Emergency Contraception (EC)

Access to EC and EC information in
Catholic hospital emergency rooms

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Women who feel that they might need to obtain this medication in the future because of rape or contraceptive failure might wish to determine, in advance of need, the nearest pharmacy which stocks the medication. They might also wish to obtain a prescription from their physician, if necessary, and purchase the medication to have it on hand in case they need it. "The American College of Obstetricians and Gynecologists has urged its members to offer prescriptions for emergency contraception during patients' regular checkups." 5 Since EC is most effective if taken as soon as possible after unprotected sex, speed is of the essence. If your local hospital is Catholic, you might wish to not rely on its emergency room for EC medication or referrals to a place where you can obtain EC.

In this essay:

• EC" refers to "emergency contraception," a higher than normal dosage of birth control pills which can prevent:"
  • ovulation, (the release of an ovum (a.k.a. egg) or
  • conception.
    
    
• Initially it was believed that one mechanism by which EC might operate would be to prevent the implantation of the blastocyst -- pre-embryo -- in the wall of the uterus. However, this has since been shown to be extremely improbable or imposible.
  
  
• "MAP" refers to "Morning After Pills," a common name for EC. It is not a particularly good term because EC is reasonably effective long after the "morning after," to about 72 hours after unprotected intercourse.

A quotation:

• "You can try some of the other ERs, but this hour of the night I can honestly tell you, you won't find any place." Response by a person at a Roman Catholic ER room to a woman calling about a rape victim.

Availability of EC and information about EC:

If unwanted pregnancies, and thus the number of abortions,* are going to be reduced through the use of emergency contraceptives, then public health officials and others have an uphill battle. Both the dispensing of EC and information about EC is being impeded by some pharmacies and some religiously affiliated hospitals.

Hospitals affiliated with the Roman Catholic Church "are the nation's largest single group of nonprofit medical facilities, operating an estimated 621 hospitals, 367 nursing homes and 62 healthcare systems some of which manage "public" facilities." Church controlled hospitals total about 15% of all hospital beds in the U.S. "₁ About 15% of visits to U.S. emergency rooms are to Catholic hospitals. ₄ This can result in conflicts over matters related to human sexuality -- particularly those involving pregnancy and pregnancy avoidance. Some American hospitals affiliated with the Roman Catholic Church refuse to supply EC medication, referrals, or even information to women in their emergency departments.

Catholic teachings:

The Roman Catholic Church teaches that human personhood starts at conception, and that any abortion or other direct termination of the development of an pre-embryo, embryo, or fetus is the moral equivalent to murder. It can never be condoned. A woman who has conceived must continue until she gives birth.

EC normally prevents ovulation or fertilization; it cannot terminate an established pregnancy.* Once the embryo has attached itself to the uterine wall, EC has no effect. However, it can prevent an embryo from implanting in the womb. Catholic teaching generally opposes the use of birth control pills and EC. Providing information about EC, or a referral to a place where the woman can obtain EC, is also opposed. However, the Church allows the use of EC for rape victims if conception can be shown to have not happened.

Catholic hospital policies:

Some Catholic hospitals find themselves in a bind, having to face:

	Requests for EC by their patients who do not necessarily agree with the Church's teaching.
	The ethical requirements of the Catholic Church.
	Legal requirements. As of early 2005, a Washington state law requires hospital emergency departments to offer EC to its female rape victims. Laws in California and Illinois require emergency departments to supply information about EC to its female rape victims. "Florida, Kentucky, Connecticut, Ohio, Maryland and New York...require or encourage the dispensation of EC to rape victims through mechanisms other than a direct mandate through the law." 4

Sister Sharon Park, executive director of the Washington State Catholic Conference said: "What Catholic hospitals do is based on religious directives. They follow the teachings of our religious beliefs, which are protected under the First Amendment." ₂

Of course, actions based on religious beliefs are not necessarily protected by the First Amendment. For example:

	Parents who decide as a result of their religious beliefs to deny life-saving treatment to their children are sometimes prosecuted.
	Some fundamentalist Mormons engage in polygyny -- marriages of one man to multiple women -- and are, in rare occasions, prosecuted for bigamy.

The U.S. Roman Catholic church's Ethical and Religious Directives for Catholic Health Care Services, commonly called the "Directives," say that the church cannot approve contraceptive interventions that:

"...either in anticipation of the marital act, or in its accomplishment or in the development of its natural consequences, have the purpose, whether as an end or a means, to render procreation impossible."

However a limited exception is made in the case of a rape victim. Directive 36 states:

"Compassionate and understanding care should be given to a person who is the victim of sexual assault. Health care providers should cooperate with law enforcement officials, offer the person psychological and spiritual support and accurate medical information. A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum." ₄

According to Catholics for a Free Choice:

"Catholic ethicists within hospital systems as well as in the academic community are not in agreement regarding the implementation of the Directive. Each Catholic hospital is free to interpret the Directive and implement either a liberal or a conservative policy. That process is subject to theo-political pressure, most often from conservative bishops and lay Catholic groups demanding strict application of Catholic teachings in Catholic hospitals. Since rape is not an acceptable reason for abortion, they say, it should not be an acceptable reason for contraception."

