Is EC available in your local emergency department?

Your office dispenses emergency contraceptive pills (ECPs), your local pharmacies may fill ECP prescriptions, but do you know what your local hospital emergency department’s policy is on provision of emergency contraception?

According to a national survey of Catholic-owned hospitals, 82% denied women emergency contraception, even in cases of rape. Only 22% of the emergency departments that did not provide emergency contraception provided a useful referral.1

And in Washington state, a state noted for its progressive approach to ECPs, a 2000 survey revealed that out of 88 hospitals surveyed, just 25 supply ECPs, with nine of those hospitals only giving the drug to rape victims.2

The Clara Bell Duvall Reproductive Freedom Project at the Philadelphia-based American Civil Liberties Union of Pennsylvania contacted hospital emergency departments throughout the state. Only 28% of the hospitals surveyed routinely offered and provided EC to victims of sexual assault.3

"One of the interesting findings was that all of the hospitals provide prophylaxis for sexually transmitted diseases," observes Carol Petraitis, director of the Duvall Project. "So the question is: Why aren’t they providing prophylaxis for pregnancy?"

EC is standard of care

More than 300,000 women are raped in the United States each year, statistics show.4 Each year, more than 32,000 women become pregnant as a result of rape; about half of these pregnancies end in abortion.5

Emergency contraception is the standard of care for treatment of rape victims. Guidelines established by the Chicago-based American Medical Association require that rape victims be counseled about their risk of pregnancy and offered EC.6

There is growing concern that rape victims are not provided with EC in many hospital emergency departments, particularly in Catholic hospitals. A survey of 58 large urban hospitals across the nation, including 28 Catholic hospitals, shows that while policies at the 30 non-Catholic hospitals allow discussion of EC, prescription of EC, and hospital pharmacy dispensing of the drug, Catholic hospitals vary in their approach to these issues.7 Twelve of the Catholic hospitals surveyed said policy prohibits EC discussion, seven prohibit EC prescription, and 17 would not allow hospital pharmacies to dispense EC.

Advocate EC use

The Washington chapter of the National Abortion and Reproductive Rights Action League (NARAL) has launched a campaign to get hospitals in Pierce County and other parts of western Washington to provide the drug in their emergency departments. While Seattle has many 24-hour pharmacies that provide EC, there are few in Tacoma, Everett, and other smaller communities in western Washington. (Information on Washington’s collaborative practice project is reviewed in the August 1999 issue of Contraceptive Technology Update)

Washington NARAL presently is working with five hospitals, reports Dawn Merydith, program director. Of the five, three hospitals — Stevens Hospital in Edmonds, Tacoma General in Tacoma, and Providence of Everett in Everett — are "on board," and the other two hospitals are moving in that direction, states Merydith. The organization plans to work with all 88 Washington hospitals so that they will dis- pense ECPs (specifically Plan B, marketed by Bellevue, WA-based Women’s Capital Corp.) to all women, as well as educate hospital staff on EC and the hospital’s policy to dispense it. Catholic hospitals will be asked to dispense Plan B to all rape survivors, provide adequate referrals to all other women, and to educate staff on EC and their EC policies, says Merydith.

Washington NARAL is involving the community by asking community members to spread the word about EC and its availability at hospitals, says Merydith. The organization has developed a press release with the goal to release the information in local papers after the hospital has agreed to provide EC care, she notes.

In the Pennsylvania hospital survey, 51% of the facilities questioned said that information about EC and provision of ECPs is "physician-dependent" — given at the discretion of the emergency department physician on duty. About 70% of Catholic hospitals indicated such a response, compared to 49% of non-Catholic hospitals.

The Duvall Project is working with the Pennsylvania Coalition Against Rape in plotting the progress of EC in hospital use. Results of the survey are posted on the project’s web site (http://www.aclupa.org/duvall/ecinPA.html) and can be viewed by county. Sample letters are available so local hospitals may be contacted in regard to their current care standards. The Duvall Project is contacting emergency department chairpersons to direct their attention to the site and to have them provide updated information so that women have the most current data on local hospital practices.

"I think there is a great amount of room for work with the hospitals," observes Petraitis. "I think there are a certain number that will change their policies or improve their policies, but I also feel like there are quite a number who are not willing to do it."

References

1. Catholics for a Free Choice. Catholic Health Restrictions Updated. Washington, DC; 1999.

2. Doughton S. Contraception after the act. Tacoma News Tribune, August 20, 2001. Accessed at http://www.tribnet.com.

3. Clara Bell Duvall Reproductive Freedom Project. Emergency Contraception Services for Rape Victims in Pennsylvania Hospitals. Philadelphia. Accessed at http://www.aclupa.org/duvall/ecinPA.html.

4. American Medical Association. Strategies for the Treatment and Prevention of Sexual Assault. Chicago; 1995.

5. Tjaden P, Thoennes N. Prevalence, Incidence, and Consequences of Violence against Women: Findings from the National Violence Against Women Survey. Research in Brief. Washington, DC: U.S. Dept. of Justice, National Institute of Justice; Nov. 1998, NCJ 172837.

6. Holmes MM, Resnick HS, Kilpatrick DG, et al. Rape-related pregnancy: Estimates and descriptive characteristics from a national sample of women. Am J Obstet Gynecol 1996; 175:322.

7. Smugar SS, Spina BJ, Merz JF. Informed consent for emergency contraception: Variability in hospital care of rape victims. Am J Pub Health 2000; 90:1,372-1,376.