MINNEAPOLIS (AP) 鈥� Some leaders in states with strict bans say exceptions for rape or incest victims aren鈥檛 needed because emergency contraceptives can be used instead. But medical professionals and advocates for rape survivors say that while emergency contraception is a helpful tool, it鈥檚 not always foolproof, and getting 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 assaulted.
Here鈥檚 a look at emergency contraceptives and what some people are saying.
WHAT ARE EMERGENCY CONTRACEPTIVES?
Emergency contraceptives are used to prevent pregnancy after unprotected sex or if a method of birth control fails.
Two types of medications, sometimes referred to as 鈥渕orning after pills," are available: levonorgestrel, known by the popular brand name Plan B; and ulipristal acetate, known under the brand 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 in Chicago. If an egg is not released, it cannot be fertilized.
ARE THEY THE SAME AS ABORTION PILLS?
No. Emergency contraceptives prevent a pregnancy. mifepristone, ends a pregnancy after a fertilized egg has implanted in the lining of a woman鈥檚 uterus. It's commonly administered with the drug misoprostol and can be taken up to 11
DOES EMERGENCY CONTRACEPTION WORK?
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 they are 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鈥檚 body for up to five days, so a woman can still get pregnant if ovulation occurs after intercourse, said Dr. Dana Stone, an OB-GYN in Oklahoma City. If a woman has ovulated prior to intercourse, the pills are unlikely to help.
鈥淪o that鈥檚 where the failure comes in. It鈥檚 based on the timing,鈥� Stone said.
A woman's weight also may play a role, though there is conflicting information on that. Guidance from the American College of Obstetrics and Gynecology says levonorgestrel may be less effective in women with a body mass index that's over 25. The organization says some research suggests ulipristal acetate also has lower effectiveness among women with a BMI that's 30 or higher.
However, the FDA found conflicting data and reached no conclusion in a 2016 review of the effectiveness of levonorgestrel in women who weigh more than 165 pounds or have a BMI above 25. The agency said additional research should be a priority.
Another form of emergency contraception, a copper intrauterine device, is seen as the most effective method, if inserted into a woman's uterus within five days of unprotected sex. Its effectiveness is not dependent 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 purchased over the counter by anyone 17 or older, but younger people need a prescription. Ella requires a prescription.
WHAT DID THEY SAY?
Officials in some states, such as Gov. Greg Abbott and state Rep. Doug Gilliam, point to emergency contraceptives as a reason abortion bans don't need exceptions for rape or incest.
During an Aug. 31 House debate, Gilliam said, in a hypothetical case of a 12-year-old raped by her father, the child would have 鈥渃hoices鈥� and wouldn鈥檛 be 鈥渇orced鈥� to carry 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 lawmaker on who would take the girl to the store to get the pill, he initially replied 鈥淭he ambulance,鈥� then corrected himself and said, 鈥淭he hospital when she鈥檚 there."
In a follow-up interview with The Associated Press, the Republican lawmaker said he did not mean to suggest that an ambulance would take a girl to a store, but that if she were to go to the hospital, she would likely be offered emergency contraception.
鈥淚 don鈥檛 want anybody to think that I told you a 12-year-old that just been raped 鈥� is going to call an ambulance to go to a store,鈥� he said. 鈥淚 just let them know the options were out there, and one of them was emergency medical contraceptives.鈥�
WHAT ABOUT RAPE VICTIMS?
Most rape victims don't report the crime to law enforcement, according to Jude Foster, advocacy medical forensic and prevention programs director for the Minnesota Coalition Against Sexual Assault. Many also may not go in for immediate medical care. Not everyone knows that emergency contraceptives are an option and part of a routine rape exam, or that such an exam is free.
鈥淲hy is sexual assault used as a political football when you are talking about access to reproductive care?鈥� Foster said. 鈥淧lease don鈥檛. It just really frustrates me.鈥�
Stone said the belief that a woman can just take Plan B if she is raped is misguided.
鈥淲e need all kinds of options for women because nothing is a one size fits all,鈥� Stone said. 鈥淧eople have transportation problems, they have financial problems. There are always barriers to some percentage of women that will keep them from accessing this in the short time frame that they have.鈥�
STATE LAWS
Several states have explicitly allowed for emergency contraception in their
Arkansas, Kentucky and Oklahoma all have laws that ban abortion at all stages of pregnancy, and make no exceptions for cases of rape or incest. Arkansas鈥� and Kentucky鈥檚 laws explicitly say they don鈥檛 prohibit contraceptive measures if they are used before a pregnancy can be determined. Oklahoma鈥檚 abortion ban also does not apply to emergency contraception.
Abortion bans aside, the National Conference of State Legislatures says 21 states and the District of Columbia have statutes related to accessing emergency contraception, and 16 of them 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 a doctor and patient.
"The people writing the laws don鈥檛 understand the choices that real people are making," he said.
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For more of AP's coverage on abortion:
Amy Forliti, The Associated Press
