In South Dakota, where lawmakers passed a near-total ban on abortion last month, the leader of one of the state's Indian tribes is proposing to circumvent the legislation by establishing an abortion clinic on an Indian reservation - within reach of women who need the service but outside the reach of the strict new law.
Cecelia Fire Thunder, a former nurse who is the first female president of the Oglala Sioux Tribe, said it was "an eye-opener" when legislators approved a law that prohibits abortion in nearly all cases - even when the pregnancy is the product of a rape, even when it is the result of incest. The only exception is to save the mother's life.
"An Indian reservation is a sovereign nation, and we're going to take it as far as we can to exercise our sovereignty," said Fire Thunder, whose Pine Ridge Reservation encompasses 2.7 million acres in southwestern South Dakota. "As Indian women, we fight many battles. This is just another battle we have to fight."
Because federally recognized Native American tribes are not, in many cases, required to abide by state law, a clinic could operate lawfully at Pine Ridge even with a ban in place, said South Dakota Attorney General Larry Long. Tribes are, in many respects, treated as foreign nations.
Fire Thunder, 59, is one of 15 co-chairmen of the South Dakota Campaign for Healthy Families, which formed last week with the goal of putting the abortion ban to voters.
The tribal leader, who said she has counseled rape victims, said it was the legislators' insistence on prohibiting abortions for women who have become pregnant as the result of a rape that drew her to speak out on the issue and propose building "a Planned Parenthood-type clinic" on tribal land.
She first floated the idea to a Native American columnist in South Dakota last week. Since then it has been fodder for the local press and national blogs. Her e-mail in-box has filled up with people supporting the idea, she said.
"People need to open up their eyes in this country. Women are being raped at a tremendously high rate in this nation," she told The Sun this week. "In a perfect world, you will report the rape, the police will respond, they will take you to the emergency room. You will tell your story, you will get emergency contraception.
"We don't live in a perfect world. In rural America, that does not happen."
For now, it remains legal to get an abortion in South Dakota. About 800 a year are performed at a Planned Parenthood clinic in Sioux Falls, where doctors fly in once or twice a week from Minnesota, according to Marta Coursey, a spokeswoman for Planned Parenthood Minnesota, North Dakota, South Dakota. It is the only abortion clinic in the state. There are roughly 775,000 residents in South Dakota, a population not much larger than the city of Baltimore's.
The state ban takes effect July 1. Meanwhile, it faces hurdles.
Last weekend, the South Dakota Campaign for Healthy Families began collecting the 16,728 signatures needed to place a referendum on the law on the November ballot - and gathered nearly 1,100 in a matter of days, said Nathan Peterson, the campaign's petition director. If the group gets the required signatures, the law would be on hold until fall.
Should that fail, a lawsuit would be inevitable, said Coursey. Many expect a judge would stay the law indefinitely as the case works its way through the courts.
Bill Napoli, a state senator who voted for the law, said he welcomes the opportunity for South Dakotans to vote on the issue.
"I hope they get it on the ballot, and I hope and pray that both sides will honor what comes out of that," Napoli said. "I've asked pro-choice people, 'Would you honor it if the pro-life people won?' and they said no. I've asked pro-life people, 'Would you honor it if the pro-choice people won?' and they said no."
His goal, he insisted, is not to see the abortion ban enacted as it is written. The broader objective, he said, was to get a "clean, clear bill that said no abortions and take it straight to the Supreme Court" with the hope of overturning Roe v. Wade, which widely legalized abortion.
In recent years, the Supreme Court has allowed states to set restrictions on the procedure, but justices haven't shown an interest in reversing Roe. Still, with two new justices on the bench, Napoli and others in South Dakota believed the time was right for an all-out challenge.
Fire Thunder said she would like a reservation clinic to provide not only abortions but contraception and sex education. She envisions that it would be open to all women, not just those on the reservation. It would be the only clinic for hundreds of miles to offer abortions, she said.
"She could make this happen," said Charon Asetoyer, director of the Native American Women's Health Education Resource Center in Lake Andes, S.D.
Attorney General Long isn't so sure. He wonders how much support Fire Thunder would have, even from her own people.
"The Oglalas are basically pretty pro-life people, by and large," he said.
Should a clinic be opened, Long said, immunity from a state ban would apply only if the doctor, the patient or both are Indian. Long also said he questions whether tribal law would allow abortions to be performed on the reservation.
Still, some crimes on tribal lands fall under federal jurisdiction, Long said, and abortion remains legal in the United States as a whole.
Asetoyer disagrees with Long's interpretation of the tribal relationship and said she isn't sure the state could prosecute someone who is breaking neither federal nor tribal laws. She said it should be no problem finding a Native American doctor to perform abortions. "It can be done," she said.