Physicians neglect post-rape contraception

Erin Madsen

Rape – just the mention of it produces horror, disgust and fear. A rape-induced pregnancy might even be worse, for it is the result of an assault against a woman’s reproductive liberty and her psychological health. The most frustrating aspect of a forced impregnation is it is usually preventable, but determining the “right” action regarding post-rape contraception has unfortunately divided Minnesota’s largest medical community.

The Minnesota Medical Association accounts for 75 percent of the state’s physicians, and together they review and advocate for “fair and effective legislation and regulations for physicians and their patients.” That is, at least according to their mission statement.

But when the issue of post-rape contraception appeared on the bill at this year’s annual meeting, the battlefield was laden with so much opposition the issue will remain neglectfully silent for another year.

More than 32,000 women throughout the country will become pregnant due to rape during a single year. And that is only counting those females who are 18 and older. Victims of incest and statutory rape, often under the age of 18, are also at a high risk of forced impregnation due to repeated rape.

Many women will not be presented all their health care options during this critical moment as a result of the MMA’s indecision. The reasons are perhaps the most elusive and infuriating.

In the case of post-rape care, many hospitals have uniform protocols in accordance with their religious beliefs. That is fine, but upon a woman’s arrival, Catholic directives state if there is any chance of pregnancy, she will not be informed about or offered emergency contraceptive pills. There remains no conclusive test to show pregnancy results within three days of unprotected intercourse.

Regardless of a physician’s religious convictions, a woman should be, at the very least, informed about alternative options and referred to clinics where her needs might be sufficiently met. These women are not seeking religion but rather medical assistance, which should provide all beneficial information pertaining to their situation.

Other hospitals, which are not religiously affiliated, leave distribution of the information up to physician discretion. The problem with this is that bias might arise during post-rape treatment if the welfare of these victimized women depends on their physicians’ judgment.

How do the physicians decide who should be informed about and offered post-rape contraception? Are they relying on religious convictions to determine appropriate treatment? Most rape victims are assaulted by spouses or partners. Are physicians influenced by who the rapist was? It doesn’t matter who he was: a husband, a boyfriend, a family member, a stranger or an acquaintance. The patient was raped, and the act is no less devastating, in fact maybe even more so, when she knows her rapist well. That fact should guarantee her choice to seek pregnancy prevention, and her physician should not imply otherwise.

There are also hospitals that apparently do not believe this preventative measure is important to their patients. This is what their passiveness implies. In these hospitals, emergency contraception is not included as part of their post-rape care and doctors are not encouraged to inform their patients of such prevention. This doesn’t necessarily pertain to religious doctrines. It does, however, betray an ignorance toward post-rape care and what information might be crucial to a rape victim.

Of course, there are hospitals that require their physicians to adhere to uniform policies when treating rape victims, but sadly these are not the norm. They inform patients about the contraception, and following each woman’s decision, they either write a prescription or make a referral to another facility if they do not handle the contraceptives. This sounds like the intelligent and compassionate way of dealing with patients, but the method obviously hasn’t circulated throughout the entire medical community.

The contraceptive pills are neither new nor harmful to patients. In 1997, the U.S. Food and Drug Administration declared emergency contraceptive pills safe and effective. According to a Kaiser Family Foundation survey of that same year, while 99 percent of physicians considered the pills to be safe and 100 percent considered them to be effective, only 10 percent informed their patients about the pills on a routine basis.

This is both shocking and disappointing. Let me just clarify: Physicians know all about the pills and trust their safety and effectiveness, but they don’t like to tell their patients about them on a regular basis because…? I still can’t make any sense out of that.

Preventative medicine is also nothing new, but in the case of post-rape care, women’s reproductive health is in the hindsight of physicians who find advocating for an unfamiliar cause uncomfortable. No doubt, it is uncomfortable, but there is an urgency to remedy this issue on behalf of the women in this state and throughout the country. This affects every woman because every woman is at risk of being raped. The numbers are too horrifying to ignore.

According to the National Victims Center’s 1992 statistics, one in three women will be sexually assaulted in her lifetime. One in seven will be raped by her husband. One in four college women have been raped or suffered attempted rape.

Many of these women will not seek treatment because of the shame, fear and shock that envelopes rape victims. Those who do seek medical treatment need to be informed about this measure. Many do not even know the preventative measure exists; some are too traumatized to ask; and others have been raped by a husband or boyfriend, leaving these women to believe they have no options.

This is an important option about which women have the right to be well-informed. Furthermore, there needs to be consistency throughout the medical community in advocating the practice as part of routine, post-rape care. It doesn’t seem like a difficult solution to require hospitals to adopt uniform post-rape care protocol, where the victim would be presented with information about emergency contraception. Beyond that, referrals could easily be given and those hospitals that choose to handle the drug would be allowed to do so within their individual policies.

Even though the American Medical Association voted in December 2000 to expand the education of post-rape contraceptive care across the United States, not one state association has taken the initiative to adopt a similar policy. The issue has become too taxing on physicians who are consumed by personal doubts or don’t give enough weight to the price victims of rape are paying across the country because of physicians’ hesitation.

It comes as no surprise, female physicians are among the largest advocates for emergency contraception pills in the case of post-rape care. They know they’d like their own health care to consist of preventative options and beneficial information in such an awful circumstance. They know the contraceptive pills are essentially high doses of birth control pills. They know the pills function by delaying or inhibiting ovulation or deterring a fertilized egg form implanting in the womb. They know the pills are 75 percent to 99 percent effective when used within 72 hours of unprotected intercourse. They know this information puts rape victims back in control of their reproductive liberties and personal welfare.

According to the U.S. Department of Justice, 75 percent of all rape victims require medical treatment after a rape. The percentage of women who will be informed or offered emergency contraception during their treatment remains an elusive statistic. Needless to say, it’s a tragically low number.

If a physician informs his/her patient about birth control during an annual exam, there is no reason not to revisit those options in an emergency setting. For these rape victims, it is urgent and it is necessary. This is about their reproductive rights and their systems require as much protection and rehabilitation as their mental health, which is always addressed in post-rape care procedures.

Physicians who say this information is not “appropriate” in such circumstances are not only discrediting themselves as medical professionals but are also trivializing their patients’ well-being and recovery and are guilty of neglecting their patients’ valuable health care options.

Although the Minnesota Medical Association did not resolve the issue, it thankfully did not abandon it. However, the division among its members has sadly delayed women’s access to appropriate and responsible post-rape care.

Even though only 4.7 percent of rape victims become pregnant, that doesn’t justify the institutional disregard towards these victims who trust and rely on their physicians to advocate for their health and recovery. It’s seems like a small number until you or someone you love becomes one of them.

 

Erin Madsen is an English and creative writing senior. She welcomes comments at [email protected] Send letters to the editor to [email protected]