Letter to Jana White

* Since the original letter with 277 signatories was sent to the Department of Justice on January 6, 2005, many more groups have signed on to challenge the exclusion of emergency contraception from the protocols. (The letter, with the additional signatures, was re-sent on February 2, 2005 to the Department of Justice.) The full list appears below.

Jana S. White
Office on Violence Against Women
Department of Justice
810 Seventh Street, N.W.
Washington, DC 20531

by email to Jana.S.White@usdoj.gov

Re: Written testimony to be submitted to the Advisory Committee for the Violence Against Women Act

Dear Ms. White:

We write to strongly urge you to amend the National Protocol for Sexual Assault Medical Forensic Examination (“”Protocol””) to include the routine offering of pregnancy prophylaxis (or “”emergency contraception””) to sexual assault victims who are at risk of pregnancy from rape. The failure to include a specific discussion of emergency contraception in the first national protocol for sexual assault treatment is a glaring omission in an otherwise thorough document. Including counseling about pregnancy prevention and the provision of emergency contraception would help rape victims prevent the trauma of unintended pregnancies, avoid abortions, and safeguard their reproductive and mental health.

The establishment of a national protocol is an important step toward ensuring that all sexual assault victims receive high quality medical and forensic services. The 130-page Protocol provides step-by-step medical treatment guidelines for sexual assault patients. Yet despite recognizing that pregnancy is “”often an overwhelming and genuine fear”” of sexual assault victims, the Protocol includes only a single, vague sentence on pregnancy prevention: “”[D]iscuss treatment options with patients, including reproductive health services.”” For any further information, medical professionals are referred, in a footnote, to the National Sexual Violence Resource Center’s website. While the NSVRC is an excellent source of information, it is not a substitute for a clear explanation of the issues surrounding pregnancy risk and a woman’s options for treatment.

Nowhere does the Protocol mention emergency contraception or recommend that it be offered to sexual assault victims. Nor does the Protocol make clear that sexual assault victims have a right to be offered this basic care. Emergency contraception must be taken within days after unprotected intercourse, but experts agree that it is more effective the sooner it is taken. 1 Because this narrow window of effectiveness makes timely access to emergency contraception critical, the Protocol should explicitly state that treatment of sexual assault victims must include routine counseling about and offering of emergency contraception.

The marked failure to include details about specific pregnancy prevention options is at odds with the Protocol’s expansive treatment of other grave medical concerns a victim faces. For instance, the Protocol’s section on sexually transmitted infection evaluation and care is more than eight times as long as the pregnancy section, with detailed instructions about counseling patients, providing referrals for treatment, dosage requirements, and factors to consider in deciding which patients should receive certain STI tests. The rights and health of sexual assault survivors will be unnecessarily endangered if they are not provided with similarly detailed information about pregnancy prevention options.

Major medical groups – including the American College of Obstetricians and Gynecologists, the American Medical Association, the American College of Emergency Physicians, and the American Public Health Association – support making emergency contraception more readily accessible to women who need it. The American College of Obstetricians and Gynecologists recommends that emergency contraception be offered to all sexual assault victims at risk of pregnancy. 2

Despite the clear need for sexual assault victims to have access to emergency contraception, hospitals often do not provide this vital service. Surveys have shown that only 6 percent of hospitals in Louisiana, 8 percent of hospitals in Idaho, and 20 percent of hospitals in Montana provide emergency contraception on-site to sexual assault patients. A recent overview of state surveys performed reveals that in eight of the 11 states studied, fewer than 40 percent of facilities dispense emergency contraception on-site to sexual assault patients. 3

Frequently, hospitals do not have clear protocols on the treatment of sexual assault patients and many of the protocols that do exist fail to include emergency contraception. Further, surveys have shown that many emergency department personnel lack even basic information about emergency contraception, often confusing it with mifepristone, the early abortion pill, even though emergency contraception prevents pregnancy and does not disrupt an existing pregnancy.

The Protocol published by the Department of Justice has the potential to fill this information void at many hospitals and to ensure appropriate treatment for sexual assault patients. To do this effectively, however, the Protocol must be revised to include an explicit discussion of emergency contraception. The undersigned urge the Department of Justice to make this critical change.

