Heather Minton couldn't bring herself to tell anyone that she just had been brutally pinned down and raped at a Friday night frat party at University of California, Riverside last November. But she did insist that one of her friends 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.
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 emergency room in a neighboring town a half-hour's freeway drive away.
When we got to the emergency room, I was hysterical. 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 two AM, and we didn't know where we were going or whether they'd refuse to treat me too, says Minton.
Where To Turn
EC, also called Plan B and the Morning After pill, is a regimen of high potent hormonal birth control pills that can prevent pregnancy if taken no more than 72 hours after having sex. Studies show that the pills - most commonly manufactured by Barr Laboratories with the brand name Preven - are more effective the sooner they are taken. It's legal and safe, and Abby could have easily gotten it from the college nurse, so why wouldn't the nurse in the hospital giver her the necessary pills to prevent pregnancy?
In some states, new laws allow pharmacists and other health care providers the right to refuse patients medications on the basis of their faith. Today, access to emergency contraception depends on the state in which you live, as well as the health-care provider and pharmacy you choose. For example, in the 1990s Arkansas and Illinois passed conscience clause laws granting pharmacists the right to refuse EC to patients on the basis of ideology. The Arkansas law is written specifically for pharmacists and other health care professionals who do not want to dispense EC and contraceptives. Mississippi passed a law earlier this year that broadly allows pharmacists and other health care workers to invoke their conscience and faith to justifiably refuse to provide care and/or fill prescriptions. South Dakota law allows a pharmacist to refuse to fill a prescription for any medication if there is reason to believe it will destroy an unborn child. South Dakota defines unborn child as beginning at fertilization.
In contrast, California, New Mexico, Hawaii, Maine and Washington have passed laws that offer women access to EC without a prescription as long as the pharmacist can provide sufficient counseling to women who request it. But even within these states that have more liberal laws, health care organizations that are owned and operated by the Catholic Church often do not inform their patients about EC. In rare cases, Catholic hospitals will offer EC, but only to women who have convinced them that they have been the victims of rape.
Riverside, the hospital where Heather Minton attempted to get EC, is owned by one of the largest health care companies in the country, HCA, a Catholic franchise. It follows the Vatican's rules about reproductive health, including barring access to emergency contraception. HCA is one of a growing number of health care providers and individual pharmacists refusing EC for religious reasons, aided in some cases by state laws.
According to the American Journal of Preventive Medicine, an estimated 25,000 American women become pregnant after being raped every year. But only twenty-eight percent of 597 US-based Catholic hospitals surveyed in August 2002 offer emergency contraception to women who have been raped, according to Emergency Contraception in Catholic Hospital Emergency Rooms a study conducted for Catholics for a Free Choice. The same study reports that Catholic hospitals provide health care to 1 in 5 people in the US.
Is EC Abortion or Birth Control?
Demand for EC has increased with women's awareness of its availability, but Catholic hospitals aren't the only ones fighting to make it less acceptable. Anti-abortion groups, such as Pharmacists for Life, believe that EC kills babies. When Barr Labs, the makers of Preven, applied for over the counter status for their drug with the FDA earlier this yea, anti-abortion organizations rallied to reject the application. The American Life League has fought particularly hard in the past 3 years to limit access to EC and to draft legislation giving pharmacists and other healthcare workers the right to withhold medications on the basis of conscience.
And even though the American College of Obstetricians and Gynecologists, research scientists, and the Food and Drug Administration have considered the drug safe since they approved it in 1999, this past May the FDA overruled its own independent panel of experts and rejected an application for over-the-counter status for EC.
The anti-abortion belief - that emergency contraception is abortion - is at the heart of the difficulties experienced by Heather Minton and other women seeking EC. Scientists and physicians including representatives from the American College of Obstetricians and Gynecologists (ACOG), Physicians for Reproductive Choice and Health, the American Medical Association, and state health departments attempted to clarify the objective distinctions between abortion and the effects of emergency contraception on a women's body.
Physicians and scientists associated with anti-abortion organizations such as Americans United for Life claim that EC, like RU-486, is a non-surgical abortion. Rudd says that scientific evidence indicates that the drug works in part by preventing a developing embryo from attaching to the uterine wall, leaving it to pass out of the mother's body and die.
Many scientists and doctors disagree, claiming that EC can prevent but not terminate a pregnancy. EC works much like birth control pills to prevent pregnancy. Taken in two doses within 72 hours, the drug stops the release of an egg from the ovary, preventing fertilization. In the case of fertilization, EC may prevent a fertilized egg from attaching to the womb. If a woman is already pregnant and an embryo is already implanted in the wall of the uterus, EC will have no effect.
Truth and Consequences
Employers such as the Eckert and CVS drug store chains have disciplined and in some cases fired pharmacists for withholding EC and basic birth control. While professional associations believe that their members have the right to refuse to fill EC and other prescriptions if it compromises their religious beliefs, they also say that such pharmacists should refer customers to colleagues who will.
To date, job loss is the worst consequence pharmacists have faced for refusing to fill prescriptions or refer customers to other pharmacists. On bulletin boards and the Pharmacists for Life Website, pharmacists who risk their jobs for denying women access to EC are roundly congratulated for acting on their religious convictions.
In a widely reported case in Denton, Texas, pharmacist Gene Herr was fired earlier this year for refusing to fill an EC prescription for a rape victim. According to the Texas state licensing board, Herr still has his license. Herr said that he couldn't fill the prescription because he was a practicing Catholic.
In another case in Texas in July, the only druggist in a small town refused to fill the birth control prescription of a young woman who was visiting her mother. The woman and her husband had to drive 40 miles roundtrip to get her prescription filled in El Paso.
Herr and others are willing to stake their jobs on their belief that EC is chemical abortion and abortion is a sacrilege. In July of this year, several veteran nurses - all practicing Catholics - quit a hospital in Alabama because if they'd stayed they would have been required to counsel women about emergency contraception.
Emergency contraception is the next high-stakes reproductive rights battle. The FDA and some pharmacists and nurses are willing to risk their credibility and their jobs to limit access. How will reproductive rights advocates respond?