In Rape Cases, Morning-After Pill Stirs Debate for Catholics

Lily had been raped in the street by a stranger. Bruised, with blood running from her lower lip, she sat in the interview room with a nurse at California Hospital Medical Center recounting the attack. The nurse explained that there was a possibility she could become pregnant. Lily became sickened by the thought and at the same time confused about what to do.

Her mind went spinning, flashing from her husband and children back to the dirty hands of the assailant. Feelings of fear, shame and guilt compounded the horror as she imagined raising a child fathered by a rapist.

She thought about taking the morning-after pill to prevent the pregnancy. Then amid the ugly aftermath, she reflected for a moment on faith.

Isn’t that the same as an abortion? she asked.

Lily (a pseudonym) resolved her dilemma by taking the pill. But her concern is an example of a sometimes confusing ethical debate within the Catholic Church that has divided believers and created difficult issues for Catholic hospitals: Is the use of the morning-after pill permitted by Catholic teaching in cases of rape? Or is it comparable to having an abortion?

Across the nation, Catholic hospitals serve as primary sources of health care in low-income areas of many cities, Los Angeles among them. Most non-Catholic hospitals do provide emergency contraceptives, although some refer patients to nearby clinics. Because of the increasing importance of Catholic hospitals in the health care system, the dispute over emergency contraception has echoed beyond the church itself.

In Sacramento, the Assembly recently debated--and ultimately defeated--a bill that could have required Catholic hospitals to offer emergency contraceptives.

Farther afield, in the Balkans, relief agencies have fought with the Vatican over providing morning-after contraceptives to Kosovo refugees who report being raped.

Emergency contraception, commonly known as the morning-after pill, prevents pregnancy if taken within 72 hours after unprotected sex. Morning-after drugs are basically high-dose birth control pills. They are about 75% effective but work only until an embryo implants itself in a woman’s womb. That is in sharp contrast with the abortion-inducing RU-486, which in effect works by inducing a miscarriage.

The conflict over emergency contraceptives represents a gray area of Catholic doctrine.

Church teachings forbid artificial contraception of any type. But rape is distinguished from consensual sex because church teachings view the sperm as an extension of the violation. A woman is seen as having a right to defend herself against conception from the sexual assault, said Fred Caesar, spokesman for Catholic Health Assn.

The church considers anything that interrupts pregnancy after conception to be a form of abortion. But, Caesar said, according to the principles governing Catholic hospitals, emergency contraception is permitted in cases of rape provided that the pill is taken before actual conception has taken place.

Pill Available in Southland Hospitals

Because sperm can live in a woman’s body for several days before fertilizing an egg, a window of time exists during which emergency contraception is permitted by the church.

On that basis, all 14 hospitals owned by Catholic Healthcare West in Southern California make emergency contraception available to rape victims. Carol Bayley, director of ethics and justice education for Catholic Healthcare West, said the directive is clear.

“The real Catholic teaching is on sex,” she said. “In cases of rape, she has not consented to sex, so she has a right to prevent pregnancy.”

Catholic Healthcare West is discussing plans to develop a more formal policy to govern use of the contraceptives, Bayley said. But others contend that the state should require all hospitals to offer emergency contraception to rape victims. “This decision should rest with the woman who has been raped, not within a hospital’s religious beliefs,” said Susan Berke Fogel with the California Women’s Law Center.

Most critics of emergency contraception believe that life begins the moment an egg is fertilized and therefore consider the drug equivalent to an abortion. Several groups, such as American Life League, Pro-Life America, Protestants Against Birth Control and Pharmacists for Life International, oppose the drug because they say it functions as an early abortion.

Last month, Wal-Mart Stores said it would not fill prescriptions for emergency contraception and would refer requests to pharmacies that carry the drugs.

Helen Alvare, spokeswoman for the National Conference of Catholic Bishops Secretariat for Pro-Life Activities, said confusion abounds among Catholics because the morning-after pill can act as a contraceptive or an abortifacient, depending on when it is used. If conception has occurred, the drug would produce an abortion, she said.

In Peoria, Ill., Alvare said, Catholic hospitals have decided to use blood tests that show if a woman has conceived to determine whether she can be given the morning-after pill in good faith.

“It’s a critical difference for distinguishing the drug as a contraceptive or an abortifacient,” she said.

A recent report by Catholics for a Free Choice, a group that favors abortion rights, charged that most Catholic hospitals deny the drug to rape victims.

Although the report gained considerable attention, it appears to be flawed. Several of the Southern California hospitals that the report said did not offer emergency contraception to rape victims actually do offer it. Officials at the Catholic Health Assn. say those conducting the survey did not identify themselves as rape victims, misleading the emergency room attendants.

California Hospital Medical Center, a Catholic-owned facility, provides one of the most comprehensive rape and trauma units in Los Angeles and was not contacted for the study. Jeannie Stephenson, director of the sexual assault team, said her unit sees about 25 rape victims each month. The majority of women want the morning-after pill, she said.

“I tell women about it. I have no qualms about it,” said Stephenson. “And the sisters who own this hospital, they support me,” she said. “Does it make us less Catholic? I say no.”