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Federal Rape Response Protocol Ignores Emergency Contraception

by Jessica Azulay

A breakthrough document guiding health care providers through the many aspects of treating rape survivors fails to mention the option of offering treatment to prevent pregnancy, upsetting women’s rights advocates.

Jan. 10, 2005 – A coalition of women’s rights groups and advocates petitioned the Justice Department last week, demanding it amend recently released guidelines on the treatment of sexual assault survivors. The 130-page National Protocol for Sexual Assault Medical Forensic Examinations is meant as a suggestive guide for medical professionals and law enforcement as they conduct examinations and care for survivors of rape. Yet, as women’s rights activists point out, the document does not provide information about emergency contraception for women who want to prevent pregnancy resulting from rape.

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In a letter sent last week to the Justice Department, 206 national, state and local organizations along with 71 individuals -- many who work with sexualized violence survivors as counselors or health care providers -- asked that the Protocol be amended to include a thorough discussion of options for and counseling about pregnancy prevention.

"The failure to include a specific discussion of emergency contraception in the first national protocol for sexual assault treatment is a glaring omission in an otherwise thorough document," the letter says. "Including counseling about pregnancy prevention and the provision of emergency contraception would help rape victims prevent unintended pregnancies, avoid abortions, and safeguard their mental health."

In the brief section entitled "Pregnancy Risk Evaluation and Care," the protocol instructs care providers to discuss the probability of pregnancy with female patients, conduct a pregnancy test with the patient’s consent and discuss treatment options. Though the document advises that assault survivors’ "often overwhelming and genuine fear" of pregnancy "should be taken seriously," the protocol merely suggests that care providers "discuss treatment options with patients, including reproductive health services."

The groups petitioning the Justice Department for an amendment to the protocol point out that "the marked failure to include details about specific pregnancy prevention options is at odds with the Protocol’s expansive treatment of other grave medical concerns a victim faces."

By comparison, the section on sexually transmitted infections (STI’s) is substantially longer and more detailed than the one discussing pregnancy.

Late last month, Gail Burns-Smith, former director of the Connecticut Sexual Assault Crisis Services and one of numerous experts who the Justice Department consulted during the Protocol’s development, told Knight Ridder news service that a discussion of emergency contraception did appear in earlier drafts. She said she did not know who, if anyone, opposed it.

At least some of the groups that are petitioning the Justice Department believe that the omission was politically motivated.

Gloria Feldt is the president of Planned Parenthood Federation of America, the nation's largest voluntary reproductive health organization, which operates nearly 850 health centers nationwide, providing reproductive health care and sexuality education to women and men. "It is outrageous that the ‘comprehensive’ protocols do not mention emergency contraception," she said in a press statement. "This is a blatant example of politics taking precedence over the emotional and physical health needs of women."

Meanwhile, some socially conservative groups are content to leave the wording of the Protocol as is. "I think it's very smart not to put that in the guidelines," Dr. George Isajiw, the anti-abortion group, Physicians for Life, told Knight Ridder. Isajiw said that he believes emergency contraception is "a dangerous drug that’s not doing any good" and that it can cause an abortion. "As a moral principle, a woman has the right to defend herself against an aggressor. But she doesn't have the right to kill the baby."

Nevertheless, the efficacy of emergency contraception, which is a high dose of the same hormones used in birth control, is well documented, at a pregnancy prevention rate of 75 to 90 percent up to 72 hours after unprotected intercourse, depending, at least in part, on how soon it is taken. Additionally, emergency contraceptives, which are often referred to as the "morning after pill," does not abort a pregnancy in most cases, but instead prevent fertilization of the egg outright. Advocates of emergency contraceptives also point out that abortion for rape survivors as well as other women who do not want to carry a fetus to term is a legal right under most circumstances in all states and say it should be medically available.

Asked about the omission, Justice Department spokesperson Eric Holland simply told Knight Ridder, "The goals of the protocol are to ensure that all victims, regardless of differences in background or location of service, receive the same high quality medical and forensic exam, while being treated with respect and compassion, and to improve prosecution of sexual assault cases through the appropriate collection of evidence."

He added, "The protocol is not intended to supercede the many state, local, and tribal protocols that are currently in practice."

But for women’s rights advocates, the disparate nature of the state and local laws underscores the necessity for strong wording in the national Protocol. Surveys conducted by the American Civil Liberties Union, the University of Pennsylvania and the University of Medicine and Dentistry of New Jersey, have found that significant numbers of hospitals do not routinely offer emergency contraception to rape survivors and some had explicit policies against it.

"The Protocol published by the Department of Justice has the potential to fill this information void at many hospitals and to ensure appropriate treatment for sexual assault patients," write the groups. "To do this effectively, however, the Protocol must be revised to include an explicit discussion of emergency contraception."

And, they say, time is of the essence. Considering that the efficacy of the drug is greater when taken sooner, offering it as an option to women as a routine part of rape aftercare is most appropriate.

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The NewStandard ceased publishing on April 27, 2007.

Jessica Azulay is a staff journalist.

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