Missouri hospitals and clinics that perform forensic exams following sexual assault are not required by law to offer emergency contraception to survivors, a coverage inconsistency a bipartisan group of lawmakers is trying to correct with legislation aimed at standardizing care after rape.
The proposal, called the Compassionate Assistance for Rape Emergencies Act, would require facilities providing emergency care to sexual assault survivors to offer emergency contraception as well as screening and treatment for sexually transmitted infections. The cost would be covered by the Missouri Department of Public Safety.
Supporters say the bill would fix an uneven system in which hospitals that don’t offer the medication often leave survivors to navigate travel, pharmacies and out-of-pocket costs while racing a narrow window in which the medication is most effective.
“Missouri is a state that is under strain when it comes to access to reproductive healthcare,” said Michelle Trupiano, executive director of Beacon Reproductive Health Network. “So anything we can do to reduce barriers, to make it easier for people to access care, we see as a priority.”
The bill is sponsored by state Reps. Jaclyn Zimmermann, a Democrat from Manchester, and Cecelie Williams, a Republican from Dittmer, and is part of a broader bipartisan push to expand access to contraception in Missouri.
Emergency contraception, often known as the morning-after pill, works by stopping or delaying ovulation. It does not end an existing pregnancy. Providers first administer a pregnancy test; if a patient is already pregnant, the medication is not given. The medication can only be given within five days of the assault.
Tonya Vega is the chief nursing executive at SANE Healthcare Services, a Missouri-based nonprofit that provides forensic sexual assault exams for victims across 51 facilities. She has performed more than 600 of these exams and said one of the first questions survivors often ask is about emergency contraception.
Vega said about 83% of the patients who receive exams through her organization take emergency contraception. The rest either declined, didn’t qualify or were assaulted in a way that wouldn’t result in pregnancy.
But not every health care facility stocks or prescribes the medication, Vega said, noting that while most hospitals with religious affiliations in Missouri do prescribe it, some are “adamant that they will not offer the medication.”
For those who end up at emergency departments that don’t offer emergency contraceptives, the news can be “detrimental,” Vega said.
This is especially true of adolescents between 14 and 18, who make up 36% of the patients SANE sees, Vega said.
She said denying emergency contraception at the time of the exam and requiring survivors to find a pharmacy and potentially pay out of pocket can be a significant burden, particularly in rural areas.
But some lawmakers raised concerns about the state mandating that hospitals provide medication even if it conflicts with religious beliefs.
State Rep. Brad Banderman, a Republican from St. Clair, asked during a hearing whether hospitals could opt out using “conscientious objections.”
No, Vega said.
State Rep. Brian Seitz, a Republican from Branson, voiced concerns for Catholic hospitals and asked whether patients would be counseled.
“Rape is a traumatic event,” he said. “You’re not necessarily gonna be in the proper frame of mind to make certain decisions anyway.”
When the committee voted on the bill last week, Banderman and Seitz joined Republican state Reps. Holly Jones, of Eureka, and Bennie Cook, of Houston, in voting against it.
“If people are anti-abortion, this would be something they should champion because this would prevent abortions from occurring in the first place,” Zimmermann said.
The uncertainty around abortion access in Missouri adds urgency to the debate. Abortion is currently legal until fetal viability after voters overturned a near-total ban in 2024, though access remains limited in parts of the state.
This story originally appeared here.