Ensuring Access to Emergency Contraception After Rape

February 13, 2007

Ensuring Access to Emergency Contraception for Rape Survivors

    Throughout the country, many emergency care facilities fail to offer women who’ve been raped the treatment they need to prevent pregnancy.  Emergency contraceptive (EC) pills, sometimes referred to as the “morning-after pill” can prevent pregnancy after unprotected intercourse, including rape.1   EC significantly reduces the risk of pregnancy if taken within 72 hours of unprotected intercourse or contraceptive failure.  It is most effective if taken within 12 hours of intercourse, but can be effective up to at least 120 hours.2

 

    Many emergency care facilities fail to provide EC to women who’ve been raped and some fail even to inform women seeking care after an assault that such a treatment is available.  According to a study by the ACLU, fewer than 40 percent of emergency care facilities in eight of eleven states surveyed provide EC on-site to rape victims.3   The failure of hospitals and other facilities treating rape victims to provide EC unacceptably leaves these women at risk of becoming pregnant as a result of assault.  EC is part of comprehensive care for women who have been raped and should be offered on-site by emergency care facilities.

    Ten states, including California, Connecticut, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Oregon, Washington, and Wisconsin, have passed laws requiring emergency care facilities to offer EC to rape victims they treat. Many other states have introduced similar measures. 

Emergency care facilities should offer EC to a woman during her initial exam following a sexual assault.

    Time is absolutely critical for a woman who wishes to prevent pregnancy after rape.  The effectiveness of EC diminishes with delay:  Experts stress that EC is most effective the sooner it is taken, with effectiveness decreasing every 12 hours.4   Therefore it is extremely important that emergency care facilities offer EC to women who have been raped during their initial exam.

    A woman who has been raped who does not obtain EC in an emergency care facility must track down EC on her own.  Because of recent action by the Food and Drug Administration, EC is currently available at the pharmacy to women 18 and older who present government-issued proof of age.  For women under the age of 18 and adult women who do not have government-issued proof of age, a prescription is still necessary to obtain EC. 

    Regardless of this effort to increase availability of EC, a woman who has been raped should not have to seek out additional medical care to prevent pregnancy.  In addition to the emotional burden this imposes, a rape victim would face increased risk of pregnancy because of the delay inherent in having to take further steps to track down EC, and in some instances she may be unable to obtain EC at all.

Major medical groups recommend that EC be offered to women to prevent pregnancy after a sexual assault.

    The American College of Obstetricians and Gynecologists and the American Public Health Association recommend that EC be offered to all rape patients at risk of pregnancy.5   Likewise, in their guidelines for treating women who have been raped, the American Medical Association advises physicians to ensure that rape patients are informed about and, if appropriate, provided EC.6  

    Sexual assault victims’ groups around the country have also advocated to increase access to EC for rape victims.7   In addition, the National Sexual Violence Resource Center has worked to ensure that every sexual assault victim is offered the means to prevent pregnancy when she receives treatment at an emergency care facility.8

A bill that merely requires emergency care facilities to provide information, a referral, or a prescription for EC, fails to ensure women’s health and well-being.

    By the time a woman arrives at an emergency facility, hours may have already elapsed since the rape took place.  In the time remaining before the EC will cease to be effective, a woman who is merely informed that EC exists would most likely have to find a pharmacy that carries the medication.  Unfortunately, studies show some pharmacies do not stock EC and others refuse to dispense it.9   As the hours tick by, her chances of preventing pregnancy decrease.  Depending on when the rape occurs and where she lives, obtaining EC in time may be virtually impossible. 

    Some bills may not require that the emergency care facility actually offers the woman EC.  Instead, they may only require the facility to simply tell rape victims that EC exists.  Because the needs of rape victims are so acute and the window to prevent pregnancy through EC so brief, bills that do less than impose a blanket requirement to offer EC on-site to rape victims are unacceptable.

All emergency care facilities should be required to provide EC.

    A rape victim is often taken to an emergency care facility by the police or emergency medical technicians.  Under these conditions, most women lack the time, information, and opportunity to assess a given hospital’s policy and ask to be taken to a facility that provides EC.  Nor should she be expected to do so after surviving such a brutal crime. 

    Moreover, in some rural communities, there is only one local hospital.  If that hospital does not provide EC, it may be extremely difficult or even impossible for a rape victim to access the care she needs to avoid a pregnancy as a result of the rape.

An institution’s religious objections to EC must not imperil a woman’s access to timely and comprehensive treatment.

