Emergency contraception (EC) is a safe and effective means of reducing the risk of pregnancy after unprotected intercourse. Despite its enormous potential, anti-choice groups, whose goal it is to eliminate abortion, oppose this important means of reducing unplanned pregnancies. In order to hinder women's access to EC, they falsely claim that it is an abortifacient, and they disseminate other misinformation about its safety and efficacy.

Women who have been sexually assaulted have a particularly compelling need for quick and easy access to EC. More than 300,000 women are sexually assaulted each year in the U.S. Of these an estimated 25,000 will become pregnant as a result. About 22,000 of these pregnancies could be prevented if all women who were raped used EC (Stewart & Trussell, 2000).

Alarmingly, there is mounting evidence that some hospitals, especially religiously affiliated hospitals, are not providing EC to sexual assault survivors. This practice is counter to the standards outlined by the American Medical Association, which state that women who have been sexually abused should be counseled about the risk of pregnancy, and offered EC (AMA, 1995).

EC Defined

EC can reduce the risk of pregnancy after unprotected intercourse. Emergency contraception pills (ECPs) — the most common method of EC — contain hormones that reduce the risk of pregnancy if started within 120 hours (five days) of unprotected intercourse. The treatment is more effective the sooner it begins (“FDA Approves …,” 1999; Rodriguez, 2001; Van Look & Stewart, 1998).

ECPs are safe and effective at reducing the risk of pregnancy. Almost all women can safely use ECPs — millions of women around the world have safely reduced their risk of pregnancy by using them (Guillebaud, 1998; Van Look & Stewart, 1998). When initiated within 72 hours after unprotected intercourse, ECPs that contain both estrogen and progestin reduce the risk of pregnancy by 75 percent; progestin-only regimens reduce the risk by 89 percent. When initiated within 24 hours of unprotected intercourse, progestin-only ECPs were found to reduce the risk of pregnancy by 95 percent (TFPMFR, 1998; Van Look & Stewart, 1998). Plan B®, a progestin-only medication, is currently the only product marketed specifically as EC (OPR, 2005).

ECPs should not be confused with mifepristone, a medicine used for medication abortion. ECPs will not induce an abortion in a woman who is already pregnant, nor will they affect the developing pre-embryo or embryo (Van Look & Stewart, 1998). ECPs prevent unintended pregnancies — and help prevent the need for abortion. Most often, ECPs prevent pregnancy by inhibiting ovulation. They also work by altering the tubal transport of sperm or ova to inhibit fertilization. In 1997, the FDA stated that ECPs may also work by altering the endometrium to inhibit implantation, but a recent study suggests that progestin-only ECPs work only by preventing ovulation or fertilization, and have no effect on implantation, although interception of implantation is a theoretical possibility (Croxatto, et al., 2003; FDA, 1997; Marions, et al., 2002).

An alternate, less common form of EC involves inserting a copper-releasing IUD up to seven days after unprotected intercourse. When used as EC, the IUD is very effective, reducing the risk of pregnancy by more than 99 percent (“IUD Most …,” 1995; Van Look & Stewart, 1998).

Despite its long history of safety and efficacy, knowledge about EC is still limited among the general public. More than 30 percent of American women do not know enough about EC to effectively use it — unless hospitals advise women who are brought to the emergency room following sexual assault about EC, women will be unlikely to know enough to ask for this vital treatment (KFF, 2004).

EC Access in Hospitals

Many hospitals neglect their responsibility to offer EC to sexual assault survivors as an option for reducing the risk of pregnancy. For example, in Pennsylvania, only 28 percent of hospitals routinely offer and provide EC to sexual assault survivors, and 12 percent do not provide any EC services to sexual assault survivors (Clara Bell Duvall Education Fund, 2000). As a result of hospitals’ failure to provide EC services, alarming numbers of women are placed at risk of pregnancy following sexual assault. A study of sexual assault survivors who were treated in emergency rooms found that less than half of the women at risk of pregnancy received EC (Amey & Bishai, 2002). Another study found that as many as 1,000 sexual assault survivors per year left New York State emergency rooms without having received emergency contraception (FPANYS, 2003).

Catholic hospitals have a deplorable record of providing EC to sexual assault survivors. U.S. Catholic hospitals must observe the Ethical and Religious Directives for Catholic Health Care Services, established by the United States Conference of Catholic Bishops. In general, the Directives greatly limit access to reproductive health care, including EC, but because they are subject to interpretation by each bishop for his diocese, there is wide variation in the effect that the Directives have on reproductive health services (Lagnado, 1999; USCCB, 2001).

