EC in D.C.: an analysis of Washington D.C.'s emergency contraception legislation.

• Author: Emerson, Joelle

INTRODUCTION

In 2009, Washington, D.C. passed a law requiring that sexual assault victims in the District's emergency rooms be given information about--and access to--emergency contraception (EC). The law joined a group of thirteen other state "EC in the ER" (emergency contraception in the emergency room) laws, (1) but is potentially stronger than existing legislation. Built into the statute is a unique system of proactive enforcement, including the option of fining hospitals that violate the law. (2) Despite these advances, D.C.'s law has fallen short in its implementation: those charged with ensuring that the law is complied with seem unaware of the law and their enforcement responsibilities. D.C. thus serves as an important example to other local jurisdictions by highlighting how implementation problems can thwart otherwise innovative and well-intentioned laws.

1. IMPORTANCE OF PROVIDING EC TO RAPE VICTIMS

   Emergency contraception, commonly referred to as the "morning after pill," is an FDA-approved method of preventing pregnancy after sexual assault, unprotected intercourse, or failure of another birth control method. (3) EC is effective if taken within seventy-two hours, but has the highest success rate if taken within twenty-four hours. (4) In general, the sooner EC is taken, the better it works. (5) Because of the time-sensitive nature of emergency contraception, and because emergency rooms serve as an entry point into the health care system for victims of sexual assault who may not have the time or ability to get to a primary care doctor, (6) it is essential that emergency rooms provide EC to victims.

   EC drugs in the United States contain the hormone progestin, and can reduce the risk of getting pregnant by seventy-five percent if taken within seventy-two hours. (7) EC is not an abortion pill: it works to prevent pregnancy, not to end an existing pregnancy. (8) If taken while pregnant, EC will not affect the pregnancy. (9) In fact, it works in much the same way as do other types of birth control pills, (10) used by over eleven million American women annually. (11) Proponents of EC suggest that it would eliminate the need for roughly one million abortions in the United States each year. (12)

   Emergency contraception is an important part of comprehensive medical care for sexual assault victims. The National Protocol for Sexual Assault Medical Forensic Examinations has found that "[f]or individuals who experience this horrendous crime, having a positive experience with the criminal justice and health care systems can contribute greatly to their overall healing." (13) The World Health Organization recommends that if a woman sees a doctor within five days of being sexually assaulted, emergency contraception should be offered. (14) Women who are not provided with EC are forced to choose between having an abortion and carrying an unwanted pregnancy to term.

   While the medical community widely recognizes the benefits of emergency contraception, (15) and advocates consider it a critical part of the treatment of sexual assault victims, (16) victims are still facing major barriers to accessing EC in emergency rooms. In some cases hospitals have a policy of not providing EC; in others, individual doctors or nurses choose not to provide it. (17) Particularly problematic are the objections raised by Catholic Church-affiliated hospitals which, under the Ethical and Religious Directives for Catholic Health Care Services (the Directives) developed by the U.S. Conference of Catholic Bishops, claim that providing emergency contraception--even to sexual assault victims--conflicts with their religious beliefs. (18) The Directives were designed to ensure that Catholic hospitals, which make up 12.7% of the nation's hospitals (19) and 25% of emergency rooms in D.C., (20) do not violate Catholic teachings, including a prohibition on the use of artificial contraception. This prohibition means that Catholic hospitals, in general, are not likely to dispense EC. (21) Thus, it makes sense that states that want sexual assault victims to be given appropriate care in emergency rooms attempt to regulate EC provision. Without regulation, provision of the drug--especially in Catholic hospitals--cannot be guaranteed.

2. D.C. ENACTS LEGISLATION TO ENSURE EC ACCESS FOR VICTIMS

   The District of Columbia's Emergency Care for Sexual Assault Victims Act of 2008 passed unanimously in the Committee on Health, was signed by Mayor Adrian Fenty, and became effective March 25, 2009. (22) It ensures that hospitals within the District provide medically and factually accurate information about emergency contraception to patients, as well as give sexual assault victims the option to receive emergency contraception to prevent unwanted pregnancy resulting from the assaults. (23) Before the law was passed, there was no requirement that hospitals provide EC, despite the fact that advocacy groups and medical experts agree that it is an essential element of comprehensive and compassionate care for victims of sexual assault. (24) The legislature was prompted to enact this law by the overwhelmingly high rates of sexual assault both nationwide and within the District, (25) and by the fact that sixteen other states have legislation requiring hospitals to provide sexual assault victims with information...