Editor's Note: The story misidentified the organization NARAL Pro-Choice Texas. Also, NARAL Executive Director Kae McLaughlin was misidentified. The Texan regrets the errors.
Mary Levy, head of the Austin Travis County Sexual Assault Nurse Examiners' program, based in the emergency room of St. David's Hospital, sees rape victims just hours after they've been attacked. The program has examiners on call 24 hours a day, seven days a week. As head examiner, Levy conducts many of the sessions herself. A regular policy at the program is to inform patients so they can decide whether or not to take emergency contraception medication. In her time working for the program, two of Levy's patients refused emergency contraception medication for moral reasons.
At the Capitol, a bill has been proposed that would standardize the very same care Levy provides. House Bill 676, presented by state Rep. Senfronia Thompson, D-Houston, mandates that all hospitals should prescribe the emergency contraception pill, also known as the morning-after pill, at the request of a rape survivor.
"I think women ought to have some alternative to make use of, particularly in cases of sexual abuse," said Thompson. "Women ought to have a choice."
Having a choice is what prompted state Rep. Frank Corte, R-San Antonio, to propose HB 16 that would allow pharmacists not to fill prescriptions they find morally or ethically objectionable. This includes abortion and emergency contraception medication.
"We have had some [pharmacists] tell us that they wanted similar protection of [the] law that doctors and nurses have for moral or ethical objections," said Corte, defending the bill's intent.
These bills push for the freedom of choice. One asks that rape victims be allowed to chose not to become pregnant. The other asks that pharmacists not be forced to fill prescribtions medication they morally object to. Yet, should both pass, each will limit the other.
Conflicting freedoms
A 2003 study conducted by the Texas Association Against Sexual Assault (TAASA), found that nearly 60 percent of care facilities did not provide emergency contraception pills to rape victims, said Chris Lippincott, media spokesperson for TAASA. Advocates for providing the emergency contraception pill argue that because emergency contraception is crucial to helping victims of sexual assault, the majority of emergency facilities in Texas provide substandard care by failing to offer this option.
"That's unacceptable. This is the standard of care we need. It is recommended by the American Medical Association, American College of Obstetricians and Gynecologists, Association of Emergency Physicians, and Texas Evidence Collection Protocol for Crime Victims," said Danielle Tierney, spokeswoman for Planned Parenthood of the Texas Capital Region. Planned Parenthood is an organization that provides provides health care, birth control, counseling and education services to local communities.
Kae McLauglhin, executive director of NARAL Pro-Choice Legal, was enthusiastic about the importance of House Bill 676.
"We do support the legislation. I would encourage our members to be supporters of [it]," she said. She added that emergency contraception would reduce the pregnancies due to rape by up to 50 percent. However, only 1-in-10 women know about emergency contraception, she said.
Opponents of the measure disagree that medical personnel should be forced to provide emergency contraceptives.
"The thing [we oppose] is forcing hospitals to give medication that would cause an early abortion by preventing implantation of a human embryo," said Joe Pojman, executive director of the Texas Alliance for Life.
Pojman explained that there are several reasons why the Texas Alliance for Life refuses to support HB 676.
"Well, one thing I point out is that pregnancy after assault rape is extremely rare," said Pojman. "For one thing, the woman may already be on contraceptives. Very seldom does an assailant ejaculate; it's all about power and control."
Arguing that a raped woman has been extremely traumatized, he concluded: "A woman has gone through a trauma; for these reasons her body may not be fertile."
Contraception confusion
The main argument between the two representatives and lobbying interests arises from the different understanding of the emergency contraception pill and it's effects.
"We know that emergency contraceptives do not work if you are pregnant," said Thompson. "I know the problem [with emergency contraception] has been people tying it into RU-486," she said, referring to the chemical medication used for abortion.
Emergency contraceptives do not induce abortion, but rather aim to prevent pregnancy, Thompson said.
Levy agreed. The pill has three functions, she said. It can delay ovulation, thin the uterine lining to prevent implantation of fertilized eggs and prevent the egg and sperm from uniting.
