Emergency Contraception & Sexual Assault: Why Compassionate Care Should be a Standard of Care

The Compassionate Assistance for Rape Emergencies (CARE) Act (HR.2928/S.1264) and the Prevention First Act (HR.1709/S.20) were introduced in Congress in 2005. The sole purpose of the CARE Act, and one of several goals of the Prevention First Act would be to direct hospitals and emergency medicine facilities that receive federal funding to inform all women who have been sexually assaulted about emergency contraception (also known as the "morning after pill" or "Plan B") and to make it available to them, regardless of their ability to pay.

The idea behind this legislation is not radical. In fact, it is supported by the nation's leading medical organizations, including the American Medical Association, the American College of Emergency Physicians, ¹ the American College of Obstetrics and Gynecologists, the American Academy of Pediatrics, ² and the American Public Health Association. It is needed because many hospital emergency departments don't talk about EC with assault victims, and neither dispense it nor provide prescriptions to obtain it at outside pharmacies.³ Unfortunately, no action has been taken on either bill because neither has received much support from Republicans in Congress. Once EC becomes available over-the-counter in US pharmacies (which is expected by the end of 2006) it will still be important to educate women who have been raped about this option to prevent pregnancy.

What is Emergency Contraception?
Emergency contraception, also known as the "morning after" pill, contains the same active ingredients as regular oral birth control medications, but in higher concentrations. EC has been determined by the Food and Drug Administration (FDA) to be safe for preventing pregnancy, and is most effective when taken within 72 hours after unprotected sex.⁴ Possible side effects - which include nausea, vomiting, and spotting - are relatively mild. EC does not induce abortion, because it will not terminate an already established pregnancy. It is believed that it prevents pregnancy by preventing the egg from leaving the ovary; by preventing the sperm from joining the egg; or by preventing a fertilized egg from attaching to the uterus.

EC and Sexual Assault Victims
Almost two-thirds of all rapes are committed by individuals who are known by the victim, with 70% of these individuals being either an acquaintance or a friend of the victim.⁵ Approximately 57% of all acquaintance rapes occur while on a date.⁶ Dates and other social settings of acquaintance rape, like parties, typically occur at night or on the weekends, when the only medical facility available to a victim for treatment is the hospital emergency room.

One study, based on data from the National Hospital Ambulatory Medical Care Survey from 1992 to 1998, found that less than half of all women who went for treatment for sexual assault and who were considered to be at risk for pregnancy (that is, they were not already sterilized, pregnant, or currently taking regular oral contraceptives) received EC.⁷ A national telephone survey using a "mystery client" approach in which researchers pose as women simply inquiring about the availability of EC in 597 Catholic hospitals and 615 non-Catholic hospitals, found that 55% and 42%, respectively, do not dispense EC, even in cases of sexual assault.⁸

State Laws
In the absence of federal legislation, a few states have tried to amend this unfortunate situation with laws that require their state's hospital emergency departments to inform assault victims about EC or to dispense EC to assault victims when they request it, or both.⁹ It is unclear whether these laws have corrected the problem.

One study looked at the availability of EC in Catholic hospitals in Washington, New York, California, and South Carolina, after these states passed legislation that either directly or indirectly mandated that EC be provided to sexual assault victims.¹⁰ Based on a survey administered to sexual assault nurse examiners regarding their hospitals' written policies on providing EC to rape victims and a "mystery client" approach, the researchers found that there is still room for improvement. While most of the hospitals' policies appeared to comply with their local EC laws, 35% of the hospitals informed a "mystery client" caller that they do not provide EC, regardless of a patient's circumstance, and 38% of the hospitals surveyed indicated that they do not treat sexual assault patients.

Federal Legislation is Still Needed
Legislation to ensure that women who are raped can have access to EC - regardless of where they live and what hospital cares for them - is desperately needed. The odds that the current proposals will gain momentum before this congressional session is over are very slim, but it is important that the public, along with public health professionals and sexual assault advocates, continue to let lawmakers know how important this issue is.

Women can't afford to be kept waiting for this legislation. Sadly, approximately 5% of all rape victims, ages 12 through 45, will become pregnant as a result of their attack. This translates into roughly 25,000 to 32,000 pregnancies each year. It is estimated that wider knowledge about and availability of EC could reduce that by as much as 89%.^{11, 12} Those victims of sexual assault who summon the courage to go to a medical facility to receive treatment deserve the utmost compassion and respect. Just as they deserve to be fully informed about treatment options to prevent sexually transmitted infections, they deserve the opportunity to prevent the occurrence of unwanted pregnancy.

1. American College of Emergency Physicians. (2002, October). Management of the Patient with the Complaint of Sexual Assault. Retrieved on August 2, 2006 from: http://www.acep.org

2. American Academy of Pediatrics. (2001). Care of the adolescent sexual assault victim. Pediatrics, 107(6), 1476-1479.

3. Rosenberg, K. D., DeMunter, J. K., & Liu, J. (2005). Emergency contraception in emergency departments in Oregon, 2003. American Journal of Public Health, 95(8), 1453-1457.

4. U.S. Department of Health and Human Services, Office on Women’s Health. (2006, May). Emergency Contraception: Frequently Asked Questions. Retrieved on August 10, 2006 from: http://www.4woman.gov/faq/econtracep.htm

5. Rape, Abuse & Incest National Network. (2006). Facts about Rape. Retrieved on August 10, 2006 from: http://www.rainn.org/statistics/index.html

6. Rape Crisis Volunteers of Cumberland County. (2000). Date Rape. Retrieved on August 10, 2006 from: http://www.rapecrisisonline.com/DateRape.htm

7. Amey, A. L. & Bishai, D. (2002). Measuring the quality of medical care for women who experience sexual assault with data from the National Hospital Ambulatory Medical Care Survey. Annals of Emergency Medicine, 39(6), 631-638.

8. Harrison, T. (2005). Availability of emergency contraception: A survey of hospital emergency department staff. Annals of Emergency Medicine, 46(2), 105-110.

9. Guttmacher Institute. (2006, August 1). State Policies in Brief: Emergency Contraception. Retrieved on August 7, 2006 from: http://www.guttmacher.org/statecenter/spibs/spib_EC.pdf

10. Catholics for a Free Choice. (2006, January). Complying with the Law? How Catholic hospitals respond to state laws mandating the provision of emergency contraception to sexual assault patients, A study conducted by Ibis Reproductive Health for Catholics for a Free Choice. Washington, DC: Catholics for a Free Choice.

11. Holmes, M. M., Resnick, H. S., Kilpatrick, D. G., & Best, C. L. (1996). Rape-related pregnancy: Estimates and descriptive characteristics from a national sample of women. American Journal of Obstetrics and Gynecology, 175(2), 320-325.

12. Stewart, F. H. & Trussell, J. (2000). Prevention of pregnancy resulting from rape: A neglected preventative health measure. American Journal of Preventive Medicine, 19(4), 228-229.