Many women in the United States will be sexually assaulted during their lifetimes. And the aftermath of sexual assault impacts women health long after the assault itself.
Survivors of sexual assault have been shown to have a greater increase in psychiatric disorders directly after their assaults than patients who have not been assaulted. Other research reaffirms this impact on psychiatric health, with 30% of women survivors of sexual assault reporting symptoms of post-traumatic stress disorder nine months after their assault, and 13% of women who are raped attempt suicide.
Physical health problems have also been shown to increase after a sexual assault, reflected in increases in obstetrics and gynecology services. Women with recent sexual assault or abuse have also been shown to have a much higher rate of sexually transmitted infections. Survivors of sexual assault also have higher rates of drug addiction than those who have not been assaulted.
The wide-reaching mental and physical health impacts of sexual assault have been known to the public and healthcare practitioners for some time, and have led to many conversations on how to best provide compassionate and trauma-informed healthcare to survivors. Legislation, such as the Violence Against Women Act has sought to help mandate justice, solutions, and access for survivors of assault, and many healthcare providers want to be part of those solutions.
Yet, while discussion about engaging sensitively with survivors of assault in healthcare settings is important, as it stands, only 13 states currently mandate that emergency contraception must be dispensed upon request in hospitals for survivors of sexual assault. And without access to healthcare like emergency contraception that could prevent the added burden of an unplanned pregnancy, we cannot say we are truly providing trauma-informed care to survivors.
Anywhere from 25,000-32,000 pregnancies occur per year as a result of sexual assault (additional source). Sexual assault and an unwanted pregnancy are already independently traumatic for women. But, the addition of the physical, mental, and financial trauma of a pregnancy as a result of rape, adds exponentially to distress.
There are a number of gaps in our healthcare and legislative system preventing survivors from universal access to emergency contraception after rape. One major one is the “religious refusal” that both explicitly and implicitly plays a role in the denial of trauma-informed care to sexual assault survivors. Many major hospitals that have religious affiliations can claim the right of “religious refusal” to deny abortion and contraceptive services to individuals. And, there is increasing momentum to enable individual health care providers to refuse to perform or refer for reproductive health care services based on their religious beliefs.
However, even in states or hospitals where the law does mandate emergency contraception for survivors of sexual assault, survivors are often denied this access. Studies have found that even when at non-Catholic hospitals, emergency contraception often isn’t provided, and often times even the referrals (Catholic and non-Catholic) are ineffective. Even when comprehensive healthcare is provided to survivors after rape, often times survivors are billed for extraneous costs, compounding their emotional and physical burden with a financial burden.
Even though there are other ways to get emergency contraception, for example, over the counter, time is of the essence in making emergency contraception as effective as possible. Second, the cost of emergency contraception over the counter is still prohibitive to many with an average cost of $60 at pharmacies. A woman should not be forced to pay for her rape and to carry the burden of an unplanned or unwanted pregnancy. This is why, as public health practitioners and advocates, we want comprehensive access to emergency contraception for all survivors of sexual assault.
Health care practitioners need to consider better solutions that include easy access to emergency contraception if they truly want trauma-informed care for their patients. There are a number of ways healthcare practitioners and decision-makers can help:
- Emergency rooms should provide emergency contraception without cost to the survivor—especially given the importance of time in efficacy. This could be covered by the Crime Victim Compensation Fund, which is already the established source to help cover the post-sexual assault healthcare costs of survivors.
- Doctors, nurses, and other healthcare providers should acquaint themselves with their hospitals’ policies. If they live in a state where providing emergency contraception on request is not mandated, they should be prepared with effective referrals for survivors.
- If concerned citizens live in a state, or work in a hospital where providing emergency contraception is not currently mandated, they should lobby legislators and hospital boards for pharmacies to be able to dispense emergency contraception for survivors of rape consistently.
The National Protocol for Sexual Assault Medical Forensic Examinations declares that when rape or other forms of sexual assault occur, [pdf] “victims deserve competent and compassionate care.” In order to provide that kind of care, we need to ensure that survivors of sexual assault have access to a range of healthcare services—including emergency contraception. Without this access that could prevent a survivor from having to carry a pregnancy that was the result of her rape, we cannot claim we are providing trauma-informed care.
Megha Ramaswamy
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