Improving the Provision of Emergency Contraception for Sexual Assault Survivors in the Emergency Department: A Quality and Health Equity Initiative.

New Mexico enacted a law in 2003 requiring that emergency departments (EDs) offer emergency contraception (EC) to survivors of sexual assault and that both doses be administered in the ED. This investigation sought to examine practices and knowledge of ED providers about EC in the setting of sexual assault. We visited hospitals in New Mexico from July 2005 to December 2005 and administered an 18-item questionnaire to three providers-a physician, a nurse, and a clerk-in the ED. The questionnaire included items related to characteristics of the hospital, knowledge of providers about EC and the law, and ED practices relevant to EC for sexual assault survivors as well as for women who had consensual unprotected intercourse. Surveys were completed at 33 of 38 hospitals (87%). Overall, 52% of respondents reported that EC was routinely offered to sexual assault survivors, and 33% reported that both doses were administered in the ED. Forty-one percent of RNs, MDs, and clerks reported that EC was offered to sexual assault survivors who were minors regardless of age. Overall, 64% of respondents knew that EC may prevent pregnancy up to 72 hours after unprotected intercourse, and only 12% of respondents reported awareness of any requirements to offer EC to sexual assault survivors. Respondents reported that physicians in the ED more often routinely offered EC to sexual assault survivors (52%) than to women who requested it after consensual sex (20%). Thirty-three percent of respondents indicated parental consent was necessary for minors in the setting of sexual assault, although there is no requirement for parental notification in New Mexico. EDs in New Mexico are not universally complying with the law. Better dissemination of the law and education about EC could improve care of sexual assault survivors in New Mexico.

Assessing Sexual Assault Survivors' Access to Emergency Contraception: Results From a Mixed Methods Study in South Carolina

Objective: We conducted a scoping review of the literature to assess the prevalence of hospital policies regarding emergency contraception (EC) and the frequency that U.S. emergency departments (EDs) provide EC to sexual assault survivors. Study Design: We searched PubMed, Embase, the Cochrane Library, and CINAHL from inception to January 2019 for studies that assessed access to EC for sexual assault survivors in EDs. We included English-language studies that surveyed ED staff at U.S. hospitals and reported the weighted mean of the percentage of hospitals with an EC policy for sexual assault survivors and the percentage that provided EC counseling, offered or dispensed EC onsite. Secondary outcomes were rates of testing and prophylaxis for sexually transmitted infections (STIs) and HIV. Results: From 390 articles retrieved, 14 studies met the inclusion criteria; all studies were published between 2000 and 2013. Eligible studies surveyed staff at 3,314 hospitals. Overall, 60% (weighted mean) of hospitals had a policy on EC, 75% provided EC counseling, 44% offered EC, and 62% had EC available to dispense onsite. Four studies reported secondary outcomes: 81% of hospitals provided STI testing, 84% provided STI prophylaxis, 64% provided HIV testing, and 53% provided HIV prophylaxis. Conclusion: Existing literature demonstrates significant variability in EC policies and practices for sexual assault survivors in U.S. hospital EDs. Future research should assess whether EC access for survivors has improved in ED settings as well as evaluate persistent or new barriers to access.

Emergency Contraception Services for Adolescents: a National Survey of Children's Hospital Emergency Department Directors

To determine the availability of emergency contraception (EC) in Massachusetts emergency departments (EDs) and to identify patient, hospital, and system factors that could affect access to EC. This was a prospective, cross-sectional study of all Massachusetts EDs using two structured scenarios: one, a patient asking for EC for condom failure (patient scenario); and the other, a social worker asking about EC for a client who was sexually assaulted the night before (social worker scenario). Calls were made during day and night shifts requesting information from a nurse or doctor. The data collected included EC availability, whether pills or prescription would be given, cost, services available to rape victims, and other institutions where EC could be obtained. Descriptive statistics and chi-square were used for comparisons. Responses were made by 248 of 288 nurses, ten of 288 physicians, and 30 of 288 clerks. Overall, EC was reported to be available in 80% of calls, not available in 15%, and up to the physician in 5%. In the patient scenario day shift, 53 of 72 (73%) responded that EC was available, 15 of 72 (20%) stated it was not available, and four of 72 (5%) said it was up to prescribing physician. In the social worker scenario day shift, 62 of 72 (86%) reported that EC was available, six of 72 (8%) reported it was not available, and four of 72 (5%) stated it was up to the prescribing physician. Availability did not vary comparing day vs. night shift for either scenario. Of the nine Catholic hospitals, for the patient scenario, one of nine (11%) reported that EC was available, seven of nine (78%) reported that EC was not available, and in one of nine (11%), it was up to the physician. In the social worker scenario, five of nine (56%) reported EC was available, three of nine (33%) reported it was not available, and in one of nine (11%), it was up to the physician. There was significant variability in access to EC in Massachusetts EDs and in services for sexual assault survivors. Hospital type and provider preference affected availability. This study suggests that access to EC is limited, and that there are not consistent services for women seeking EC, including for victims of sexual assault.

