Right to an abortion: “morning after pill” not always an option after rape

Some leaders in states with strict abortion bans say exceptions for rape or incest victims are not needed because emergency contraception can be used instead. But medical professionals and rape survivor advocates say that while emergency contraception is a helpful tool, it isn’t 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 is currently has been attacked.

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


Emergency contraception is used to prevent pregnancy after unprotected sex or when a contraceptive method has failed.

Two types of medications, sometimes referred to as the morning-after pill, 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 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 at Chicago. If an egg is not released, it cannot be fertilized.


no Emergency contraceptives prevent pregnancy. The abortion pill mifepristone terminates a pregnancy after a fertilized egg implants in a woman’s womb lining. It is commonly given with the drug misoprostol and can be taken for up to 11 weeks after the first day of a woman’s last period.


Not 100% of the time. The effectiveness of the pills improves the sooner they are taken after unprotected sex, the doctors said. The drugs won’t prevent pregnancy 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 in a woman’s body for up to five days, so if ovulation occurs after intercourse, a woman can still get pregnant, Dr. Dana Stone, a gynecologist in Oklahoma City. If a woman ovulated before intercourse, the pills are unlikely to help.

“So this is where the error comes in. It’s based on timing,” Stone said.

A woman’s weight can also play a role, although there is conflicting information on this. Guidelines from the American College of Obstetrics and Gynecology say levonorgestrel may be less effective in women with a body mass index over 25. The organization says some research suggests ulipristal acetate may also be less effective in women with a BMI of 30 or greater.

However, the FDA found conflicting data and came to no conclusions in a 2016 review of levonorgestrel’s effectiveness in women who weigh more than 165 pounds or have a BMI over 25. The agency said additional research should be a priority.

Another form of emergency contraception, a copper intrauterine device, is considered to be the most effective method when inserted into a woman’s uterus within five days of unprotected intercourse. Its effectiveness isn’t dependent on weight, Fleisher said.

A doctor or nurse must insert a copper IUD, which can stay in place for many years as a regular form of birth control.

Plan B can be purchased over the counter by anyone over the age of 17, but younger people will need a prescription. Ella needs a recipe.


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

During a House debate Aug. 31, Gilliam said in a hypothetical case of a 12-year-old raped by her father, the child would have “choices” and would not be “forced” to carry a pregnancy to term. 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 colleague as to who would take the girl to the store to get the pill, he first replied, “The ambulance,” then corrected himself and said, “The hospital when she gets there.”

In a follow-up interview with The Associated Press, the Republican lawmaker said he didn’t want to suggest that an ambulance take a girl to a store, but that she would likely be offered emergency contraception if she went to the hospital.

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

What about rape victims?

Most rape victims do not 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 may also not go for immediate medical attention. Not everyone knows that emergency contraception is an option and part of a routine rape investigation, or that such an investigation is free.

“Why are you using sexual assault as a political toy when you’re talking about access to reproductive care?” Foster said. “Please do not. It just frustrates me.”

Stone said the belief that a woman can just go with plan B if she’s being raped is misguided.

“We need all possible 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 a certain percentage of women that prevent them from accessing it in the short timeframe that they have.”


Several states have specifically allowed emergency contraception in their abortion laws.

Arkansas, Kentucky and Oklahoma all have laws prohibiting abortions at all stages of pregnancy and making no exceptions for cases of rape or incest. Arkansas and Kentucky laws specifically state that they do not prohibit contraceptive measures if they are used before pregnancy can be detected. Even Oklahoma’s abortion ban does not apply to emergency contraception.

Aside from 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 them and the District of Columbia require hospitals or health care facilities to provide or administer information about emergency contraception women who have been sexually abused.

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

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

Copyright © 2022 by The Associated Press. All rights reserved.

https://abc7.com/emergency-contraceptives-rape-victims-abortion-bans-laws/12222028/ Right to an abortion: “morning after pill” not always an option after rape

Laura Coffey

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