Sexual Violence and EC Access

One in five women worldwide experiences rape or attempted rape in her lifetime. In conflict settings, rape can be even more common, (for more on EC use in conflict settings, click here), but even in non-conflict settings, rape is frequent. Unfortunately, one result of sexual assault for many survivors is unwanted pregnancy. In the U.S., for instance, among all women who reported rape in 1998, 25,000 became pregnant. Most of these pregnancies could have been avoided by using EC.

Offering emergency contraception (EC) to rape survivors who seek care within 5 days after the crime is a critical option in preventing the traumatic psychological and physical consequences of rape-related pregnancy. EC can successfully prevent pregnancy if taken up to 120 hours after unprotected sex. (To learn more about how EC works, click here.)

EC should be offered to sexual assault survivors as part of routine post-rape care

Despite high incidences of rape worldwide, national policies on providing EC in post-rape care vary significantly. International bodies support rape survivors’ right to EC access. The World Health Organization (WHO) released new global guidance on sexual violence in 2013, including clear recommendations for the provision of EC as part of prompt and comprehensive women-centered care. In addition, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) issued guidance to its global programs on EC for post-rape care of children and adolescents. Some national governments, such as those in KenyaEcuadorSouth Africa, Brazil, Bolivia and the United States have published management guidelines for sexual assault survivors which recommend EC use. Other countries, like Colombia, either do not offer national guidelines or have guidelines that do not include EC. In Mexico, several states have refused to implement federal legislation requiring EC as part of post-rape care. Even worse, in Honduras, where it is illegal to sell or provide EC, all women, including rape survivors, can be arrested for taking EC.

Policies should ensure that EC is a consistent component of post-rape care. This includes requiring first responders to counsel women on the existence of EC, ensuring that a dedicated EC product is dispensed to survivors on-site, and mandating that police officers, forensic doctors, and other emergency health providers receive sufficient training on EC’s availability and mechanism of action. Where a registered product does not exist, health practitioners should offer higher dosages of combined oral contraceptives, a regimen known as the Yuzpe method (for more information, click here). Finally, because many women do not receive EC in time and because EC sometimes fails to prevent pregnancy when used, health care providers should offer counseling about other available options, including abortion where it is legal.

Policies requiring EC in post-rape care must be enforced

In addition, even where standing policies require health care providers to dispense EC in emergency settings, additional efforts must be made to ensure that these policies are enforced. This is particularly urgent in many Catholic hospitals and clinics, which sometimes delay women’s access to EC or entirely prohibit individual doctors and health care staff from providing or counseling on EC. (For more information on this issue, click here.) Rape survivors who present within 120 hours should immediately be provided with EC on-site.

For more information, see our fact sheet Emergency Contraception for Rape Survivors: A Human Rights and Public Health Imperative.

To learn more about provision of EC in U.S. emergency rooms, please see MergerWatch.