Where does your state stand on EC in the ED?
A new patient tells you that she is a recent victim of sexual assault. What care was she provided when she underwent treatment at your local hospital's emergency department (ED)?
There is a good chance she was not offered emergency contraception (EC). According to results from a 2005 national telephone survey of 615 non-Catholic hospitals and 587 Catholic hospitals, ED staff answering the telephone at 42% of the non-Catholic hospitals and 55% of Catholic hospitals said their department does not dispense emergency contraception under any circumstance. The survey was conducted by Ibis Reproductive Health, a Cambridge, MA-based women's reproductive health research and advocacy organization.1
In 2004, the Department of Justice published the first-ever national medical guidelines for sexual assault treatment; however, no mention of EC was included in the document.2 According to the American Civil Liberties Union (ACLU) Reproductive Freedom Project, based in New York City, the Department of Justice ignored requests filed in 2005 by advocates and members of Congress to amend the publication's protocol to include information about EC and pregnancy prevention. In August 2005, the ACLU sent a Freedom of Information Act request to the federal government on behalf of a broad coalition asking for documents that explain the omission of information about EC from the protocol; however, the government failed to provide responsive materials, according to the ACLU.2
Sexual assault groups, legislative officials, medical groups, women's health advocates, and civil liberties groups throughout the country have launched statewide campaigns to urge governors and other state officials to adopt protocols for treating sexual assault survivors that ensure access to emergency contraception.
Advocates are looking to states to get EC in the ED: 12 states have introduced bills this year, according to Jennifer McAllister-Nevins, state strategies attorney for the ACLU Reproductive Freedom Project. The states are Arizona, Connecticut, Florida, Hawaii, Illinois, Minnesota, Missouri, Pennsylvania, South Dakota, Tennessee, Wisconsin, and West Virginia. "We don't know if any of these are moving, but we expect that state legislatures will recognize the importance of providing appropriate care to rape victims," she says.
In addition, advocates in Alaska, Colorado, Idaho, New Hampshire, Oklahoma, Pennsylvania, and Wyoming have issued letters asking their governors and other state officials to "act where the federal government has failed to, making certain that [their state] protocol recommends victims of sexual assault be offered emergency contraception on-site in their initial exam."3 The letters also ask for officials to advocate for increased funding in their state for medical staff that specialize in treating sexual assault patients.3
Through this project, reproductive rights advocates around the country have joined forces with sexual assault victims' advocates to ensure rape victims receive appropriate care in the ED, explains McAllister-Nevins. The states that participated in the letter-writing campaign did so because they believe that writing letters to state official to include emergency contraception in their state sexual assault protocols is an effective way to ensure rape victims receive the care they need, she notes.
Reproductive rights advocates and sexual assault victims' advocates are continuing to work together to increase access to EC for rape victims, including efforts in states that did not participate in the original letter-writing campaign, says McAllister-Nevins.
Use the toolkit
Nine states now require hospital EDs to provide EC-related services to sexual assault victims, according to the Alan Guttmacher Institute in New York City.4 Eight states — California, Illinois, Massachusetts, New Jersey, New Mexico, New York, Texas, and Washington — require EDs to provide information about EC. Seven states — California, Massachusetts, New Jersey, New Mexico, New York, South Carolina, and Washington — require EDs to dispense EC on request to assault victims. While Ohio and Oregon have EC in the ED policies, neither have an enforcement mechanism in place.4
While progress has been made on the state front, there still is room for improvement, says Carol Petraitis, director of the Clara Bell Duvall Reproductive Freedom Project at the Philadelphia-based American Civil Liberties Union of Pennsylvania. According to a just-released survey conducted by Ibis Reproductive Health for the Washington, DC-based Catholics for a Free Choice, staff at 35% of Catholic hospitals in New York, California, South Carolina, and Washington state — three states with EC in the ED legislation on the books — refused to provide emergency contraception to women who requested it.5
If your state does not have EC legislation, take a look at "Preventing Pregnancy from Sexual Assault: Four Action Strategies to Improve Hospital Policies on Provision of Emergency Contraception," a joint publication of the National Sexual Violence Resource Center Education in Enola, PA, the Education Fund of the Albany, NY-based Family Planning Advocates of New York State, and the Clara Bell Duvall Reproductive Freedom Project. It offers information on how to assess the need for EC in your state's EDs, as well as how to build coalitions among reproductive health advocates and sexual assault victim organizations.
About 25,000 American women become pregnant each year following an act of sexual violence; as many as 22,000 of these pregnancies could be prevented through the prompt use of emergency contraception.6 Know that the number of women who visit an ED following a sexual assault represent only a "tiny fraction" of the number who have been assaulted, says Petraitis. Increasing access to emergency contraception through legislation, pharmacy access, and other efforts is important to help reach these women, she adds.
- Harrison T. Availability of emergency contraception: A survey of hospital emergency department staff. Ann Emerg Med 2005; 46:105-110.
- U.S. Department of Justice. Office of Violence Against Women. National Protocol for Sexual Assault Medical Forensic Examinations. Adults/Adolescents. Washington, DC; September 2004.
- American Civil Liberties Union Reproductive Freedom Project. Advocates throughout the Country Urge States to Ensure Access to Emergency Contraception for Rape Victims. Press release. Jan. 19, 2006. Accessed at: www.aclu.org/reproductiverights/contraception/23543prs20060119.html.
- Alan Guttmacher Institute. State Policies in Brief. Emergency Contraception. April 1, 2006. Accessed at: www.guttmacher.org/statecenter/spibs/spib_EC.pdf.
- Ibis Reproductive Health for Catholics for a Free Choice. Complying with the Law? How Catholic Hospitals Respond to State Laws Mandating The Provision of Emergency Contraception to Sexual Assault Patients. Washington, DC. January 2006.
- Stewart FH, Trussell J. Prevention of pregnancy resulting from rape: A neglected preventive health measure. Am J Prev Med 2000; 19:228-229.
To access the publication "Preventing Pregnancy from Sexual Assault: Four Action Strategies to Improve Hospital Policies on Provision of Emergency Contraception," go to the Clara Bell Duvall Reproductive Freedom Project web site, www.aclupa.org/duvall. Click on "Duval Project Publications," then "EC toolkit," to download the publication.