By Molly M. Ginty
Tuesday, December 27, 2005
As rape survivors encounter problems getting emergency contraception at Catholic and even secular hospitals, health advocates express growing impatience with the FDA for not approving Plan B for over-the-counter sale.
(WOMENSENEWS)--Even though many state laws require hospitals to offer emergency contraception after sexual assault, rape survivors who go to Catholic hospitals may find that it is not, in fact, offered to them.
In New York in 2004, a 22-year-old rape survivor was denied the emergency contraception drug Plan B by a nurse who told her, "We're a Catholic hospital and don't do birth control." It was one of a growing number of reports of hospitals denying access to this medication, which prevents unintended pregnancy.
Directives approved by the Vatican for all Catholic hospitals permit Plan B after sexual assault, but advocates say the hospitals sometimes withhold it when a woman's chances of becoming pregnant are greatest, during ovulation.
"Many Catholic hospitals test the rape victim to see if she is ovulating, and if she is, refuse to give her emergency contraception," says Jill Morrison, a senior counsel at the Washington-based National Women's Law Center. "In other words, if a woman needs emergency contraception, they don't provide it."
The Washington-based American College of Obstetricians and Gynecologists and the Bethesda, Md.-based National Institutes of Health define pregnancy as beginning at implantation. But the Catholic Church and some pharmacists define pregnancy as beginning earlier, when the sperm and egg first unite before implantation.
This discrepancy can mean that rape survivors seeking treatment at Catholic hospitals, which comprise 12 percent of U.S. health care facilities, can lose access to emergency contraception.
In a statement to Women's eNews about the approach that Catholic hospitals take to administering Plan B to rape survivors, the St. Louis-based Catholic Health Association of the United States said that most Catholic hospitals test for a pregnancy that occurred before and is unrelated to the sexual assault.
"If the pregnancy test is negative, the woman is offered emergency contraception. Some other Catholic hospitals test for ovulation in order to check whether a woman is at the point in her menstrual cycle when conception might have already occurred. Since there is no current method for ascertaining that an ovum has been fertilized until implantation, this tests whether conception is a possibility (though a remote one, less than 1 percent to 5 percent). Because of the assumptions of the ovulation approach, it would not be morally licit to give a woman emergency contraception at this point. Nor would it be morally licit to refer a woman who has been sexually assaulted to another provider to receive emergency contraception if she has ovulated recently. This would mean that the woman receives emergency contraception at a point in her cycle when the medication is believed to have an abortifacient effect."
Amid access difficulties such as this, some health advocates are growing increasingly impatient with the Food and Drug Administration, which for two and a half years has refused to approve over-the-counter sales of Plan B, an emergency contraception drug that is 89 percent effective at preventing unintended pregnancy if taken within 72 hours of unprotected intercourse.
"For rape victims, the possibility of becoming pregnant is terrifying and overwhelming," says Lois Uttley, director of the New York-based MergerWatch. "Thus, women's health advocates consider it cruel for the FDA to continue placing obstacles in the path of rape victims who need emergency contraception."
Even at secular institutions, access is not guaranteed. Some hospitals provide emergency contraception on site. Some give rape survivors prescriptions but--if the hospitals don't have the drugs on site--require survivors to find pharmacists to fill prescriptions. Other hospitals require patients to get a prescription from an independent doctor then find an independent pharmacist. Less than 40 percent of hospitals in 11 states surveyed provided Plan B on site to rape survivors, a 2005 report by the New York-based American Civil Liberties Union found.
Sometimes called the "morning-after pill" or "emergency contraception," Plan B is made of the synthetic hormone progestin and is dispensed in two doses that must be taken within 12 hours of each other.
The Centers for Disease Control and Prevention, the Chicago-based American Medical Association and the Washington-based American College of Obstetricians and Gynecologists all recommend that women be offered emergency contraception following a sexual assault.
"When I was raped in 1995, getting easy access to emergency contraception brought me indescribable relief," says Lori Robinson, author of "I Will Survive: The African-American Guide to Healing from Sexual Assault and Abuse."
According to a 2004 survey by the Philadelphia-based Clara Bell Duvall Reproductive Freedom Project, three-quarters of 174 pharmacies surveyed were not able to fill a rape survivor's Plan B prescription within 24 hours.
"When I was raped in 1994 and wasn't offered emergency contraception at the hospital, I was up in arms about it when what had happened hit home later," says Karen D. Carroll, associate director of the Bronx Sexual Assault Response Team in New York. "At both Catholic and non-Catholic hospitals, emergency contraception is an issue that many doctors are still not bringing up with rape survivors."
Emergency contraception could prevent up to 90 percent of the 25,000 pregnancies resulting from rape in the United States each year, according to studies published in 1998 in The Lancet and 2000 in the American Journal of Preventive Medicine.
At least 9,000 abortions each year stem from pregnancies resulting from rape, according to the New York-based Guttmacher Institute. Many abortion funds report that high levels of women seeking abortion (up to 11 percent) are pregnant as a result of rape or incest, according to the Boston-based National Network of Abortion Funds.
Health advocates say that if the FDA, based in Rockville, Md., put Plan B on drug store shelves, it would spare rape survivors the problems they face when they try to get it from pharmacies and hospitals that block access. It could also spare them the consequences of unwanted pregnancy: either seeking an abortion or deciding to carry a rapist's child to term.
Whether they are protecting their privacy or fear retaliation by their attackers, whom they know in 60 percent of cases, rape survivors often do not follow the recommended medical protocol: forgoing a shower and heading straight to the hospital to get a forensic exam and take emergency contraception.
FDA approval of Plan B over-the-counter sales would allow sexual assault survivors--60 percent of whom never report their attacks--to prevent unintended pregnancy even if they never seek medical care and even if they never interact with authorities.
"Rape survivors should be able to get the morning-after pill when they need it by walking into a drug store and buying it regardless of their decision to report the attack as a crime," says Annie Tummino, vice-chair of the New York-based Women's Liberation Birth Control Project.
Nine states do require hospitals to offer emergency contraception on site. But even in those states--California, Massachusetts, New Jersey, New Mexico, New York, Ohio, Oregon, South Carolina and Washington--there are stories of hospitals barring access.
"We hear sporadic reports and are actually doing a survey with the advocates in those states to see how they think it's going," says Carol Petraitis, director of the Clara Bell Duvall Reproductive Freedom Project. "It's hard to understand how in such a compelling situation, these hospitals are failing victims--and failing all of us who expect more from our health care providers."
Molly M. Ginty is a freelance writer based in New York City.
Sexual Assault Survivors Speak Out:
Kaiser Family Foundation--
"Emergency Contraception: Background Brief":