"It's not abortion," she said.
Advocates of HB 16 argue that this is not the case. According to them, the emergency contraception pill can cause early abortion if it is misused.
"Really, emergency contraceptive is just a higher dosage of birth control pill," Corte said. "A super [high] dose can cause abortion of a fetus."
The problem arises in the definition of abortion. An emergency contraceptive prevents implantation of a fertilized egg. Thus, advocates of emergency contraception view this as a preventive measure. However, opponents argue that stopping the implantation of the fertilized egg is defined as an abortive measure.
"If it prevents an implantation or causes a death, that's what we are talking about: early abortion," said Pojman.
The issue is further complicated by legal matters. Corte argues that the definition of emergency contraceptives is not fully clear. As a result, contraceptive pills that can act as abortive agents when misused will be allowed under the bill proposed by Thompson.
"From what I have been taught, it's a little grey area," said Corte.
Corte emphasized that his legislation was not meant to prevent victims of rape from getting access to emergency contraceptive that worked solely as preventive medication. The intent of the bill is to ensure the rights of pharmacists regarding abortion procedures, including pills that can result in abortion.
"There have been two incidents where employees who didn't fill prescriptions were fired," he said. "I know emergency contraceptives [issue] evolve around rape victims. In no way would I want a rape victim" to not have access to birth control pills.
Maintaining freedoms
The TAASA study, titled "A report on the level of care for sexual assault patients in Texas hospital emergency rooms," concluded that "urban settings are more likely than rural hospitals to give emergency contraception."
As a result advocates of Thompson argue that regulating the treatment of rape victims will allows all Texan women fair access to a minimum standard of care.
"I don't see how rape victims will not be able to get emergency contraception under my bill," said Corte, contending that even rural places have access to more than one pharmacist.
He went on to explain that his proposed bill simply ensures that pharmacists continue to exercise their freedom regarding their practices. Currently, pharmacists are unregulated in their discretionary powers to serve patients.
"A lot of them exercise that latitude within their own business or pharmacy," he said. "We are not asking anymore than they can do now."
He went on to voice his argument against Thompson's legislation, which would force doctors to prescribe emergency contraception and pharmacists to fill that prescription.
"Her requirement is a little more onerous from a philosophical standpoint," he said.
Thompson emphasized the need for state regulation to ensure that women have access to the help they need.
"[Emergency contraception is] an avenue of safety precaution to prevent the [raped] women from getting pregnant," she said. "I am looking forward to this passing, for women who are raped, as an alternative."
The prospects
This is not the first time Thompson has sponsored legislation to standardize procedures for the care of rape victims. She proposed a similar bill during the 78th regular session. That bill was referred to the House Public Health Committee. However, the bill was left pending in committee at the end of the session.
"We had the chairman of the committee wait until very later in the session to give me a hearing. And that was an intentional choice," Thompson said referring to the last year's legislation. Most members of the committee then were anti-abortion advocates, she said.
When asked about her predictions for this year's legislation, which has similarly been referred to the Public Health Committee, she remained optimistic.
"We have asked for a hearing, and we are hopeful we are getting a hearing. We are hopeful that reasonable minds" will listen this time around, she said.
Committee Chairwoman Dianne Delisi, R-Temple, could not be reached for comment. However, the bill has not been scheduled for a hearing yet.
Public Heath Committee member Garnet Coleman, D-Houston, expressed his strong support of the bill.
"No woman whose being has been violated by forcible sexual assault should have the burden of bearing the child," he said. "We are talking about the emotional and psychological health of the individual."
Corte remains confident about HB 16. He said he thinks he can garner enough support to get the bill passed.
"I feel the committee is favorable. I think I can get it out of committee," he said, referring to the State Affairs Committee, which is reviewing the bill.
Meanwhile, Mary Cullimane, a concerned citizen, sits at the Planned Parenthood Lobby Day 2005. She hopes her participation in the day's events will help secure the rights of women, especially those who have undergone the trauma of rape. In response to opponents of emergency contraception, she said, "It's really somebody's ideological position, and it's not based on science and medicine."
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