Analysis Law and Policy

How Did Emergency Contraception Get Excluded From VAWA?

Sidra Zaidi

By all accounts, the women’s rights advocates who fought to reauthorize VAWA never made EC a priority.

Women’s health advocates in the United States often pride themselves on leading the world toward greater gender equality. The celebration over S.47, the Violence Against Women Reauthorization Act of 2013 (VAWA), was no exception. Passage of VAWA required sustained and public fights to ensure it included protections for sexual minorities, immigrants, and Native women and access for individuals in need of post-exposure HIV prophylaxis treatment, which prevents possible HIV infection after unprotected sex.

Yet despite these considerable gains, the advocates failed to ensure that the bill fully protects rape survivors from the psychological and physical threat of unwanted pregnancy.

VAWA makes no explicit mention of emergency contraception (EC), also known as the morning-after pill, which is the only available method to prevent pregnancy after unprotected sex. The exclusion of EC from VAWA was not the result of opposition from the usual suspects. Rather, by all accounts, the women’s rights advocates who fought to reauthorize VAWA never made EC a priority.

In a conversation over email, a committee aide for Sen. Patrick Leahy (D-VT), the primary author of the VAWA reauthorization, told me the following: “The law requires states to make sure defendants get tested for HIV within 48 hours or they lose a certain percentage of money from one of the grant programs. Basically, the focus has always been around HIV, and emergency contraception was not an issue raised by any of the groups that the Chairman worked so closely with to reauthorize VAWA.”

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I also talked to members of women’s health advocacy groups involved in passing VAWA to find out more about EC’s exclusion. None were willing to speak with me on the record. They all, however, confirmed what Leahy’s staffer said: The failure to include language on pregnancy prevention in the final version of VAWA did not result from fear that the bipartisan law would be rejected. Rather, EC was simply not a top priority for advocates, who instead chose to focus specifically on HIV prevention. 

Several sources from these organizations also told me that ensuring access to EC for rape survivors was not significant enough to merit inclusion in federal legislation. They contended that states, not Congress, should adopt laws requiring EC in post-rape care.

The reality, however, is that state legislatures have largely failed to do this, and given the climate of current state EC laws, they cannot be expected to, either.

The majority of states have no requirements regarding the provision of EC to survivors of sexual assault. Only 16 states require hospitals to offer information and counseling about EC, and only 12 of those states (California, Connecticut, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Utah, Washington, and Wisconsin) plus the District of Columbia also mandate that hospitals provide EC on-site to victims. (Hawaii’s Senate recently passed a bill requiring hospitals to dispense EC to rape survivors, but it has not yet become law.) 

While I believe that most health workers do their best to offer compassionate post-rape care, lack of federal policy on EC provision leaves women in 34 states vulnerable to the whims of individual providers or hospital policies. As brought to light by organizations such as MergerWatch and Catholics For Choice, the increasing number of Catholic hospital mergers has greatly limited access to EC, even for rape survivors. In addition, pharmacists in several states refuse to provide EC on grounds of conscientious objection, a move that has been supported in federal court.

In addition, age restrictions for EC persist. Currently, only women and men age 17 and older are allowed to purchase EC over the counter. Forcing a teenage girl who has already been violated to seek a prescription or ask an older friend to purchase EC for her adds to her trauma. Age restriction policies are also unnecessary.

EC is safe and effective for all ages, and has been approved for adolescent use by both the Food and Drug Administration (FDA) and the American Academy of Pediatrics. However, Health and Human Services Secretary Kathleen Sebelius overruled the FDA in 2011, requiring adolescents under the age of 17 to present a prescription for EC. (Some state laws also require doctors to prescribe EC to adolescent rape survivors if necessary, but, again, these laws are few and far between.) Moreover, Sebelius overruled the FDA’s approval of EC as an on-the-shelf product, rather than a behind-the-counter drug.

