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, and it decreases in efficacy the further from the initial 24 hour mark it’s taken.
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 over the past decade 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 because they were outside the timeframe 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 the majority of hospitals with religious-affiliations in Missouri do prescribe it, the holdouts are “adamant that they will not offer the medication.”
For those who end up at one of the several emergency departments around the state that don’t offer emergency contraceptives, the news can be “detrimental,” Vega told The Independent.
This is especially true of adolescents between the ages of 14 and 18 who make up 36% of the patients SANE sees, Vega said, adding that many survivors don’t seek emergency treatment immediately, but rather a few days after the assault, once they’re started to process what happened.
“It’s one of the most vulnerable populations anyways that we treat,” she said of young victims. “…They’re still growing, they’re still learning, they’re still working with coping.”
Vega recently testified about her experience during a Missouri House Crime and Public Safety Committee hearing on the CARE Act.
She said denying emergency contraception to a survivor at their exam and then putting the onus on them to find a an open pharmacy and potentially pay for that prescription out of pocket can be a monumental task for someone still processing the trauma of the violent crime they just experienced. That’s especially true, she said,if they live in a rural area or have few resources.
But some lawmakers raised concerns with the state mandating that a hospital administer a medication even if it goes against the institution’s religious beliefs.
State Rep. Brad Banderman, a Republican from St. Clair, asked during the hearing if hospitals would be able to opt out of this requirement using “conscientious objections.”
No, Vega said.
State. Rep. Brian Seitz, a Republican from Branson, voiced concerns for Catholic Hospitals that might morally disagree with contraceptives and asked if patients would be counseled on the medication.
“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 the bill.
All four lawmakers previously voted in support of placing a constitutional amendment on the statewide ballot that would reinstate Missouri’s abortion ban, a fact noted by proponents of the CARE Act.
“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 after her bill was voted out of committee.
The uncertainty of the fate of abortion access in Missouri makes her efforts to prevent unwanted pregnancies all the more timely.
One in 20 women in the United States have become pregnant as the result of rape or sexual coercion, according to the Centers for Disease Control and Prevention.
The abortion ban appearing on the statewide ballot this year includes limited exceptions for survivors of rape and incest who end the pregnancy in the first trimester.
Abortion is currently legal up until the point of fetal viability in Missouri after voters approved a constitutional amendment overturning a near-total abortion ban in 2024. But pending court decisions around state laws regulating abortion have limited access to the procedure around the state and prevented providers from prescribing medication abortion to patients.
Following the hearing, Zimmermann said one colleague who voted in opposition approached her to say they felt sorry for any victims of this violent crime. She didn’t give their comment much credence.
“They’re more concerned that someone might have to dispense medication they don’t agree with,” Zimmerman said, “than they are concerned about the health and well-being of a sexual assault victim.”