Post by Moses on Jan 3, 2005 21:29:32 GMT -5
www.philly.com/mld/inquirer/10536368.htm?1c
Posted on Fri, Dec. 31, 2004
Victims' advocates call emergency contraception key, seek Justice changes.
By Marie McCullough
Inquirer Staff Writer
The U.S. Department of Justice has issued its first-ever medical guidelines for treating sexual-assault victims - without any mention of emergency contraception, the standard precaution against pregnancy after rape.
The omission of the so-called morning-after pill has frustrated and angered victims' advocates and medical professionals who have long worked to improve victims' care.
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. But in an e-mail, 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 supercede the many state, local, and tribal protocols that are currently in practice."
Lynn Schollet, a lawyer with the Illinois Coalition Against Sexual Assault, said that without emergency contraception, the trauma of rape could be compounded by an unplanned pregnancy.
"It is very unfortunate to set forth a model national standard that is not giving women the best care available," Schollet said.
The controversy has erupted just weeks before the Food and Drug Administration is scheduled to reconsider whether to make it easier to get emergency contraception. A year ago, the FDA 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 own staff, advisory panels and major medical societies.
The manufacturer's latest application would make Plan B available without a doctor's orders to females 16 and over.
Responding to the Justice Department guidelines, the Pennsylvania chapter of the American Civil Liberties Union is collecting signatures on a petition urging the 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 say emergency contraception, which is high-dose birth-control pills, reduces the chance of pregnancy 75 to 90 percent - but only if taken within 72 hours of unprotected sex.
"This narrow window of effectiveness makes timely access to emergency contraception critical," declares the petition.
Five states - New York, Illinois, California, Washington and New Mexico - have laws requiring hospitals to provide the contraception to victims, or at least tell them how to get the pills.
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, a sexual-assault exam trainer 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 out 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, estimated James Trussell, a Princeton University population researcher.
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 may sometimes 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 of Lansdowne, a board member of Physicians for Life, a Philadelphia antiabortion 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."
Anne Liske, executive director of the New York State Coalition Against Sexual Assault, said the decision should be left to the woman. "The victim needs to be in charge of decisions about her care," she said.
New York state - which mandates that hospitals, regardless of religious affiliation, provide the contraception to rape victims - recently fined a Coney Island hospital $46,000 for not giving it correctly and mishandling forensic evidence needed for prosecution.
"We've just started to get successful lawsuits" against hospitals that don't provide emergency contraception, said Ledray in Minneapolis. "I'm afraid such lawsuits will fail if the national protocol doesn't treat emergency contraception as the standard of care."
Some experts who reviewed the protocol think it is a huge step forward - just not the last step.
Dr. Michael Weaver of Kansas City, Mo., helped write the American College of Emergency Physicians' sexual-assault response protocol, which prominently includes emergency contraception.
"If we can get this national protocol out there," he said, "we can gather evidence more appropriately and prosecute more cases, and it will be a much healthier society."
Contact staff writer Marie McCullough at 215-854-2720 or mmccullough@phillynews.com.
Posted on Fri, Dec. 31, 2004
Victims' advocates call emergency contraception key, seek Justice changes.
By Marie McCullough
Inquirer Staff Writer
The U.S. Department of Justice has issued its first-ever medical guidelines for treating sexual-assault victims - without any mention of emergency contraception, the standard precaution against pregnancy after rape.
The omission of the so-called morning-after pill has frustrated and angered victims' advocates and medical professionals who have long worked to improve victims' care.
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. But in an e-mail, 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 supercede the many state, local, and tribal protocols that are currently in practice."
Lynn Schollet, a lawyer with the Illinois Coalition Against Sexual Assault, said that without emergency contraception, the trauma of rape could be compounded by an unplanned pregnancy.
"It is very unfortunate to set forth a model national standard that is not giving women the best care available," Schollet said.
The controversy has erupted just weeks before the Food and Drug Administration is scheduled to reconsider whether to make it easier to get emergency contraception. A year ago, the FDA 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 own staff, advisory panels and major medical societies.
The manufacturer's latest application would make Plan B available without a doctor's orders to females 16 and over.
Responding to the Justice Department guidelines, the Pennsylvania chapter of the American Civil Liberties Union is collecting signatures on a petition urging the 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 say emergency contraception, which is high-dose birth-control pills, reduces the chance of pregnancy 75 to 90 percent - but only if taken within 72 hours of unprotected sex.
"This narrow window of effectiveness makes timely access to emergency contraception critical," declares the petition.
Five states - New York, Illinois, California, Washington and New Mexico - have laws requiring hospitals to provide the contraception to victims, or at least tell them how to get the pills.
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, a sexual-assault exam trainer 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 out 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, estimated James Trussell, a Princeton University population researcher.
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 may sometimes 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 of Lansdowne, a board member of Physicians for Life, a Philadelphia antiabortion 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."
Anne Liske, executive director of the New York State Coalition Against Sexual Assault, said the decision should be left to the woman. "The victim needs to be in charge of decisions about her care," she said.
New York state - which mandates that hospitals, regardless of religious affiliation, provide the contraception to rape victims - recently fined a Coney Island hospital $46,000 for not giving it correctly and mishandling forensic evidence needed for prosecution.
"We've just started to get successful lawsuits" against hospitals that don't provide emergency contraception, said Ledray in Minneapolis. "I'm afraid such lawsuits will fail if the national protocol doesn't treat emergency contraception as the standard of care."
Some experts who reviewed the protocol think it is a huge step forward - just not the last step.
Dr. Michael Weaver of Kansas City, Mo., helped write the American College of Emergency Physicians' sexual-assault response protocol, which prominently includes emergency contraception.
"If we can get this national protocol out there," he said, "we can gather evidence more appropriately and prosecute more cases, and it will be a much healthier society."
Contact staff writer Marie McCullough at 215-854-2720 or mmccullough@phillynews.com.