Women and teens who need EC must therefore wait until pharmacies are open to buy the drug and also hope that the pharmacist will not object to selling EC. Because EC is only effective within five days of unprotected sex, unnecessary delays jeopardize a woman’s chance to prevent pregnancy, which is especially egregious if the woman was raped. Lack of EC services within VAWA therefore obstructs adolescents’ and women’s already limited access to EC at a time when they are most likely to need it.

Given all of these obstacles to EC access, especially for sexual assault survivors, it is notable that reproductive health advocates overlooked the possibility to incorporate language on EC into the reauthorization of VAWA. Indeed, very few advocates have critically analyzed VAWA, perhaps because many do not recognize the law’s exclusion of EC access and other pregnancy-related services.

For example, after the passage of VAWA, Chloë Cooney of Planned Parenthood Global published a commentary on Rewire urging international leaders to model resolutions after VAWA. She was specifically speaking to U.S. delegates at the UN Commission on the Status of Women (CSW)—which last week concluded a conference on violence against women—encouraging them to “leverage this victory and momentum for women’s rights and turn our attention to women and girls beyond our borders” by including “a commitment to expand access to sexual and reproductive health services” in CSW’s annual resolution.

Cooney perhaps did not realize that U.S. women’s rights advocates failed to include EC in VAWA. However, her call for widening access to reproductive health services was achieved when the international partners at CSW moved beyond the scope of VAWA by strengthening the commitment to expand EC access at the global level.

Less than one week after President Obama signed VAWA, delegates at CSW agreed to global commitments for eliminating and preventing violence against women. Despite opposition from conservative representatives, including those from Iran, Russia, and the Vatican, the majority of CSW’s 45 member states were able to push forward language that explicitly included post-exposure HIV prophylaxis and EC as well as safe abortion services (where legal), which were also excluded from VAWA.

Comparing CSW’s progress on reproductive health guidelines to that of VAWA is in many ways disheartening. Despite VAWA’s passage, we have at best a scattershot approach to providing survivors of sexual assault with the means of preventing pregnancy resulting from rape. The failure on our part to do so causes further violence to them and clouds any mission to help women “beyond our borders.”

Culture & Conversation Violence

Breaking Through the Fear: How One Woman Investigated the Life of Her Rapist

Ilana Masad

Ignorance is caused by fear, reporter Joanna Connors writes, and it is with this attitude that, 21 years after she was raped, she begins the process of trying to understand the man who raped her, the man she thought “would be the last human being [she] would see on this earth.”

She was fine. That’s what she told everyone, including herself. After filing a report with the Cleveland police and getting her rapist locked up, she was fine. Fine, fine, fine. Except she wasn’t.

In I Will Find You: A Reporter Investigates the Life of the Man Who Raped Her, reporter Joanna Connors realizes that she is most assuredly not fine during a college campus visit with her daughter.

Ignorance is caused by fear, Connors writes. And it is with this attitude that, 21 years after she was raped—she immediately reported her rape to the police, and her rapist was caught the next day—she begins the process of breaking through the fear to understand the man who raped her, the man she thought “would be the last human being [she] would see on this earth.” She had thought she was over it, but it wasn’t until breaking down during that college tour that she realized she was still afraid of her rapist and still terrified he would find her.

When Connors was 30, she went to a Case Western Reserve University theater where a rehearsal of a play that she was covering for her newspaper, Cleveland’s Plain Dealer, was taking place.

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A man inside the empty theater—the actors had left by the time Connors arrived—beckoned her inside, saying that he was working on the lights. Then, brandishing a sharpened pair of scissors, he threatened to kill her if she didn’t do what he said and spent more than an hour raping her.

The chapter detailing her rape is chilling, as she describes the various acts performed, the way she went along with what her rapist told her to do, coaxing him on, hoping to make the ordeal end more quickly. By describing specifics of her rape, Connors is confronting and stripping away the shame she experienced by showing the reader the cold, hard facts of what a rape can be like.

Her words demonstrate how a person who was raped becomes a survivor. Even in her dissociative state, she didn’t want to die there at the hands of a man she didn’t know. She managed to convince him to stop and leave, and he kissed her goodbye outside, as if what had just happened was completely, utterly normal. Maybe, for him, a man whom she says was smoking menthols and who had a tattoo on his arm with his own name on it—”DAVE”—it was.

