EC in the ED: What is your state’s policy?
When it comes to emergency contraception (EC), it is an accepted standard of care in your clinic. But when it comes to the emergency department (ED) at your local hospital, is it the same story?
Not likely — and that is a concern for women who have been sexually assaulted. Women’s health advocates had looked to the publication of the first-ever national medical guidelines for sexual assault treatment to rectify the matter; however, no mention of EC is included.
The 130-page document, released by the Department of Justice (DOJ) in September 2004, represents an important step toward ensuring that all sexual assault victims receive high-quality medical and forensic services, notes Jennifer McAllister-Nevins, state strategy attorney with the New York City-based American Civil Liberties Union (ACLU) Reproductive Freedom Project. However, failure to include EC in the guidelines is a "lost opportunity," she says.
The guidelines devote five pages to evaluation and care of sexually transmitted diseases. Yet, just one page is given to pregnancy risk evaluation and care, where the guidelines direct providers to "discuss treatment options with patients, including reproductive health services."1 No mention is made of EC, although previous drafts of the document had included discussion of the method.2
The new federal regulations are out of compliance with Washington, DC-based American College of Obstetricians and Gynecologists (ACOG) standards, which specifically state that physicians should administer pregnancy tests and offer EC as part of their overall sexual assault exam,3 states Anita Nelson, MD, professor in the obstetrics and gynecology department at the University of California in Los Angeles (UCLA) and medical director of the women’s health care clinic and nurse practitioner training program at Harbor-UCLA Medical Center in Torrance. Similar guidelines established by the Chicago-based American Medical Association require that rape victims be counseled about their risk of pregnancy and offered EC.4
The Dallas-based American College of Emergency Physicians includes information on emergency contraception in its recommendations on the evaluation and management of sexual assault patients.5 Most ED providers surveyed at a national medical conference said they were willing to provide EC.6
EC not used in sexual assault treatment
A 2002 study found that EC is not part of routine ED procedures.7 According to the analysis of national ED data by researchers at the Newark-based University of Medicine and Dentistry of New Jersey, just 21% of sexual assault victims were given EC.7
In a recently released ACLU briefing paper, analysts found that in eight out of eleven states studied, fewer than 40% of emergency care facilities routinely provide EC on-site to women who have been sexually assaulted. The results varied from a low of 6% of facilities in Louisiana and 8% in Idaho, rising to 28% in New Mexico, Pennsylvania, and Wisconsin, to 80% in New Hampshire and 85% in New York.8
Women’s health advocates are working within their individual states to see that EC language is included in legislation for sexual assault treatment, says McAllister-Nevins. There is much room to cover, though; only a handful of states have legislation on EC in the ED, according to the New York City-based Alan Guttmacher Institute:
- Five states (California, Illinois, New Mexico, New York, and Washington) require EDs to provide information about EC to women who have been sexually assaulted.
- Five states (California, New Mexico, New York, South Carolina, and Washington) require EDs to dispense upon request EC to women who have been sexually assaulted.
- One state — Ohio — requires health care providers that object to dispensing EC to refer patients to another health care provider.9
- Oregon law authorizes state payment when EC is dispensed to women who have been assaulted, although it does not mandate treatment or information.10
A broad coalition of national, state, and local organizations have banded together to seek inclusion of EC information in the DOJ guidelines. In addition, a "Best Help for Rape Victims Act" bill (HR 1214) has been filed in the federal House of Representatives to require the Department of Justice to include EC in its new guidelines.
"It is really important to have a national protocol," says McAllister-Nevins. "The document in many ways is so thorough and addresses several important points; EC should be one of them."
References
- U.S. Department of Justice. Office of Violence Against Women. National Protocol for Sexual Assault Medical Forensic Examinations. Adults/Adolescents. Washington, DC; September 2004.
- McCullough M. Sex-assault treatment guidelines omit pill. Philadelphia Inquirer, Dec. 31, 2004. Accessed at: www.philly.com/mld/inquirer/10536368.htm.
- American College of Obstetricians and Gynecologists. Sexual assault. ACOG Educ Bull 1997; 242:1-7.
- American Medical Association. Strategies for the Treatment and Prevention of Sexual Assault. Chicago: American Medical Association; 1995.
- American College of Emergency Physicians. Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient. Dallas; 1999.
- Keshavarz R, Merchant RC, McGreal J. Emergency contraception provision: A survey of emergency department practitioners. Acad Emerg Med 2002; 9:69-74.
- Rovi S, Shimoni N. Prophylaxis provided to sexual assault victims seen at U.S. emergency departments. J Am Med Women’s Assoc 2002; 57:204-207.
- American Civil Liberties Union. Preventing Pregnancy after Rape. Emergency Care Facilities Put Women at Risk. New York City; December 2004.
- Alan Guttmacher Institute. State Policies in Brief. Access to Emergency Contraception. New York City; March 2005.
- Gold RB. Key reproductive health-related developments in the states: 2003.Guttmacher Report Pub Pol2003; 6:11-12.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content