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

MINNEAPOLIS (AP) — Some leaders in states with strict abortion bans say they don’t need exemptions for rape or incest victims because emergency contraception can be used. However, health professionals and advocates for rape survivors say that while emergency contraception is a useful tool, it is not always foolproof, and access to these emergency measures in the short time frame in which they would be effective may not be realistic. for someone who has just been attacked.

Here’s a look at emergency contraception and what some people are saying.


Emergency contraceptives are used to prevent pregnancy after unprotected sex or if a birth control method fails.

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

The pills block 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.


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


Not 100% of the time. The pills’ effectiveness improves the sooner they are taken after unprotected sex, 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 up to 120 hours or five days.

Timing is important because sperm can live inside a woman’s body for up to five days, so a woman can get pregnant if ovulation occurs after intercourse, said Dr. Dana Stone, an OB-GYN in Oklahoma City. If a woman ovulates before intercourse, pills are unlikely to help.

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

A woman’s weight may also play a role, although there is conflicting information about this. Guidance from the American College of Obstetricians and Gynecologists says levonorgestrel may be less effective in women with a body mass index of more than 25. The agency says some research shows that ulipristal acetate also has less effectiveness in women with a BMI of 30 or greater .

But the FDA found conflicting data and reached no conclusions in a 2016 review about the effectiveness of levonorgestrel in women who weigh more than 165 pounds or have a BMI over 25. The agency said additional research should be 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 remain in place for many years as a regular form of birth control.

Plan B can be bought over the counter by anyone 17 years of age or older, but younger people need a prescription. Ella needs a prescription.


Officials in some states, such as Texas Gov. Greg Abbott and South Carolina state Rep. Doug Gilliam, point to emergency contraception as a reason abortion bans don’t need exceptions for rape or incest.

During a House debate on Aug. 31, Gilliam said, in a hypothetical case of a 12-year-old raped by her father, the child would have “choices” and not be “forced” into pregnancy. Among them, she said, she could go to the hospital and get an emergency contraceptive or go to the store and get one over the counter.

Pressed by a fellow MP about who would take the girl to the store to get the pill, he initially replied, “The ambulance,” then corrected himself and said, “The hospital when they’re there.”

In an interview with The Associated Press, the Republican congressman said he did not want to suggest that an ambulance would take a girl to a store, but that if she went to the hospital, she would likely be offered emergency contraception. .

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


Most rape victims do not report the crime to law enforcement, according to Jude Foster, director of forensics 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 test, or that such a test is free.

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

Stone said the belief that a woman can just take Plan B if she’s in a hurry is wrong.

“We need all kinds of options for women because nothing is one size fits all,” Stone said. “People have transportation problems, they have financial problems. There are always barriers for some percentage of women that will prevent them from accessing it in the short time they have.”


Several states have expressly 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. Arkansas and Kentucky laws specifically say they do not prohibit contraceptive measures if they are used before a pregnancy is determined. Oklahoma’s abortion ban also does not apply to emergency contraception.

In addition to abortion bans, the National Conference of State Legislatures says 21 states and the District of Columbia have laws related to access to emergency contraception, and 16 of those and the District of Columbia require hospitals or health care facilities to provide information about or administer emergency contraception to women who have been sexually assaulted.

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

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


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