Forensic Nurses' Understanding of Emergency Contraception Mechanisms: Implications for Access to Emergency Contraception : Journal of Forensic Nursing

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Forensic Nurses' Understanding of Emergency Contraception Mechanisms

Implications for Access to Emergency Contraception

Downing, Nancy R. PhD, RN, SANE-A, SANE-P, FAAN1; Avshman, Elaine BS2; Valentine, Julie L. PhD, RN, CNE, SANE-A, FAAN3; Johnson, Luke M.3; Chapa, Hector MD, FACOG2

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Journal of Forensic Nursing 19(3):p 150-159, 7/9 2023. | DOI: 10.1097/JFN.0000000000000430



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.


We evaluated sexual assault nurse examiners' understanding of the mechanism of action of oral ECs levonorgestrel (LNG) and ulipristal acetate (UPA).


A cross-sectional survey of practicing sexual assault nurse examiners was conducted through the International Association of Forensic Nurses.


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.


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.

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