Justice department fails to mention emergency contraception after rape
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《英国医生杂志》
More than 200 US medical organisations, religious leaders, women抯 health advocates, and groups providing advice for people who have been sexually assaulted have asked the US Department of Justice to correct its guidelines for treating people who have been raped because they fail to mention emergency contraception.
The issue is controversial with US anti-abortion groups. Emergency contraception usually prevents an egg from being released or fertilised, but it may, rarely, prevent implantation of a fertilised egg. Some anti-abortion groups believe that life begins at conception and prevention of implantation is murder.
The Department of Justice was required by law to develop the first national guidelines for caring for people who have been sexually assaulted. The 141 page guide was published in September 2004. It offers far more information on checking patients for sexually transmitted infections than on the risk of pregnancy after rape.
The guidelines say that health workers should discuss the possibility of pregnancy with women who have been raped, give a pregnancy test for those who might have become pregnant, and "discuss treatment options with patients, including reproductive health services."
The guidelines do not mention emergency contraception. An earlier version of the guidelines included information about emergency contraception, but this was removed before the final draft was released, according to the Planned Parenthood Federation of America and an expert quoted by the Philadelphia Inquirer, which reported the guidelines?lack of advice about emergency contraception in late December.
For two weeks, officials at the Department of Justice did not answer questions from the newspaper抯 staff writer, Marie McCullough, who wrote the story. Then a spokesperson for the department repeated points in the guidelines, saying that all victims of sexual assault should receive high quality care.
A pro-life Pennsylvanian doctor, George Isajiw, told Ms McCullough that emergency contraception "was a dangerous drug that抯 not doing any good or else you抮e causing an abortion." He added that "as a moral principle, a woman has the right to defend herself against an aggressor, but she doesn抰 have the right to kill the baby."
Guidelines from the American Medical Association, the American College of Obstetricians and Gynecologists, and the American College of Emergency Physicians, among others, say that women who have been raped should be offered emergency contraception.
According to the Planned Parenthood Federation of America, about 300 000 US women are raped each year. Only 2-5% become pregnant—about 25 000 women. Nearly all these pregnancies, about 22 000, could be prevented by emergency contraception.
Last year the Food and Drug Administration over-ruled its advisory committee抯 recommendation that emergency contraception be made available over the counter at pharmacies without a doctor抯 prescription (BMJ 2004;328:1219). The administration said that young teenagers would not understand the instructions and asked for proof that they would—something not done before. The emergency drug will come up for review for over the counter status again later this month.
Dr Vivian Dickerson, president of the American College of Obstetricians and Gynecologists, said that a study in JAMA (2005;293:54-62) showed that women aged 15 to 24 did not take advantage of emergency contraception to engage in risky sexual behaviour.
At present, five states require hospitals to provide emergency contraception to patients or to tell them how to get the pills. Emergency departments are inconsistent in providing emergency contraception or information, however, according to the American Civil Liberties Union and the Alan Guttmacher Institute, which collects information about reproductive issues.(New York Janice Hopkins Tanne)
The issue is controversial with US anti-abortion groups. Emergency contraception usually prevents an egg from being released or fertilised, but it may, rarely, prevent implantation of a fertilised egg. Some anti-abortion groups believe that life begins at conception and prevention of implantation is murder.
The Department of Justice was required by law to develop the first national guidelines for caring for people who have been sexually assaulted. The 141 page guide was published in September 2004. It offers far more information on checking patients for sexually transmitted infections than on the risk of pregnancy after rape.
The guidelines say that health workers should discuss the possibility of pregnancy with women who have been raped, give a pregnancy test for those who might have become pregnant, and "discuss treatment options with patients, including reproductive health services."
The guidelines do not mention emergency contraception. An earlier version of the guidelines included information about emergency contraception, but this was removed before the final draft was released, according to the Planned Parenthood Federation of America and an expert quoted by the Philadelphia Inquirer, which reported the guidelines?lack of advice about emergency contraception in late December.
For two weeks, officials at the Department of Justice did not answer questions from the newspaper抯 staff writer, Marie McCullough, who wrote the story. Then a spokesperson for the department repeated points in the guidelines, saying that all victims of sexual assault should receive high quality care.
A pro-life Pennsylvanian doctor, George Isajiw, told Ms McCullough that emergency contraception "was a dangerous drug that抯 not doing any good or else you抮e causing an abortion." He added that "as a moral principle, a woman has the right to defend herself against an aggressor, but she doesn抰 have the right to kill the baby."
Guidelines from the American Medical Association, the American College of Obstetricians and Gynecologists, and the American College of Emergency Physicians, among others, say that women who have been raped should be offered emergency contraception.
According to the Planned Parenthood Federation of America, about 300 000 US women are raped each year. Only 2-5% become pregnant—about 25 000 women. Nearly all these pregnancies, about 22 000, could be prevented by emergency contraception.
Last year the Food and Drug Administration over-ruled its advisory committee抯 recommendation that emergency contraception be made available over the counter at pharmacies without a doctor抯 prescription (BMJ 2004;328:1219). The administration said that young teenagers would not understand the instructions and asked for proof that they would—something not done before. The emergency drug will come up for review for over the counter status again later this month.
Dr Vivian Dickerson, president of the American College of Obstetricians and Gynecologists, said that a study in JAMA (2005;293:54-62) showed that women aged 15 to 24 did not take advantage of emergency contraception to engage in risky sexual behaviour.
At present, five states require hospitals to provide emergency contraception to patients or to tell them how to get the pills. Emergency departments are inconsistent in providing emergency contraception or information, however, according to the American Civil Liberties Union and the Alan Guttmacher Institute, which collects information about reproductive issues.(New York Janice Hopkins Tanne)