The Justice Department has issued its first-ever medical guidelines for treating sexual-assault victims — without mention of emergency contraception, the standard precaution...
PHILADELPHIA — The Justice Department has issued its first-ever medical guidelines for treating sexual-assault victims — without mention of emergency contraception, the standard precaution against pregnancy after rape.
Omission of the so-called morning-after pill has frustrated and angered victims’ advocates and medical professionals.
Washington and four other states — California, Illinois, New Mexico and New York — have laws requiring hospitals to provide the contraception, or at least tell victims how to obtain the pills.
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Gail Burns-Smith, one of several dozen experts who vetted the protocol during its three-year development by Justice’s Office on Violence Against Women, said emergency contraception was included in an early draft, and she does not know of anyone who opposed it.
“But in the climate in which we are currently operating, politically it’s a hot potato,” said Burns-Smith, retired director of Connecticut Sexual Assault Crisis Services.
For two weeks, Justice officials were unavailable to talk about the new 141-page protocol, published in September. In an e-mail, however, department spokesman Eric Holland reiterated points made in the document.
“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 wrote. “The protocol is not intended to supersede the many state, local and tribal protocols that are currently in practice.”
The controversy has erupted weeks before the Food and Drug Administration is scheduled to reconsider whether to make it easier to obtain emergency contraception. The FDA last year rejected nonprescription sales of Plan B, an emergency contraceptive. The ruling delighted conservative groups that had lobbied the Bush administration, but went against the FDA’s staff, advisory panels and major medical societies.
The manufacturer’s latest application would make Plan B available without a doctor’s orders only to girls and women 16 and older.
The Pennsylvania chapter of the American Civil Liberties Union is collecting signatures on a petition urging the Justice Department to fix the “glaring omission in an otherwise thorough document.”
In the half-page on pregnancy “risk evaluation and care,” the protocol says to take victims’ pregnancy fears “seriously,” give a pregnancy test, and “discuss treatment options, including reproductive-health services.”
Advocates note that emergency contraception — nothing more than high-dose birth-control pills — reduces the chance of pregnancy 75 to 90 percent, but only if taken within 72 hours of sex.
“This narrow window of effectiveness makes timely access to emergency contraception critical,” the petition declares.
The development of national guidelines was required under the 2000 renewal of the decade-old federal Violence Against Women Act to develop uniform, quality care for sexual-assault victims.
“In too many hospitals, the nurses and doctors are still reading the rape-kit directions while they’re doing the exam,” said Linda Ledray, who directs the Sexual Assault Resource Service in Minneapolis.
One of the most inconsistent aspects of care is the morning-after pill. A 2002 analysis of national emergency-room data by the University of Medicine and Dentistry of New Jersey found that only 21 percent of sexual-assault victims received it. In a 1998 survey of urban Catholic hospitals, a University of Pennsylvania study found that 12 of 27 centers had rules against informing rape victims about the method.
The risk of pregnancy after rape is small — less than 5 percent — but the vulnerable group is large. Of 333,000 sexual assaults and rapes reported in 1998, about 25,000 resulted in pregnancies — of which 22,000 could have been prevented, a Princeton University population researcher estimated.
Emergency contraception is controversial because, like stem cells and cloning, it has become tangled in the politics of abortion. The method usually works by keeping an egg from being released or being fertilized. However, it sometimes may prevent a fertilized egg from implanting in the uterus — equated with murder by some conservative groups and the Catholic Church (which opposes all forms of contraception).
“I think it’s very smart not to put that in the guidelines,” said Dr. George Isajiw, a board member of Physicians for Life, a Philadelphia anti-abortion group.
By giving emergency contraception, he said, “you’re giving a dangerous drug that’s not doing any good, or else you’re causing 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.”