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EC FOR RAPE SURVIVORS A Human Rights and Public Health Imperative (на английском языке)

According to new estimates from the World Health Organization (WHO), one-third of women worldwide will experience violence in their lifetimes; an estimated 7.2% of women will be sexually assaulted by a stranger and many more (23-36%, depending on region) will experience unwanted sex from an intimate partner.1To add to the physical and psychological trauma of rape, victims of sexual violence also risk unwanted pregnancy and exposure to sexually transmitted infections (STIs), including HIV/AIDS. Sexually assaulted women (and men) require a range of emotional, psychological, and medical care. Medical services for post-rape care should include prophylaxis against STIs, including HIV, and emergency contraception (EC) to reduce the risk of pregnancy. While HIV prophylaxis is often provided, EC is not so frequently offered, despite the fact that the risk of pregnancy is higher than the risk of HIV.2,3 Emergency contraception must be readily available in emergency care facilities as both a human rights and public health imperative.

About emergency contraception

Emergency contraceptive pills (ECPs), sometimes called the "morning after pill," can be used to prevent pregnancy for up to 120 hours (five days) after unprotected sex, as often occurs during forced or coerced sex. ECPs should be taken as soon as possible after unprotected intercourse because they are ineffective once a woman is close to ovulation; therefore, prompt access is critical. Levonorgestrel ECPs, the most commonly-available form, primarily work by preventing ovulation;4,5 they cannot terminate or interfere
with an established pregnancy. ECPs reduce the risk of pregnancy by up to half and possibly by as much as 80-90% for one act of unprotected sex. If a dedicated EC product is not available, higher dosages of combined oral contraceptives, a regimen known as the "Yuzpe method," can be used as emergency contraception instead. (For more information on the Yuzpe regimen, please visit

Although some governments and providers impose age restrictions on ECP access, ECPs are safe and effective for females of all ages. Therefore, all female survivors of rape, no matter their age, can and should be offered emergency contraception, if they have reached puberty or are otherwise believed to be at risk of pregnancy.
Some countries require a pregnancy test before ECPs can be administered as part of post-rape care. However, guidance from the WHO and others does not support pregnancy testing; ECPs will not work if a woman is already pregnant and will not harm an existing pregnancy.6,7 In addition to ECPs, the Copper Intrauterine Device (IUD) can also be used as emergency contraception, including in post-rape care. The Copper IUD is the most effective method of emergency contraception, at close to 100% effectiveness, and it is safe for women of any age or parity, including those who have never had children. Although many providers and health care settings do not offer the IUD for post-rape care,
IUDs can be offered as an EC option to survivors of sexual assault with simultaneous STI testing and prophylactic treatment, as long as informed consent protocols are carefully followed and collection of forensic evidence is not compromised.8 In settings in which providers are trained on IUD insertion, they can offer an IUD as one emergency contraceptive option, in addition to the option of EC pills, and allow women to
choose their preferred method.

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