    Some emergency care facilities, invoking religious objections, refuse to provide EC because it may interfere with the implantation of a fertilized egg.  Such objections cannot be allowed to stand against the urgent needs of a woman who has been raped.  Emergency care facilities — whether religiously affiliated or not — are ethically and morally obligated to offer the best care possible to everyone who comes through their doors in need of care.  EC is basic health care for women who have been raped. 

    Moreover, emergency care facilities treat and employ people of many faiths; they should not be allowed to impose one set of religious beliefs on the people of diverse backgrounds who provide and seek care.  If a hospital is unwilling to dispense EC, it is not equipped to treat rape victims.10

EC prevents pregnancy.  It does not induce an abortion.

    Emergency contraceptive pills are high doses of oral contraceptives, the birth control pills that millions of women take every day.  EC generally works by preventing ovulation or fertilization.  It may also work by preventing implantation, although there is no proof of this.  EC does not disrupt an established pregnancy, which the medical community defines as beginning with implantation.  EC should not be confused with mifepristone (RU-486 or the early-abortion pill), a drug approved by the Food and Drug Administration in September 2000, which causes an abortion in the first 63 days of pregnancy.

    The EC regimen usually consists of two doses: the woman must take the first dose within 120 hours of the unprotected intercourse; she takes the second dose 12 hours after the first dose. If the EC is a progestin-only pill, like Plan B, the only FDA approved product specifically designed for emergency contraception, a patient may take both doses at the same time.

To help protect rape victims from unintended pregnancy go to /ReproductiveRights/ReproductiveRights.cfm?ID=17705&c=30

—February 2007

ENDNOTES

1 For purposes of this fact sheet, EC means emergency contraceptive pills.  Intrauterine devices (IUDs) may also be used as post-coital contraceptives if inserted within 5 days of the unprotected intercourse.  However, pills are far more commonly used than IUDs as emergency contraception.

2 Charlotte Ellertson et al., Extending the time limit for starting the Yuzpe regimen of emergency contraception to 120 hours, 101 Obstet. Gynecol. 1168, 1168 (2003); Helena von Hertzen et al., Low dose mifepristone and two regimens of levenorgestrel for emergency contraception:  A WHO multicentre randomized trial, 360 Lancet 1803, 1809-10 (2002).

3 A copy of the ACLU briefing paper, Preventing Pregnancy after Rape: Emergency Care Facilities Put Women at Risk, may be downloaded at www.aclu.org/reproductiverights/gen/12748pub20041215.html. If you are interested in conducting a survey, the ACLU manual, EC in the ER: A manual for improving services for women who have been sexually assaulted, may greatly assist your efforts.  For copies of the manual, or for printed copies of the ACLU EC briefing paper, contact rfp@aclu.org or call 212-549-2633.

4 G. Piaggio et al., Timing of emergency contraception with levonorgestrel and the Yuzpe regimen, 353 Lancet 721, 721 (1999); see also Task Force on Postovulatory Methods of Fertility Regulation, Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception, 352 Lancet 428, 430-31 & Table 3 (1998).

5 American College of Obstetricians and Gynecologists, Sexual Assault 242 Educ. Bull. 3 (Nov. 1997); American College of Obstetricians and Gynecologists, Violence Against Women: Acute Care of Sexual Assault Victims (2004), at http://www.acog.org/departments/dept_notice.cfm?recno=17&bulletin=1625.

6 See, e.g., American Medical Association, Strategies for the Treatment and Prevention of Sexual Assault (1995).

7 Letter from Montana Coalition Against Domestic & Sexual Violence et al., to Diane M. Stuart, Director, Office on Violence Against Women (January 6, 2005), available at /ReproductiveRights/ReproductiveRights.cfm?ID=17278&c=30

8 National Sexual Violence Resource Center et al., Preventing Pregnancy from Sexual Assault:  Four Action Strategies to Improve Hospital Policies on Provision of Emergency Contraception (2003), available at http://www.nsvrc.org/resources/docs/ECtoolkit.pdf

9 Eve Espey et al., Emergency Contraception: Pharmacy Access in Albuquerque, New Mexico, 102 Obstet. Gynecol. 918, 920 (2003); Clara Bell Duvall Reproductive Freedom Project of the ACLU of Pennsylvania, Knowledge and Availability of Emergency Contraception in Pennsylvania Pharmacies (2002), at http://www.aclupa.org/duvall/ecinpa/pharmacists.html

10 For a detailed and useful response to religious objections to providing EC for rape victims, see National Sexual Violence Resource Center et al., Supra note 9, at 37-39.

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