Sincerely,

National Organizations
Advocates for Youth
African-American Women Evolving, Inc.
American Association of University Women
American Civil Liberties Union
American College of Obstetricians and Gynecologists
American Humanist Association
American Jewish Committee
American Medical Women’s Association
American Public Health Association
Association of Reproductive Health Professionals
Break the Cycle
Catholics for a Free Choice
Center for Health and Gender Equity
Center for Reproductive Rights
Center for Women Policy Studies
Choice USA
Christians for Justice Action (United Church of Christ)
Coalition of Labor Union Women
Compton Foundation, Inc.
Concerned Clergy for Choice
Disciples for Choice
Disciples Justice Action Network
Episcopal Church USA
Episcopal Women’s Caucus
Equal Partners in Faith
Feminist Majority & Feminist Majority Foundation
General Board of Church and Society, United Methodist Church
Gynuity Health Projects
Hadassah
Healthy Teen Network
Ibis Reproductive Health
Institute of Women and Ethnic Studies
Ipas
Law Students for Choice
Legal Momentum
Medical Students for Choice
MergerWatch
Ms. Foundation for Women
NARAL Pro-Choice America
National Abortion Federation
National Advocates for Pregnant Women
National Asian Pacific American Women’s Forum
National Association of Nurse Practitioners in Women’s Health
National Coalition Against Domestic Violence
National Council of Jewish Women
National Family Planning and Reproductive Health Association
National Health Law Program
National Latina Institute for Reproductive Health
National Network of Abortion Funds
National Organization for Women
National Partnership for Women & Families
National Research Center for Women & Families
National Women’s Health Network
National Women’s Law Center
People For the American Way
Physicians for Reproductive Choice and Health
Planned Parenthood Federation of America
Population Connection
Presbyterian Church (USA) Washington Office
Pro-Choice Public Education Project
The Rabbinical Assembly of Conservative Judaism to the Religious Coalition for Reproductive Choice
Religious Coalition for Reproductive Choice
Religious Institute on Sexual Morality, Justice and Healing
Reproductive Health Technologies Project
Republican Majority for Choice
Robert Sterling Clark Foundation
Sexuality Information and Education Council of the United States
Stop Family Violence
The Alan Guttmacher Institute
Union for Reform Judaism
United Church of Christ-Justice and Witness Ministries
Unitarian Universalist Association of Congregations
The WISH List
Women’s Health Task Force