Connors found an eerie irony in that she was raped on a college campus before such rapes were more widely discussed. In recent years, there has been a rise in awareness regarding the frequency of rapes at institutions of higher learning. There are now websites dedicated to explaining the statistics as well as documentaries like The Hunting Ground, which explores the sexual violence that happens on U.S. college campuses and how students are pushing back against institutional cover-ups and injustices. Since Connors’ experience, society has begun to more broadly understand the terms “rape” and “sexual assault,” and there has been more discussion about the rapes and sexual assaults that happen within existing relationships; eight out of ten rapes occur between people who know one another.

It’s perhaps less common these days to find discussions of the other kind of rape: the kind that we’re warned about when we’re young and told not to take candy from strangers, the kind that makes us automatically cross the street when a group of men we find threatening happens to be walking toward us, the kind that happens when a complete stranger attacks us. This was Connors’ experience.

I Will Find You takes the reader through two distinct processes. The first is Connors’ discovery that her rapist may have been a sexual-violence survivor in his own right. The second, which carries the narrative, is how Connors came to terms with how being raped by David Francis, the “DAVE”-tattooed man, separated her life into a “before” and an “after.”

Before the rape, she was a reporter who lived largely without fear. Connors explains that she went into the theater, where her rapist, a young Black man, was beckoning her, for one reason: “I could not allow myself to be the white woman who fears black men.”

But after, she writes, “this new fear of black men shamed me more than the rape.” Connors explains she didn’t want to be the stereotypical white woman of privilege, who clutches her purse and crosses the street when she sees a Black man walking her way. As a woman aware of her socioeconomic and racial privilege, she didn’t want to participate in oppression.

But it wasn’t just Black men that she feared—it was everything:

I turned my life into performance art. I acted normal, or as normal as I could manage, all the while living on my secret island of fear. As time went on, the list of my fears continued to grow. I was afraid of flying. Afraid of driving. Afraid of riding in a car while someone else drove. Afraid of driving over bridges. Afraid of elevators. Afraid of enclosed spaces. Afraid of the dark. Afraid of going into crowds. Afraid of being alone. Afraid, most of all, to let my children out of my sight.

From the outside, my performance worked. I looked and acted like most other mothers. Only I knew that my entire body vibrated with dread, poised to flee when necessary.

Years after her rape, Connors tells her children about it—both were born after the living nightmare in the theater and are college-aged by then—and begins to confront the fact that she has never “gotten over” it, even though she’s told countless therapists that she has. It is then, despite her husband’s protests and her own fears, that she decides that she must also confront her ignorance regarding her rapist and find him, just as he once threatened that he would find her.

Connors’ investigation is difficult, as she finds out almost at once that her rapist died in a prison hospital some years before. This, however, doesn’t stop her: She begins to investigate his family, trying to find anyone who may have known him and could explain, perhaps, why he did what he did.

Connors regards what she finds out about her rapist with empathy. Connors doesn’t forgive and forget—rather, she forgives, in a sense, by remembering, by finding others who remember, by dredging up a past that is as unpleasant for her interviewees as it is for her.

She eventually gets support from her newspaper to research and write her own story. At every one of the interviews, she expresses discomfort with what she’s doing and almost backs off. Pushed on by her photographer co-worker—and her own need to know—she continues on what has become a journalistic mission. Connors knows she is intruding into people’s lives and realizes she’s coming from a place of privilege, but ends up relating to so much of their stories that she finds her rage toward her rapist fizzling.

It’s with great care, too, that Connors treats the racial tensions that arise during her investigation. Connors talks to women of color who, in 2007 when she conducted her interviews, had never reported their rapes: “I know about rape,” one of Francis’ relatives says. “I was raped myself. Three times. But I asked for it because I was on drugs and I was prostituting.” Connors tells the woman that she didn’t ask for it or deserve it, but the woman tells her the story of how one of her rapes happened and concludes with: “And besides that […] he was a white guy.” This woman felt that nothing would be done about it, even if she did report it.

