States of Denial

Heather Minton couldn't bring herself to tell anyone that she had just been brutally pinned down and raped at a Friday night party at the University of California, Riverside last November. But she did insist that a friend get her out of the party fast and take her to the emergency room. She needed emergency contraception (EC) before it was too late and the clinic on campus wouldn't be able to help her until Monday.

Minton says the ER nurse at Riverside Community Hospital told Minton's friend that she wouldn't treat Minton if she hadn't been raped, and suggested they try another ER a half-hour's freeway drive away. "When we got to the emergency room, I was hysterical," says Minton. "No one knew what had happened to me, just that I had had sex and I wanted EC. But the nurse sent us to another hospital. It was after 2:00 a.m. and we didn't know where we were going or whether they'd refuse to treat me too."

Minton is not the only woman experiencing nightmarish problems getting access to emergency contraception, a combination of drugs that can prevent pregnancy if taken soon after sex. New state laws are giving hospitals, nurses, doctors and pharmacists the right to refuse to offer emergency contraception.

Some are refusing because they see it as abortion, which is against their principles. But because these policies are rarely publicized – and sometimes there is no official policy and decisions are left to doctors or pharmacists – it is hard for women seeking EC to know who will help them and who won't. Trouble is, delays can make EC too late to be effective. Also called Plan B and the Morning After pill, EC is a potent mixture of hormonal birth control pills that can often prevent pregnancy if taken within 72 hours after having sex. The pills – most commonly manufactured by Barr Laboratories under the brand name Preven – are more effective the sooner they are taken.

Riverside Community Hospital did not respond to repeated requests for comment. HCA, the corporation that owns the hospital, says it does not dictate clinical policy to its facilities, and physicians can use their own discretion.

Anonymous calls to Riverside on three different occasions produced three different responses from nurses on duty: "We do not offer emergency contraception"; "It depends on the physicians on duty because [providing] EC is an ethical issue"; "We offer emergency contraception to women who have been raped."

State(s) of Confusion

In some states, new laws allow pharmacists and other health care providers the right to refuse to supply some medications. This is similar to allowing doctors the right to refuse to perform abortions. For example, Mississippi's new law says pharmacists and other health care workers may refuse to fill prescriptions if doing so conflicts with their religious beliefs. Arkansas and Illinois also have laws allowing pharmacists to refuse EC to patients on religious or moral grounds. South Dakota allows a pharmacist to refuse to fill a prescription if "there is reason to believe it will destroy an unborn child"; the state defines a child's life as beginning at fertilization.

In sharp contrast, California, New Mexico, Hawaii, Maine and Washington now have laws enabling pharmacists to provide EC without a prescription as long as they can provide sufficient counseling to women who request it. But even in these states, individuals often have the discretion to refuse to provide EC.

Meanwhile, Catholic hospitals have their own policies – or lack thereof. Some will provide EC, but only to women who have convinced them that they have been raped. Directive 36, handed down by the Vatican, states that in cases of sexual assault, a woman may receive EC from a Catholic provider. However, many Catholic facilities require a pregnancy test and a full medical exam, which discourages women and, by delaying the provision of EC, reduces the likelihood that it will be effective.