State and Local Organizations
ACCESS/Women’s Health Rights Coalition, CA
Adolescent Health Center of The Door, NY
Alaska Emergency Contraception Project
Allegheny Reproductive Health Center, PA
Allentown Women’s Center, PA
American Civil Liberties Union of Colorado
American Civil Liberties Union of Idaho
American Civil Liberties Union of Kentucky Reproductive Freedom Project
American Civil Liberties Union of Louisiana
American Civil Liberties Union of New Mexico
Aradia Women’s Health Center, WA
Atlanta ProChoice Action Committee, GA
Berkshire Religious Resource Center, MA
Blue Mountain Clinic, MT
Boulder Valley Women’s Health Center, CO
Break the Cycle, San Francisco, CA
Break the Cycle, Washington, DC
Brooklyn-Queens NOW, NY
Broward Women’s Emergency Fund, FL
California Family Health Council, Inc.
Campaign for Access to Emergency Contraception, IL
Carbon County Domestic and Sexual Violence Services, MT
Cedar River Clinics, WA
Centre County Women’s Resource Center, PA
Champaign County Health Care Consumers, IL
Christian Association, University of Pennsylvania
Citizen Action/Illinois
Clara Bell Duvall Reproductive Freedom Project, ACLU of Pennsylvania
Clinical Forensic Examiner Program at Abington Memorial Hospital, PA
Clinton County Women’s Center, PA
Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR)
Columbia Public Health Students for Reproductive Freedom, NY
Community HIV/AIDS Mobilization Project, NY
Connecticut Coalition for Choice
Eastern Massachusetts Abortion Fund
Edloe’s Professional Pharmacy, VA
El Centro por los Trabajadores, IL
Empire State Pride, NY
Family Health Council of Central Pennsylvania, Inc.
Family Planning Advocates of New York State
Family Planning Council, PA
Feminist Majority at the University of Illinois
Freedom Fund of Denver, CO
Freedom Fund, Inc., WI
Friendship Center of Helena, MT
Georgia Rural Urban Summit
Georgians for Choice
Health Access and Privacy Alliance, IL
Health and Medicine Policy Research Group, IL
Health Partners, PA
Health Strategies and Solutions, Inc., PA
Helping all Victims in Need (HAVIN), Armstrong County, PA
Idaho Coalition Against Sexual and Domestic Violence
Idaho Women’s Network
Illinois Disciples Foundation
Illinois Planned Parenthood Council
Institute for Reproductive Health Access, NY
Interfaith Impact of New York State
Iowa Medical Aid Fund
Jane Doe Fund, MI
Jane Doe Inc., MA
Jane’s Due Process, TX
Juneau Pro-Choice Coalition, AK
Lansing Area Advocates for Choice, MI
Lansing Area NOW, MI
Massachusetts Coalition Against Sexual Assault and Domestic Violence
Massachusetts Emergency Contraception Network
Massachusetts Family Planning Association
Massachusetts Office of Victim Assistance
Maternal & Child Health Consortium of Chester County, PA
McKinley Presbyterian Foundation, IL
Medical and Health Research Association of New York City, NY
Memphis Regional Planned Parenthood, TN
Montana Coalition Against Domestic and Sexual Violence
Mt. Baker Planned Parenthood, WA
My Sisters’ Place, Inc., NY
NARAL Pro-Choice California
NARAL Pro-Choice Colorado
NARAL Pro-Choice Connecticut
NARAL Pro-Choice Massachusetts
NARAL Pro-Choice New Mexico
NARAL Pro-Choice New York
NARAL Pro-Choice Pennsylvania
NARAL Pro-Choice South Dakota
NARAL Pro-Choice Texas
NARAL Pro-Choice Washington
NARAL Pro-Choice Wisconsin
NARAL Pro-Choice Wyoming
National Women’s Political Caucus of Pennsylvania
Nebraska National Organization for Women
New Jersey Coalition Against Sexual Assault
New York City Alliance Against Sexual Assault
New York Civil Liberties Union
Northern Adirondack Planned Parenthood, NY
Northwest Women’s Law Center, WA
NW Chicago Choice, IL
Panhandle Community Services Reproductive Health Care Program, NE
PathWays, PA
Pennsylvania Coalition to Prevent Teen Pregnancy
Pennsylvania Section of the American College of Obstetricians and Gynecologists
Pharmacy Access Partnership, CA
Philadelphia Coalition of Labor Union Women, PA
Philadelphia NOW, PA
Planned Parenthood Advocates of Indiana
Planned Parenthood of Arkansas and Eastern Oklahoma
Planned Parenthood Association of Bucks County, PA
Planned Parenthood of Central Pennsylvania
Planned Parenthood of Chester County, PA
Planned Parenthood/Chicago Area, IL
Planned Parenthood of the Columbia/Willamette, OR
Planned Parenthood of Connecticut
Planned Parenthood of East Central Illinois
Planned Parenthood Golden Gate, CA
Planned Parenthood of Greater Iowa
Planned Parenthood of Greater Miami and the Florida Keys, Inc., FL
Planned Parenthood of Hudson Peconic, NY
Planned Parenthood of Indiana
Planned Parenthood League of Massachusetts
Planned Parenthood Mohawk Hudson, NY
Planned Parenthood of Nassau County, NY
Planned Parenthood of Nebraska and Council Bluffs
Planned Parenthood of New York City, NY
Planned Parenthood of North Central Florida
Planned Parenthood of North East Pennsylvania
Planned Parenthood of Northern New England
Planned Parenthood of Palm Beach and the Treasure Coast Area, Inc., FL
Planned Parenthood Pennsylvania Advocates
Planned Parenthood of the Rochester/Syracuse Region, NY
Planned Parenthood of San Diego and Riverside Counties, CA
Planned Parenthood of South Central New York, Inc.
Planned Parenthood of South Palm Beach and Broward Counties, Inc., FL
Planned Parenthood Southeastern Pennsylvania
Planned Parenthood of Southwest and Central Florida
Planned Parenthood of Stark County, OH
Planned Parenthood of the Susquehanna Valley, PA
Planned Parenthood of the Texas Capital Region
Planned Parenthood of Western Pennsylvania
Pro-Choice Coalition of Nebraska
Pro-Choice Resources, MN
Progressive Resource/Action Cooperative, IL
Rape Crisis Center of Dane County, WI
Rape Crisis Services, IL
Rape Recovery Center, UT
Religious Coalition for Reproductive Choice of Connecticut
Religious Coalition for Reproductive Choice of Illinois
Religious Coalition for Reproductive Choice of Indiana
Religious Coalition for Reproductive Choice of Missouri
Religious Coalition for Reproductive Choice of Nebraska
Religious Coalition for Reproductive Choice of Ohio
Religious Coalition for Reproductive Choice of Pensacola
Religious Coalition for Reproductive Choice of Southern California
Reproductive Health Access Project, NY
Richmond Reproductive Freedom Project, VA
S.A.F.E. Center, Department of Emergency Medicine, University of Mississippi
Sexual Assault Resource and Counseling Center of Lebanon County, PA
Students for Access to Emergency Contraception, IL
Texas Association Against Sexual Assault
Tri-County Network Against Domestic and Sexual Violence, MT
University of Illinois National Organization for Women
University of Illinois Office of Women’s Programs
Washington State Religious Coalition For Reproductive Choice
West Virginia Free Coalition for Reproductive Freedom
Western Pennsylvania Fund for Choice
A Woman’s Fund, IL
Women’s City Club of New York
Women’s Crisis Support, Defensa de Mujeres
Women’s Direct Action Collective, IL
Women’s Emergency Network, FL
Women’s Health and Family Planning Association of Texas
Women’s Law Project, PA
Women’s Medical Fund, Inc., WI
Women’s Reproductive Rights Assistance Project, CA
WOMENS WAY, PA

