US: Justice department fails rape victims Print E-mail
BMJ  2005;330:112 (15 January)

Justice department fails to mention emergency contraception after rape

New York Janice Hopkins Tanne

More than 200 US medical organisations, religious leaders, women’s health
advocates, and groups providing advice for people who have been sexually
assaulted have asked the US Department of Justice to correct its guidelines
for treating people who have been raped because they fail to mention
emergency contraception.

The issue is controversial with US anti-abortion groups. Emergency
contraception usually prevents an egg from being released or fertilised, but
it may, rarely, prevent implantation of a fertilised egg. Some anti-abortion
groups believe that life begins at conception and prevention of implantation
is murder.

The Department of Justice was required by law to develop the first national
guidelines for caring for people who have been sexually assaulted. The 141
page guide was published in September 2004. It offers far more information
on checking patients for sexually transmitted infections than on the risk of
pregnancy after rape.

The guidelines say that health workers should discuss the possibility of
pregnancy with women who have been raped, give a pregnancy test for those
who might have become pregnant, and "discuss treatment options with
patients, including reproductive health services."

The guidelines do not mention emergency contraception. An earlier version of
the guidelines included information about emergency contraception, but this
was removed before the final draft was released, according to the Planned
Parenthood Federation of America and an expert quoted by the Philadelphia
Inquirer, which reported the guidelines’ lack of advice about emergency
contraception in late December.

For two weeks, officials at the Department of Justice did not answer
questions from the newspaper’s staff writer, Marie McCullough, who wrote the
story. Then a spokesperson for the department repeated points in the
guidelines, saying that all victims of sexual assault should receive high
quality care.

A pro-life Pennsylvanian doctor, George Isajiw, told Ms McCullough that
emergency contraception "was a dangerous drug that’s not doing any good or
else you’re causing an abortion." He added that "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."

Guidelines from the American Medical Association, the American College of
Obstetricians and Gynecologists, and the American College of Emergency
Physicians, among others, say that women who have been raped should be
offered emergency contraception.

According to the Planned Parenthood Federation of America, about 300 000 US
women are raped each year. Only 2-5% become pregnant­about 25 000 women.
Nearly all these pregnancies, about 22 000, could be prevented by emergency
contraception.

Last year the Food and Drug Administration over-ruled its advisory
committee’s recommendation that emergency contraception be made available
over the counter at pharmacies without a doctor’s prescription (BMJ
2004;328:1219). The administration said that young teenagers would not
understand the instructions and asked for proof that they would­something
not done before. The emergency drug will come up for review for over the
counter status again later this month.

Dr Vivian Dickerson, president of the American College of Obstetricians and
Gynecologists, said that a study in JAMA (2005;293:54-62) showed that women
aged 15 to 24 did not take advantage of emergency contraception to engage in
risky sexual behaviour.

At present, five states require hospitals to provide emergency contraception
to patients or to tell them how to get the pills. Emergency departments are
inconsistent in providing emergency contraception or information, however,
according to the American Civil Liberties Union and the Alan Guttmacher
Institute, which collects information about reproductive issues.

The Department of Justice’s guidelines, A National Protocol for Sexual
Assault Medical Forensic Examinations, is available at
www.ncjrs.org/pdffiles1/ovw/206554.pdf

December 2002’s Guttmacher Report on Public Policy is available at
www.agi-usa.org/pubs/tgr/05/5/gr050510.pdf