Connors also writes that in her case, she served as the “perfect witness”; she explains that her rape “isn’t [hers] at all. It’s the state’s, as in The State of Ohio v. David Francis.” The prosecutor tells her: “You’re the ideal witness,” because she is “a journalist, trained to observe details and remember them.” She adds:

I know what he really means. To him, I’m the perfect victim because I happen to fulfill just about all the requirements of a woman accusing a man of rape, going back before the Civil War. I am white, educated, and middle-class. I resisted, and I have a cut on my neck, bruises still healing on my spine, and a torn and blood-stained blouse to prove it. I immediately ran to report the rape.

Needless to say, David Francis is the perfect defendant: black, poor, and uneducated, with a criminal record.

In fact, as she finds out during her investigation, her assailant was both Black and Native American, and spent his youth in and out of juvenile detention, starting at age 12. Connors looks at the racial disparity in prisons, at the rate of poverty in the areas of Cleveland that she visits, at the way socioeconomic status and race are interwoven, how violence and drug abuse feed into those factors as well, and how sexual assault and abusive environments are so often passed down through generations. Connors discovered fellow survivors in her rapist’s family—his sister Laura, with whom Connors is still in touch, described her mother’s boyfriend raping her in a church. His entire family, she discovers, have been survivors of one kind or another.

Connors believes that her rapist was likely raped himself. During her assault, she had a clear feeling that Francis was re-enacting something done to him. And after learning that rape was common at the juvenile detention center where Francis did many stints, she assumes that he had been abused there and during his time spent locked up as an adult.

What is most striking about Connors’ book is not its bravery—though it is brave—or its shock value, which exists. The book is valuable because Connors recognizes and conveys to readers the cyclical nature of abuse, its pathological nature, and one of its sources: in David Francis’ case, perhaps learning by example.

Commentary Politics

Young and Far From Apathetic on Abortion

Lauren Rankin & Dr. Sarp Aksel

It’s easy to say that millennials aren’t actively defending abortion rights. But it’s not true. In fact, the wide range of young people’s actions to preserve and advance access defies narrow definitions of "political activism."

This election season has brought mixed messages about youth activism. As Democratic presidential candidates Hillary Clinton and Bernie Sanders have attempted to woo young voters, there’s also been pointed criticism that millennials’ supposed apathy has contributed to the erosion of, of all things, abortion rights.

The most notable example of such criticism was Democratic National Committee Chair Debbie Wasserman Schultz’s January comments that she saw “a complacency among the generation of young women whose entire lives have been lived after Roe v. Wade was decided.”

Schultz’s perception does not mirror our reality (nor the reality of a presidential campaign in which few candidates have given abortion rights any meaningful airtime).

We are the younger generation in question. Together, we are a 28-year-old abortion provider and a 30-year-old abortion clinic escort. Every day, we enable access to abortion care, and we aren’t the only ones. Our friends and colleagues work tirelessly to not only further the abortion rights movement, but to lead it.

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According to a 2015 Gallup poll, a greater proportion of people ages 18 to 34 identify as pro-choice than does any other age group. But what the statistics don’t reveal is the myriad manifestations our generation’s activism takes. We are abortion providers, clinic escorts, fundraising champions, writers, documentarians, and storytellers.

As an OB-GYN resident in the Bronx, one of New York City’s most medically underserved boroughs, Sarp bears daily witness to the vital role abortion care plays in pregnant people’s health and lives. Too often, he sees the devastating consequences of barriers to care, whether in the form of insurance coverage, gestational age limits, financial hardships, or support system struggles. Despite New York state’s more liberal policies on abortion, access remains a challenge for many of its residents and his patients.