Individuals
Rev. Stephanie Ahlschwede, Dietz United Methodist Church, Omaha, NE
Elaine J. Alpert, MD, MPH, School of Public Health, Boston University, MA
Betty Anderson, Registered Pharmacist, NE
Heather Arnet, Executive Director, Women and Girls Foundation of Southwest, PA
Pam Baker, Planned Parenthood supporter, NE
Dana L. Barron, Executive Director, Alice Paul Center for Research on Women and Gender, PA
Margee Bartle, Sexuality Educator, NE
Wanda Bauer, RNC, WHNP
Margaret W. Beal, PhD, CNM, Associate Professor, Yale University School of Nursing, CT
Eva M. Beals, Planned Parenthood volunteer
Ann L. Begler, The Begler Group, PA
Joanne Belknap, PhD, Sociology and Women’s Studies, University of Colorado
Wendy Bennett, MD, MPH, Johns Hopkins Bayview Medical Center
John Bordwell, MD, MN
Michelle Bowdler, Director, Tufts Health Service, MA
Blondell Reynolds Brown, Councilwoman, Philadelphia City Council, PA
Tanya Cambell, MCJ, Criminal Victim Advocate, Intimate Partner Violence, Sexual Assault Advocacy, MT
Karen Carroll-Coleman, RN, Sexual Assault Nurse Examiner-A, Coordinator, Westchester Sexual Assault Nurse Examiner Program
Rabbi Howard A. Cohen, VT
Maura Costea BSW, Civil Advocate, Intimate Partner Violence, Sexual Assault Advocacy, MT
Rabbi Meryl Crean, PA
Mitchell Creinin, MD, Professor of Obstetrics and Gynecology, University of Pittsburgh, PA
Jenny Daniel, BSW, Civil Advocate, Intimate Partner Violence, Sexual Assault Advocacy, MT
Brenda DeFeo, Vice President of Administration, Bryn Mawr Hospital, PA
Anna L. Doering, Board Member, Women and Girls Foundation of Southwestern PA
Susan Donovan, MS, RN, NJ
Reverend Elizabeth Morris Downie, President, Episcopal Women’s Caucus
Marsha Epstein, MD, MPH, CA
Marilyn Erickson, Nurse Practitioner, Planned Parenthood, NE
Gail Fidjeland, LCSW, UT
Rabbi Michelle H. Fisher, Congregation Har Shalom, MD
Jonathan Fogel, MD, RPh, Emergency Medicine Physician and Pharmacists, Kent County Hospital, RI
Emily M. Godfrey, MD, MPH Department of Family Medicine, University of Illinois-Chicago
Melanie A. Gold, DO, Associate Professor of Pediatrics, University of Pittsburgh, PA
Susan E. Gove, PhD, Women and Girls Foundation, PA
Michael A. Grodin, MD, Professor of Health Law, Bioethics, and Human Rights,
Boston University School of Public Health
Rabbi Shoshana Hantman, NY
Claire Harwell, JD, Attorney Trainer, Former Prosecutor, MA
Candy Hasdall, RN, SARS Nurse, MN
Gerise Herndon, Chair, Women’s Studies, Nebraska Wesleyan University
Lois Herr, Women’s Rights Author and Advocate
Nancy Hesse, RN, BSN, Director, Emergency Trauma Center, Abington Memorial Hospital, PA
Betty-Ann Soiefer Izenman, former Department of Justice Employee
Leigh Jensen, PhD, LCSW, Coordinator, Sexual Assault Services, Mississippi State University
Carole Joffe, PhD, Department of Sociology, University of California, Davis
Lauren Kehr, Licensed Clinical Social Worker, Louisville, KY
Kendel G. Kidwell, MD, FACEP, Chairman, Department of Emergency Medicine, Abington Memorial Hospital, PA
Mardi Kildebeck, Trustee, Mary Wohlford Foundation, CA
Jeff Kirkpatrick, JD, VP, Planned Parenthood Voters of Nebraska
Rev. Rick Klimowicz, CT
Beth Kochka, RN, BSN, Sexual Assault Nurse Examiner-A, WV
Alison Kris, RN, PhD, Associate Research Scientist, Yale University, School of Nursing