Assessing the extent of provision of comprehensive medical care management for female sexual assault patients in US hospital emergency departments

374 Knowledge, Attitudes, and Behaviors Regarding Care of Sexual Assault Survivors in the Emergency Department

265 Availability of Emergency Contraception in the Emergency Department: A National Survey

Background: Despite the rise in sexual assault presentations in emergency departments (ED) in the United States, real-world access to sexual assault nurse examiners (SANE) and emergency contraception medication is unknown. We aimed to determine the real-world access of emergency sexual assault care by surveying EDs in the United States. Methods: EDs listed in the Centers for Medicare & Medicaid Services database were contacted telephonically by anonymous callers trained to collect responses from ED personnel. The study employed a cross-sectional survey to ascertain the availability of SANE and emergency contraception in EDs nationwide. Additional variables collected included regional demographics, urban status, hospital size, faith affiliation, academic affiliation, and existence of legislative requirements to offer emergency contraception to sexual assault patients. Findings: Of the 4360 eligible hospitals, 960 (22.0%) were contacted. SANE availability and emergency contraception access were reported to be available in 48.9% (95%CI: 45.5, 52.0) and 42.5% (95%CI: 39.4, 45.7) of hospitals, respectively. Emergency contraception access was a strong predictor of SANE availability. Hospitals reporting SANE availability were more likely to be large, rural, and academic affiliation. Hospitals reporting patient access to emergency contraception in the ED were more likely to be located in the Northeast, large, rural, academic affiliation, and in states with legislative requirements. Interpretation: Our results suggest that access to sexual assault services including emergent SANE and contraceptive medication in EDs remains poor with disparities. Geographic region, hospital size, and legislative status of the state are important predictors. Funding: None to declare. Declaration of Interest: None to declare.

Evaluation of documentation practices of sexual assault nurse examiners

To describe epidemiologic and clinical characteristics of patients receiving emergency contraception (EC) in a pediatric emergency department (ED), practice variations for EC, and ED return visits after EC. This single-site study describes all patients who received oral EC (1.5-mg levonorgestrel) in the ED from January 1, 2003 to December 31, 2007. A chart review provided patient demographics, history, examination findings, treatment, and ED return visits within 7 days. There were 116 patients with a mean age of 13.7 years; half were white, and most (69.8%) had Medicaid. The most common presenting complaint was nonconsensual sex or sexual assault (87.9%). Most patients (89.6%) reported last sexual contact within 72 hours of presentation. Half of the patients (50%) received 1.5-mg levonorgestrel in a single dose, and there was a significant trend toward single-dose distribution during the study (P < 0.001). Patient presentation was most common from 8 pm to midnight (P < 0.001). Most received a pregnancy test (98.3%), a pelvic bimanual or speculum examination (81.9%), and prophylactic or immediate treatment of a sexually transmitted infection (88.8%). No prescriptions for future EC were given. One patient returned to the ED 1 day after receiving EC complaining of nausea and blurry vision. Reviewing recipients of EC from a pediatric ED suggests education is needed for both health care providers and adolescents. Although providers are generally following the most recent dosing guidelines, opportunities to prescribe EC to adolescent girls with complaints other than sexual assault seem to be missed.

Provision of emergency contraception to adolescents: Position paper of the society for adolescent medicine

One in 5 women is a victim of sexual assault. This study examines the administration of emergency contraception to victims of sexual assault in North Carolina hospital emergency departments. One hundred seventeen surveys were mailed to hospital emergency departments across the state to determine their emergency contraception practices for victims ofsexual assault. The survey contained 11 questions about emergency contraception practices for victims. Of the 117 surveys, 103 were returned revealing that just over 50% of the hospitals in North Carolina treated victims with emergency contraception without exception. Both dispensing emergency contraception and providing information about emergency contraception were significantly associated with having a sexual assault nurse examiner program. Results from this study demonstrate inconsistent provision of emergency contraception to victims of sexual assault; however, there is greater consistency of emergency contraception use by emergency departments using sexual assault nurse examiners.

Conscientious Objection to Emergency Contraception

BackgroundDespite the prevalence of sexual assault presentations to emergency departments (ED) in the United States, current access to sexual assault nurse examiners (SANE) and emergency contraception (EC) in EDs is unknown.MethodsIn this study we employed a “secret shopper,” cross-sectional telephonic survey. A team attempted phone contact with a representative sample of EDs and asked respondents about the availability of SANEs and EC in their ED. Reported availability was correlated with variables including region, urban/rural status, hospital size, faith affiliation, academic affiliation, and existence of legislative requirements to offer EC.ResultsOver a two-month period in 2019, 1,046 calls to hospitals were attempted and 960 were completed (91.7% response rate). Of the 4,360 eligible hospitals listed in a federal database, 960 (22.0%) were contacted. Access to SANEs and EC were reported to be available in 48.9% (95% confidence interval [CI] 45.5–52.0) and 42.5% (95% CI 39.4–45.7) of hospitals, respectively. Access to EC was positively correlated with SANE availability. The EDs reporting SANE and EC availability were more likely to be large, rural, and affiliated with an academic institution. Those reporting access to EC were more likely to be in the Northeast and in states with legislative requirements to offer EC.ConclusionOur results suggest that perceived access to sexual assault services and emergency contraception in EDs in the United States remains poor with regional and legislative disparities. Results suggest disparities in perceived access to EC and SANE in the ED, which have implications for improving ED practices regarding care of sexual assault victims.