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It's Not Bad Enough To Be Raped

Quarter of state's ER's withhold emergency contraception

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Over 5,000 victims of sexual assault report to North Carolina hospital emergency rooms every year. Even though nurses who examine these women say the victims' number one concern is the possibility of becoming pregnant as a result of the rape, as many as 1,000 victims are sent away from NC hospitals each year without receiving emergency contraception. According to a new statewide study, over one-quarter of all NC hospitals do not provide sexual assault survivors with EC on-site, and of the hospitals that do provide it, 11 percent allow providers to refuse to do so for reasons based on conscience, even though EC does not technically terminate a pregnancy.

These findings were released last week by NC Women United, a coalition of about 40 organizations that work on women's advocacy issues, from sexual assault and domestic violence to economic justice. Last summer, the coalition surveyed all 115 hospitals in NC that have an emergency room, in order to determine each emergency department's policies for dispensing EC to survivors of sexual assault. A total of 101 hospitals responded to the survey. Of those, 75 hospitals reported that it was standard policy to dispense EC on-site, but nine had exceptions to their policy based on the refusal of the provider on duty to dispense medication. Twenty-six hospitals reported that it was not standard policy to dispense EC on-site, and 15 of those reported that they only provide a prescription for EC.

According to Melissa Reed, executive director of the NC branch of the National Abortion and Reproductive Rights Action League (NARAL), 67 hospitals were deemed as compassionate "model hospitals." This is defined as a hospital that provides emergency contraception to survivors of sexual assault in the emergency room, and does not allow the provider to refuse to provide this basic standard of healthcare. The hospitals within both of Charlotte's two major medical centers — Presbyterian Healthcare and Carolinas Medical Center — were deemed model hospitals.

Thirty-four hospitals in NC, however, either have a refusal clause which allows the doctor on-call to refuse to dispense EC, or they only provide a prescription for EC. The majority of these hospitals are in rural areas. In fact, the survey showed that nearly 40 percent of rural hospitals had no policy requiring providers to dispense EC on-site. Reed believes this is because fewer victims of sexual assault report to emergency departments in rural communities, therefore the hospitals don't have a protocol in place.

"It's critical that a woman take EC within the first 72 hours after intercourse to prevent a pregnancy," Reed says. "Often these women don't report to the hospital until a day or two after the assault has occurred. The problem with hospitals that only issue a prescription is that the victim then has to go find a pharmacy that carries the drug. It puts an additional burden and expense on the victim."

Paige Johnson, the chair of NC Women United's Board of Directors, says that compounding the problem is the fact many pharmacies in rural areas routinely refuse to carry EC. "It's like a series of hoops a woman has to go through if she doesn't get EC at the hospital," Johnson says. "We need to ensure every sexual assault survivor receives the same level of care at every hospital."

It should be noted that the most common form of EC, known as "Plan B," is not the same as Mifeprex, the early abortion option, also called RU-486. ECs do not cause abortion; rather, they reduces a woman's chance of becoming pregnant by up to 89 percent by inhibiting ovulation, fertilization, or implantation before a pregnancy occurs. ECs do not work if a woman is already pregnant and will not harm an already existing pregnancy.

According to estimates provided by Princeton University, approximately 25,000 women in the US become pregnant each year as a result of rape. An estimated 22,000 of these unintended pregnancies — 88 percent — could be prevented if sexual assault victims had timely access to EC.

Monika Johnson-Hostler, executive director of the NC Coalition Against Sexual Assault, says all hospitals should provide comprehensive care including EC to rape victims. "Rape is a horrific crime with little community support, thus for those victims that are brave enough to go to the emergency department, they deserve to receive comprehensive care which includes EC," Johnson-Hostler says.

Currently, only five states — California, New Mexico, New York, South Carolina, and Washington — have EC in the ER laws or laws with similar requirements. Reed says both the NC Hospital Association and the Department of Health and Human Services are working with NC Women United to ensure that sexual assault victims receive information about and access to emergency contraception in NC hospital emergency rooms.

For more information about NC Women United and the survey, go to: www.ncwu.org/2004/ecer.

Contact Sam Boykin at sam.boykin@cln.com.

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