According to The Interim periodical, Fr. Kevin O'Rourke, O.P., the director of the Center for Health Care Ethics at St. Louis University has "claimed responsibility for developing a United States Council of Catholic Bishops' policy" that allows Catholic emergency rooms to dispense EC to rape victims after testing to make certain that she has not conceived. ₃ This policy states that Catholic hospitals should administer:

1. A pregnancy test. This is always good medical practice. If positive, the woman would be denied EC because a pregnancy is already established. Also, EC would be ineffective in this case.
   
   
2. An ovulation test. "If the ovultaion test and the date of the woman's last period suggest that she has not yet ovulated, then the EC may delay ovulation and avert a pregnancy." ₄ Dispensing EC is acceptable to the church in the case of a rape victim who has not ovulated. Of course, if a woman is currently ovulating or about to ovulte, she is most liable to become pregnant, is in greatest need of EC, and yet is prevented from obtaining it -- regardless of her religious beliefs.

Catholics for a Free Choice concluded:

"Hospitals, we believe, are community assets, health care a public trust, and moral decision-making the right of individuals, including women. A Catholic hospital that does not put the conscience and religious freedom of individuals first is not living up to its claim that it provides 'compassionate and understanding care…to a person who has is the victim of sexual assault.' If this is not understood by Catholic health care providers, then it is essential that 'the laws' serve to protect the religious freedom, conscience and health of women." ₄

Surveys of EC availability at Catholic hospital emergency rooms:

1999: Catholics for a Free Choice surveyed the emergency departments of 589 hospitals in the U.S. which are affiliated with the Roman Catholic church. They found that: 82% do not provide EC, even for rape victims, 9% had no policy on EC, 9% supply EC to some rape victims. 1

2002: Ibis Reproductive Health surveyed 597 emergency rooms at US Catholic hospitals. This included almost all of the ERs in the country: 55% do not provide EC, even for rape victims. This number rises to 66% in southern states. 23% supply EC only to rape victims -- some only after repeated requests are made; some only after a police report is filed, etc.  6% left the decision up to the physician. 5% supply EC on request. 11% did not know, refused to answer, or could not be contacted.

Availability of information about EC at Catholic emergency departments

	1999: Among the 82% of Catholic-affiliated hospitals that deny EC treatment to women: 22% provide referrals with with phone numbers upon request, 47% provide referrals but no phone numbers, 31% do not provide referrals. 1
	2002: Among the 55% of Catholic-affiliated hospitals that deny EC treatment to women: 47% provide referrals. 64% of the referrals were "dead ends;" they would not lead to the availability of EC. About 33% led to a place that dispensed EC About 6% led to one or more other referrals and eventually to a place that dispensed EC.

Site navigation: Home > "Hot" topics > Abortion > Reducing abortion >  EC menu > here

Note:

* The term "abortion" is commonly defined as any intentional termination of pregnancy. However, there are multiple and conflicting definitions of the term "pregnancy" which cause an incredible degree of confusion:

Religious conservative, including Roman Catholics, commonly define pregnancy as beginning at conception, when a spermatozoon fertilizes an ovum. Under this definition, it was originally believed that EC could sometimes prevent the resulting blastocyst to implant in the uterus. This has since been shown to be extremely unlikely or impossible. However, many pro-life groups still believe that EC can interfere with implantation. In reality, EC works only by suppressing ovulation or impeding fertilization; it is a true contraceptive.

Others, including the medical profession and this web site, define pregnancy as beginning when the blastocyst has fully attached itself to the endometrium -- the inside the wall of the uterus. Under this definition as well, EC cannot act as an abortifacient.

The difference in timing between fertilization and implantation is on the order of 9 or 10 days.

References:

The following information sources were used to prepare and update the above essay. Unfortunately, some may have gone offline by the time that you read this:

1. "Emergency Contraception: Catholic hospitals routinely refuse to offer treatment, even to rape victims," Kaiser reproductive health report, was at: http://report.kff.org/
2. "Survey Finds 45% of Catholic Hospitals in US Dispensing Abortion Drugs," Life Site, 2005-MAY-05, at: http://www.lifesite.net/
3. Gillian Long, "Priest argues in favour of denying food and fluids," The Interim, 2004-JAN, at: http://www.theinterim.com/
4. "Second Chance Denied: Emergency Contraception in Catholic Hospital Emergency Rooms," Ibis Reproductive Health for Catholics, at: http://www.catholicsforchoice.org/
5. Lawrence Morahan, " 'Morning-After' Pill Available at Some DoD Clinics," CNSNews.com, 2002-JUN-3, at: http://www.cnsnews.com/ViewPentagon

Copyright © 2005 to 2010 by Ontario Consultants on Religious Tolerance
Originally published on 2005-MAY-06
Latest update: 2010-JUN-20
Author: B.A. Robinson

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