In regard to EC access for sexual assault survivors, the Directives state,

Compassionate and understanding care should be given to a person who is the victim of sexual assault ... A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum (USCCB, 2001).

There is no test for the presence of a fertilized egg that can be given within the time frame that EC requires. Therefore, Catholic providers take differing approaches interpreting the Directives (Bucar, 1999). The most conservative interpretation calls for no access to EC, or to information about it.

Other interpretations of the Directives support offering EC on the grounds that hospitals have “no evidence that conception has occurred already.” These interpretations do not require evidence that conception has not occurred.

Another view calls for determining whether there is a chance that the woman may have ovulated, and could potentially have had an egg fertilized. In such cases, a woman would be denied EC. Implementation of this interpretation may call for a pregnancy test, questioning about the last menstrual cycle, and hormone testing to try to determine whether ovulation might have occurred (Bucar, 1999). This approach is particularly inhumane because the average woman’s chance of getting pregnant on any given day ranges from zero percent to 35 percent, depending on the stage of her menstrual cycle (Wilcox, et al., 1995). Under this interpretation, a woman would be denied EC if she happened to be raped during the six days that end on the day of ovulation — which is precisely the time of the month she would be most at risk of becoming pregnant.

A study of the nation’s nearly 600 Catholic hospital emergency rooms found that only 28 percent offered EC to women who had been raped. Even among those Catholic hospitals that did provide EC to sexual assault survivors, the majority mandated some sort of barrier to a woman getting EC, such as requiring a police report or pregnancy test (CFFC, 2002a). In Pennsylvania, a study found that in nearly 70 percent of Catholic hospitals, information about EC was at the physician’s discretion. In the end, only six percent of Pennsylvania Catholic hospitals offer EC (Clara Bell Duvall Education Fund, 2000). Only one Catholic hospital in the state of Maryland was found to offer EC consistently to sexual assault survivors (Maryland NARAL Educational Fund, 2002).

The rates at which EC is withheld from women who have been sexually assaulted are even more disturbing when the reach of the Catholic health care system is considered:

• In June 2000, it was found that 10 of the 20 largest not-for-profit hospital systems in the U.S. were operated by Catholic entities (Pawelko & Krishnamurthy, 2001).
• During the 1990s, there were 159 mergers between Catholic and non-Catholic hospitals, which reduced access to reproductive health services, including EC (CFFC, 2002b).
• In the U.S., 13 percent of all hospitals with emergency rooms are Catholic. In many states, 30–40 percent of people who need emergency care visit a Catholic hospital (CFFC, 2002a).
• If a Catholic hospital is a community’s only provider, sexual assault survivors are left with very little chance of being taken to a hospital that will provide them with EC.

Support for EC

Widespread access and availability of EC for all women as a means of reducing unintended pregnancy is endorsed by many groups, including the American Medical Association and the American College of Obstetricians and Gynecologists (ACOG, 2001; AMA, 2000). There is overwhelming support for offering EC to women following a sexual assault. One survey found that 78 percent of women feel their hospital should provide EC for anyone who has been raped (CFFC, 2000). A survey of registered voters conducted for the Planned Parenthood Action Fund in June 2001 confirmed these findings — three of four voters favored requiring all hospitals to make EC available to women who had been raped. Further, 53 percent of voters said they would be more likely to vote for a candidate who supports mandatory EC availability in hospitals for sexual assault survivors, and half of voters said they would be less likely to vote for a candidate who would allow hospitals to deny access to EC for women who had been raped.

It is unconscionable that health care systems and practitioners unnecessarily place women who have been sexually abused at risk of the additional trauma of an unwanted pregnancy. EC has been shown to be safe and effective, and it is unethical to withhold it for any reason from a woman who has been raped. Guidelines must be established and enforced so that hospitals uniformly counsel sexual assault survivors and provide them with EC.

Additional Resources

Catholics for a Free Choice, 1436 U St., NW, Suite 301, Washington, DC 20009; 202-986-6093; http://www.cath4choice.org

EC Web site — http://www.not-2-late.com

MergerWatch, a project of the Education Fund of Family Planning Advocates of New York State, an Albany, New York-based group that has long-standing relationships with health officials and members of the legislature. Write care of Family Planning Advocates of New York State, 17 Elk St., Albany, NY 12207; 518-436-8408; http://www.mergerwatch.org

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