Emergency contraception after sexual assault: Changes in provision from 2004 to 2009

Objective: A random sample (20%) of U.S. and territorial emergency departments were surveyed in 2004 and again in 2009 to obtain information about provision and counseling of emergency contraception (EC) to sexual assault victims. Study Design: A representative sample of 20% of hospitals, stratified by state/ territory was prepared from the American Hospital Association list in order to conduct a 13-question telephone survey. Questions included (1) "Is there a written protocol for counseling about EC for sexual assault victims?" (2) "Are sexual assault victims at risk of pregnancy counseled about EC?" and (3) "Are sexual assault victims at risk of pregnancy provided EC?" A cross-sectional prevalence survey was administered in 2004 and 2009. Results: Provision of EC has changed very little from 2004 to 2009 (63% vs. 64%, respectively). Provision varies by number of victims treated, region of country and status of state legislation. Conclusion: Prophylaxis against possible pregnancy is an important part of sexual assault treatment and should be maximized. EC provision for sexual assault victims in emergency departments has not greatly increased over time and does not reflect regulatory changes in accessibility. Prophylaxes against sexually transmitted infections and pregnancy are handled differently for sexual assault victims, reflecting distinct separation of sexual and reproductive health in clinical practice.