EXPLANATION: The “morning after pill” is not always an option after a rape

MINNEAPOLIS (AP) — Some leaders of states with strict abortion bans say exceptions for victims of rape or incest are unnecessary because emergency contraceptives can be used instead. But medical professionals and rape survivor advocates say that while emergency contraception is a useful tool, it’s not always foolproof, and having access to these emergency measures in the short time during which they would be effective may not be realistic for someone coming from…

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MINNEAPOLIS (AP) — Some leaders of states with strict abortion bans say exceptions for victims of rape or incest are unnecessary because emergency contraceptives can be used instead. But medical professionals and rape survivor advocates say that while emergency contraception is a useful tool, it’s not always foolproof, and having access to these emergency measures in the short time during which they would be effective may not be realistic for someone who has just been assaulted.

Here’s an overview of emergency contraceptives and what some people are saying about them.

WHAT ARE EMERGENCY CONTRACEPTIVES?

Emergency contraceptives are used to prevent pregnancy after unprotected sex or when a contraceptive method has failed.

Two types of medication, sometimes called “morning after pills,” are available: levonorgestrel, known by the popular brand name Plan B; and ulipristal acetate, known under the brand name ella. They should be taken as soon as possible after unprotected sex.

The pills prevent ovulation, which is when an egg is released from an ovary, said Dr. Jonah Fleisher, director of the Center for Reproductive Health at the University of Illinois at Chicago. If an egg is not released, it cannot be fertilized.

ARE THEY THE SAME AS ABORTION PILLS?

No. Emergency contraceptives prevent pregnancy. The abortion pill, mifepristone, terminates a pregnancy after a fertilized egg implants in the lining of a woman’s uterus. It is commonly given with the drug misoprostol and can be taken up to 11 weeks after the first day of a woman’s last menstrual period.

DOES EMERGENCY CONTRACEPTION WORK?

Not 100% of the time. The effectiveness of the pills improves the sooner they are taken after unprotected sex, the doctors said. The drugs won’t prevent pregnancies if taken before sex, Fleisher said.

The Food and Drug Administration has approved Plan B for use up to 72 hours, or three days, after unprotected sex. Ella is approved for a maximum of 120 hours or five days.

Timing is important because sperm can live in a woman’s body for up to five days, so a woman can still get pregnant if ovulation occurs after sex, Dr. Dana Stone said. obstetrician-gynecologist in Oklahoma City. If a woman has ovulated before sex, the pills are unlikely to be effective.

“So that’s where the failure comes in. It’s based on the timing,” Stone said.

A woman’s weight may also play a role, although there is conflicting information on this. Advice from the American College of Obstetrics and Gynecology indicates that levonorgestrel may be less effective in women with a body mass index greater than 25. The organization indicates that some research suggests that ulipristal acetate also has a less effective in women with a BMI greater than or equal to 30.

However, the FDA found conflicting data and drew no conclusions in a 2016 review of the effectiveness of levonorgestrel in women weighing more than 165 pounds or with a BMI greater than 25. The agency said that further research should be a priority.

Another form of emergency contraception, a copper intrauterine device, is considered the most effective method if inserted into a woman’s uterus within five days of unprotected sex. Its effectiveness does not depend on weight, Fleisher said.

A doctor or nurse must insert a copper IUD, which can stay in place for many years as a regular form of birth control.

Plan B can be purchased over-the-counter by anyone 17 or older, but younger people need a prescription. Ella needs a prescription.

WHAT DID THEY SAY?

Some state officials, such as Texas Governor Greg Abbott and South Carolina State Rep. Doug Gilliam, point to emergency contraceptives as a reason abortion bans don’t need exceptions for rape or incest.

During a House debate on August 31, Gilliam said that in the hypothetical case of a 12-year-old girl being raped by her father, the child would have “choices” and would not be “forced” to wear a pregnancy. Among them, he said, she could go to the hospital and get an emergency contraceptive, or go to the store and get one without a prescription.

Pressed by a fellow legislator who would take the girl to the store to get the pill, he first replied, “The ambulance,” then corrected himself and said, “The hospital when she’s there.”

In a follow-up interview with The Associated Press, the Republican lawmaker said he didn’t mean an ambulance would take a girl to a store, but that if she were to go to the hospital, she would likely see herself. offer emergency contraception. .

“I don’t want anyone to think that I told you that a 12-year-old child who has just been raped…is going to call an ambulance to go to a store,” he said. “I just let them know the options were there, and one of them was emergency medical contraceptives.”

WHAT ABOUT VICTIMS OF RAPE?

Most rape victims don’t report the crime to law enforcement, according to Jude Foster, director of forensic and prevention programs for the Minnesota Coalition Against Sexual Assault. Many also may not go for immediate medical attention. Not everyone knows that emergency contraceptives are an option and part of a routine rape exam, or that such an exam is free.

“Why is sexual assault being used as a political football when you talk about access to reproductive care? Foster said. “Please don’t. It really frustrates me.

Stone said the belief that a woman can just take plan B if she is raped is wrong.

“We need all kinds of options for women because nothing is unique,” ​​Stone said. “People have transport problems, they have financial problems. There are still barriers for a certain percentage of women that will prevent them from accessing it in the short time they have.

STATE LAWS

Several states have explicitly allowed emergency contraception in their abortion laws.

Arkansas, Kentucky, and Oklahoma all have laws that prohibit abortion at all stages of pregnancy and make no exceptions for cases of rape or incest. The laws of Arkansas and Kentucky explicitly say that they do not prohibit contraceptive measures if used before a pregnancy can be determined. Oklahoma’s abortion ban also does not apply to emergency contraception.

Aside from abortion bans, the National Conference of State Legislatures reports that 21 states and the District of Columbia have laws relating to access to emergency contraception, and 16 of them and the District of Columbia requires hospitals or health care facilities to provide information about or administer emergency contraception. women who have been sexually assaulted.

Fleisher said emergency contraception does not replace the need for abortion care, and those matters should be between a doctor and a patient.

“The people who write the laws don’t understand the choices that real people make,” he said.

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