A demonstrator stands outside the Wisconsin State Capitol in Madison, Wisc., in 2022 to commemorate missing and murdered Indigenous women and girls. Researchers have launched a new survey to determine the prevalence of brain injuries in Native survivors of sexual assault and domestic violence. (Photo by Stacy Revere/Getty Images)

Abigail Echo-Hawk, director of the Urban Indian Health Institute, recalled a Native mother in her 30s who started having memory loss and other dementia-like symptoms.

The woman had suffered multiple blows to her head and falls at the hands of her husband over the years. He had wanted to disable her, to make it more difficult for her to keep her children if she tried to leave him, Echo-Hawk said.

Many Native women have traumatic brain injury symptoms as a direct result of abuse, Echo-Hawk said. Tribal health advocates and groups serving survivors have long been aware of the problem, she said, but there has been little national research documenting the extent of it.

“It’s a very difficult thing to see,” said Echo-Hawk, of the Pawnee Nation of Oklahoma. “This is a pressing concern.”

The Urban Indian Health Institute, an Indigenous health research group, this month launched a first-of-its-kind national survey of American Indian, Alaska Native and Native Hawaiian women to determine the prevalence of brain injuries in Native survivors of sexual assault and domestic violence. The goal is to illuminate the extent of the problem, guide clinicians, raise public awareness and direct resources.

A 2015 study in Arizona found a higher incidence of traumatic brain injuries in Native women in that state, but the new survey is the first national, Indigenous-led study of its kind, according to the institute.

It comes as domestic violence groups across the nation are struggling with federal funding delays caused by the government shutdown. As the impasse continues, the Trump administration has furloughed grant workers at the Office on Violence Against Women, which is part of the U.S. Department of Justice.

Traumatic brain injuries can cause memory loss, confusion and long-term behavioral changes and raise the risk of dementia. Some abusers intentionally inflict traumatic brain injuries on their victims because it doesn’t leave visible bruises, according to the Brain Injury Association of America.

The link between domestic violence and traumatic brain injuries has been documented in women generally, and the effects of such injuries have been studied in former football players and veterans. But research on Native communities is lacking. Even when victims show up in ERs, their cases can go underreported.

In a previous survey of survivors, some Native women reported broken teeth, evidence of blows to the head, Echo-Hawk said. But pushing and strangulation also can cause traumatic brain injuries.

Violence is a public health crisis among American Indian, Alaska Native and Native Hawaiian women, who are overrepresented in intimate partner violence statistics. Fifty-five percent report experiencing intimate partner violence, and a disproportionate number of Native women and girls are murdered or go missing.

In a 2020 survey by the federal Centers for Disease Control and Prevention, nearly 44% of American Indian and Alaska Native women reported being raped in their lifetime.

“People are losing their children because of memory loss and dementia,” Echo-Hawk said. “When people are experiencing intimate partner violence, they end up in ERs. Their children suffer. The whole community suffers as a direct result. And the same with the crisis of missing and murdered Indigenous women and girls.”

Doctors and other hospital staff should receive more training on brain injuries and should know which communities are most likely to experience violence, said Nikki Cristobal, policy and research specialist for Pouhana ʻO Nā Wāhine, a nonprofit domestic violence resource center for Native Hawaiians.

Cristobal said one survivor told her clinicians hadn’t performed a brain scan or traumatic brain injury assessment on her, despite her ongoing psychological and cognitive symptoms. “It never occurred to anybody,” she said.

“We have to talk more about it,” said Cristobal, who worked with Echo-Hawk on developing the survey and is the principal investigator for the Missing and Murdered Native Hawaiian Women, Girls and Mahu state task force.

Native communities, including Native Hawaiians, have endured long-term, intergenerational traumas during colonization and forced assimilation that can’t be ignored when targeting the disproportionate rates of violence, Cristobal said.

“It’s the undercurrent,” Cristobal said. “It’s the precursor.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.