but she said access to health care has only increased over the more than 14 years she has worked for IHS on the Navajo Nation.

However, more than half of the IHS budget is administered by tribes through self-determination contracts or self-governance compacts, and Howe said policies there can differ from those at IHS-run sites.

“Our goal is to make it available as quickly as possible,” Howe said. “That’s why we adopt these strategies to streamline it. A nurse realizing a patient may not need to wait for a bed to open up could take that initiative to have that dispensed and let that patient go on her way quite promptly.”

Not all IHS facilities operate around the clock. But the only other option than IHS is to drive, depending on location, perhaps even farther to a retail pharmacy and pay for Plan B themselves.

Howe said IHS would like to know about any problems in accessing health care that could be addressed through patient advocates or agency offices.