Forensic Nurses' Understanding of Emergency Contraception Mechanisms

Abstract

Background An estimated 25,000 pregnancies result from sexual assault in the United States annually. Numerous professional healthcare organizations endorse offering emergency contraception (EC) as an integrated aspect of post-sexual-assault care. Lack of knowledge surrounding EC's mechanism of action, including misinterpreting ECs as abortifacients, might restrict patient access to this important healthcare option. Purpose We evaluated sexual assault nurse examiners' understanding of the mechanism of action of oral ECs levonorgestrel (LNG) and ulipristal acetate (UPA). Methods A cross-sectional survey of practicing sexual assault nurse examiners was conducted through the International Association of Forensic Nurses. Results Among 173 respondents, 96.53% reported they prescribed/dispensed EC at the time of medical forensic examinations. LNG was prescribed more frequently than UPA (57.80% vs. 38.2%, respectively). When asked if they agreed or disagreed if LNG and UPA can disrupt an established pregnancy, 83.2% selected disagree/strongly disagree for LNG versus 78.6% for UPA, which were not significantly different. When asked whether the Supreme Court ruling overturning Roe v. Wade would change their EC prescribing, 79.77% reported it will have no change, 6.94% said it would increase, and 12.72% reported they were unsure. Several commented they were concerned whether state laws would prohibit EC and at least one program stopped prescribing EC because of their state laws. Implications Addressing misinformation regarding EC's mechanism of action and increasing access to oral EC options after sexual assault have the potential to reduce the incidence of rape-related pregnancy.

Updates in Emergency Contraception

“…A 2023 survey revealed that 16.8% of forensic emergency department nurses thought oral LNG EC could disrupt an established pregnancy, and 21.4% thought the same for UPA. 34 Ensuring that patients understand the difference between EC and pregnancy termination may help them make choices that align with personal views. If a pregnancy occurs after an IUD placement, the standard of care is to remove the IUD and counsel about options.…”

“…Unfortunately, the distinction between EC and abortion care is not always perceived by patients or health care providers. A 2023 survey revealed that 16.8% of forensic emergency department nurses thought oral LNG EC could disrupt an established pregnancy, and 21.4% thought the same for UPA 34. Ensuring that patients understand the difference between EC and pregnancy termination may help them make choices that align with personal views.…”

Public health and clinical implications of Dobbs v. Jackson for patients and healthcare providers: A scoping review

“…An overview of our screening process is presented in (Fig 1). The final sample consisted predominantly of cross-sectional (n = 6) [25,27,29,31,32,34], modeling (n = 5) [23,24,26,30,35], and observational (n = 4) study designs [19][20][21][22], along with was one retrospective chart review [18], one NLP-based study [28], and one commentary [33] (Table 2).…”

Implications of Dobbs v. Jackson for patients and providers: a scoping review

“…Seven studies (38.9%) in our sample discussed contraception (Table 2). [15][16][17][18][19][20]31 After Dobbs, we observed an increase in the demand for PCs. Notably, there was an increase in the number of Google searches for vasectomies immediately after Dobbs on June 24, 2022, as well as to a smaller extent immediately after the U.S. Supreme Court's draft of Dobbs v. Jackson was leaked on May 2, 2022.…”

“…31 Several nurses cited concerns about current or legal restrictions around EC prescribing after Dobbs (e.g., fear of prosecution). 31 Additionally, the demand for other contraceptives increased after Dobbs (Table 2). The number of Google searches for "IUD", "birth control pill", and "condom" similarly spiked after Dobbs, albeit to a lower extent than PCs and ECs.…”