Providing abortion care is an awesome responsibility, one that brings with it tremendous emotional rewards. Sarp feels it when a patient gently squeezes his hand immediately after terminating a wanted yet anomalous pregnancy. He hears it in the thoughtful thank-you notes he receives from patients long gone from his office. He sees it in the joyful tears of a patient whose abortion he performed six months ago, but who just found out she is pregnant with a partner who does not physically, emotionally, or sexually abuse her. He clings to these moments as he cares for patients and when he marches in support of their rights to choose when, whether, and with whom to be pregnant.

Sarp is a product of Medical Students for Choice (MSFC), an international nonprofit with a mission to create the next generation of abortion providers and pro-choice physicians. Students involved with MSFC take a directly activist role, working to destigmatize abortion care among medical students and residents, and to persuade medical schools and residency programs to include abortion as a part of the reproductive health services curriculum.

For Lauren, enabling access means being a support system and sometimes a human shield between patients and hateful, shaming protesters. Her Saturday mornings are spent on the sidewalk, escorting patients and companions from the safety of their cars to the safety of the clinic. Young people comprise a plurality of volunteers at Lauren’s clinic, and they show up every weekend to support those who need it.

Lauren has held sobbing teenage rape victims as they were retraumatized by the violent screams of the men outside the clinic doors. She has watched as a companion screamed at a protester, “You don’t know what we’re going through,” as he walked his partner into the clinic to terminate a wanted pregnancy.

Escorting patients means being insulted and even endangered. Lauren has been berated, harassed, threatened, and sexually harassed by protesters while volunteering. But she has also been hugged, praised, thanked, and supported by grateful patients, their companions, and even passersby.

The misconception that young people are complacent belies not only our lived experiences, but the experiences of our colleagues.

Young people are at the forefront of work with the National Network of Abortion Funds (NNAF) and state-based grassroots abortion funds. “Well over half of NNAF’s member organizations are proud to have young people in leadership positions as board members, staff, and hotline volunteers,” said NNAF Executive Director Yamani Hernandez in an email to Rewire. “Abortion funds are a welcoming place for the power and brilliance of young people because we recognize our movement is stronger when we support and amplify their leadership.”

We see young people bravely sharing their abortion stories to shatter stigma. Amanda Williams, the executive director of the Texas-based Lilith Fund, and NNAF Policy Representative Renee Bracey Sherman are among many telling their abortion stories to the world, challenging a culture of silence and shame around this basic health-care service.

And yes, young people are a visible presence at rallies for accessible abortion care. In March, they joined older activists to support abortion access at the Supreme Court during oral arguments for the Texas abortion case (and we were among them!).

On a daily basis, we see young people embodying the second-wave feminist ideal that “the personal is political” by defending abortion on the ground. Youth are making abortion accessible by doing the hands-on, personal work of funding abortions, providing abortions, escorting patients into clinics, and in some states, driving and housing patients.

This is a directly political act, particularly in states where abortion is increasingly inaccessible. Rallies and marches are good and important. But they don’t mean much to a low-income woman in Texas’ Rio Grande Valley when she has two weeks left to obtain an abortion in her state and nowhere within hundreds of miles to go. She needs money, transportation, an escort, and a provider. She needs actual, tangible help. And that is what young people are doing.

Not only that, but young people are making the abortion rights movement more inclusive and more effective. In many ways, the abortion rights frameworks and tactics of the 1960s and 1970s don’t hold water for the movement today; our social movements have changed, and so has technology. Young people are demanding that the right to a safe and legal abortion be contextualized along all other reproductive rights, including youth-led campaigns like #NoTeenShame, which seeks to destigmatize pregnant and parenting teens. Young people are raising hundreds of thousands of dollars for abortion care by engaging social and digital media, leveraging the support of our followers to make access a reality. And young people are pushing the movement to be more gender-inclusive, to reflect the fact that not everyone who has an abortion identifies as a cisgender woman.

Young people aren’t checked out. We are engaged. We are working to make abortion accessible in an increasingly hostile landscape. Given the opportunity and support, young people can be the difference makers. So the next time critics of millenials are looking to blame someone for the current state of abortion rights, don’t look at us. We have work to do.