Several intriguing comments were made to my post on “legitimate rape, contraception, and the Catholic Church.”

There is vigorous debate in Catholic bioethic circles regarding whether the ERDs mandate testing for pregnancy at the time of sexual assault versus testing for ovulation. My understanding of the process of conception is that the window for conception is the 12-24 hours after ovulation when the ovum is able to be fertilized. Sperm take a few hours to reach the distal ends of the fallopian tubes, where fertilization takes place. Our NFP teachers would know more about the window of opportunity, but I thought fertilization was the result of sperm waiting at the distal end of the fallopian tubes at the time of ovulation. Therefore, a woman would need to be raped, sperm would need to move into place, and then a woman would need to ovulate after the sexual assault for fertilization to be the result of the rape. Given that a woman is only fertile for an approximately 24 hour window in her cycle, during any given sexual assault during any given cycle, there is a very low chance that any given woman would be able to be impregnated as a result of an assault. I have seen mention of an article which I think Rep. Akin is referencing when he speaks to a woman’s body trying to prevent a pregnancy in the face of a sexual assault: a 1981 study by Mahkorn and Dolan regarding pregnancy rates in sexual assault. I have not yet found this article, either via PubMed or Google Scholar. I have seen reference to it in a chapter I have from a book entitled Ethical Issues in Reproduction. I’m going to try to track it down, it may be available via interlibrary loan.

A more recent study in 1996 estimates the rate of pregnancy after sexual assault at no greater than 5% (Holmes, et al). This is still a large number (approximately 36,000 pregnancies a year). Of interest is a statement in their conclusion which reads “Rape-related pregnancy occurs with significant frequency. It is a cause of many unwanted pregnancies and is closely linked with family and domestic violence.” I think this plays into Akin’s statement about “legitimate rape” contrasting women raped by partners or family members versus those whose rape is the result of a crime committed by a stranger (I’m not implying that one type of sexual assault is more legitimate than the other).

A really great article to look at is written by Daniel P. Sulmasy, MD, entitled “Emergency Contraception for Women Who Have Been Raped: Must Catholics Test for Ovulation, or is Testing for Pregnancy Morally Sufficient? (Kennedy Institute of Ethics Journal, 2006. Vol 16, No 4, 305-311). His abstract states: “on the gr0unds that rape is an act of violence, not a natural act of intercourse, Roman Catholic teaching traditionally has permitted women who have been raped to take steps to prevent pregnancy, while consistently prohibiting abortion even in the case of rape. Recent scientific evidence that emergency contraception (EC) works primary by preventing ovulation, not by preventing implantation or by aborting implanted embryos, has led Church authorities to permit the use of EC drugs in the setting of rape. Doubts about whether an abortifacient effect of EC drugs has been completely disproven…[has] lead to controversy with the Church about whether it is sufficient to determine that a woman is not pregnant before using EC drugs or whether one must establish that she has not recently ovulated. This article presents clinical, epidemiological, and ethical arguments why testing for pregnancy should be morally sufficient for a faith community that is strongly opposed to abortion.”

Dr. Sulmasy speaks about scientific and practical uncertainty: there are some things that are not known, much of what is claimed to be known is provisional, and much of that is statistical. If we know that something happens 1% of the time, we do not know if the patient being seen will fall into that 1%. As it is now known that the major effect of EC drugs is to prevent ovulation—which is morally permissible as it functions to prevent fertilization from the “unjust aggressor” it becomes necessary to change our prior strongly held beliefs about the abortifacient effect of EC. Obviously, most drugs work on more than one level or do more than one thing. And no one can be 100% certain that these drugs do not on the very rare occasion prevent implantation of a fertilized ovum. But we live with medical uncertainty all the time and rape victims shouldn’t be held to a higher standard of proof of non-pregnancy than other women. For instance, if I need a CT scan and I’m sexually active but not using contraception, the Radiology Department may require that I undergo a standard urine pregnancy test to ensure I’m not pregnant to avoid harmful radiation. But there is no guarantee that I’m not less than 10 days pregnant at the time of the pregnancy test. Theoretically I could be radiated and suffer a spontaneous abortion that is a result of that radiation exposure. We don’t require these women to demonstrate whether or not they have ovulated, so why should this burden be placed on the victim of sexual assault?