Kim Lavender, Victim/Witness Coordinator and MCADSV Sexual Violence Task Force Chairperson, MT
Annie Lewis-O’Connor, Pediatric and Obstetrics and Gynecology Nurse Practitioner, Sexual Assault Nurse Examiner, Boston Medical Center Emergency Services, MA
Rabbi Mordechai Liebling, The Shefa Fund, NY
Sandy Liljestrand, RN, NE
Rabbi Marc J. Margolius, PA
Aubrey Marron, Former Ingham County Commissioner, MI
Elizabeth McElrath, RN
Margaret McGoldrick, Executive Vice President, Abington Memorial Hospital, PA
Cindy McKenzie, MSW, Superintendent, Riverside Youth Correctional Facility, MT
The Rev. Dr. Judith E. Michaels, Washington, DC
Peter Morris, Associate Professor Emeritus, Penn State University
Patricia Aikins Murphy, CNM, DrPH, FACNM, endowed chair, College of
Nursing, University of Utah
Wendy Murphy, New England School of Law, MA
Kerry O’Donnell, Maurice Falk Fund, PA
Rev. Charles Blustein Ortman, NJ
Judy Patrick, V.P. of Programs, The Women’s Foundation of California, CA
Rev. Dr. Katherine Hancock Ragsdale, Vicar, St. David’s Church, MA
Carol Ramos, Lincoln County Victim Witness Program, MT
Maria G. Ramos, M.S.W., Assistant Coordinator, Temple University Center for Social Policy and Community Development, PA
Lisa Rarick, MD, Consultant, Reproductive Health and Regulatory Affairs, Formerly with the Center for Drug Evaluation and Research, US FDA
Elyse Reznick, Former Criminal Investigator, Sex Crimes Unit, NJ Prosecutor’s Office
Ralph Riviello, MD, FACEP, Thomas Jefferson University, PA
Rabbi H. David Rose, Congregation Har Shalom, MD
Babbette Rose-Faison, Medical Advocate, PA
Shallotta Sharp, RN, ADN, Sexual Assault Nurse Examiner, Rush Foundation Hospital, MS
Linda Simkin, Action Research Associates, NY
Rebecca Simons, MD, MPH, Clinical Instructor in Family Medicine, Brown University, RI
Abbigail Swatworth, BSW
Pat Tetreault, PhD, Coordinator, Sexuality Education Exchange, Nebraska
Rabbi David Teutsch
Carolyn Torre, RN, MA, APN, C, Director of Practice, New Jersey State Nurses
Association and Nurse Practitioner, Princeton University Health Services
Joanne L. Tosti-Vasey, PhD, Treasurer, Pennsylvania NOW, Inc.
David Toub, MD, MBA, PA
James Trussell, PhD, Director, Office of Population Research, Princeton University, NJ
Elise J. Turner, CNM, Sexual Assault Nurse Examiner-A, Education Coordinator, Mississippi Coalition Against Sexual Assault
Erin S. Wieand, Administrative & Financial Officer, University of Pennsylvania Department of Medical Ethics/Center for Bioethics Beverly Winikoff, MD, MPH

1 See Charlotte Ellertson et al., Extending the time limit for starting the Yuzpe regimen of emergency contraception to 120 hours , 101 Obstet. Gynecol. 1168, 1168 (2003); Helena von Hertzen et al., Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: A WHO multicentre randomized trial , 360 Lancet 1803, 1809-10 (2002); Gilda Piaggio et al., Timing of emergency contraception with levonorgestrel or the Yuzpe regimen , 353 Lancet 721, 721 (1999).

2 Am. Coll. Obstet. Gynecol., Violence Against Women: Acute Care of Sexual Assault Victims (2004), at http://www.acog.org/from_home/departments/dept_notice.cfm?recno=17&bulle….

3 ACLU Reproductive Freedom Project Briefing Paper, Preventing Pregnancy after Rape: Emergency Care Facilities Put Women at Risk (2004), at /node/21982.