In the summertime of 2021, a lady searching for an abortion got here to the Texas clinic the place I labored as a doctor. She’d been raped and was 15 weeks pregnant. I used to be the primary medical supplier she had seen since being assaulted. She advised me she hadn’t gone to the emergency room after her rape as a result of she was uninsured and afraid of racking up an enormous medical invoice.
It was not the primary time I’ve heard such a narrative.
Rapid medical care after a rape — often delivered in emergency rooms — is crucial to the well being and restoration of victims of sexual violence. In lots of ERs, specifically educated nurses carry out forensic exams to gather proof to be used in a prosecution if the attacker is ever caught. Generally, the federal Violence Towards Ladies Act — a regulation that’s supposed to guard survivors of sexual violence — pays for the forensic examination by way of state-run sufferer compensation funds.
However a forensic examination is much from the one medical service rape victims want. They want medicines to stop severe sexually transmitted infections resembling HIV, and generally they want restore of accidents resembling vaginal or rectal lacerations. They usually want psychological well being therapy and often want emergency contraception to stop being pregnant.
For the reason that federal regulation doesn’t cowl the complete vary of vital providers, getting them might be financially catastrophic for victims. As my colleagues and I reported in a research within the New England Journal of Medication, victims of sexual violence are sometimes anticipated to pay for a minimum of a few of their care out of pocket, and that presents a strong disincentive for ladies to hunt care at a time they desperately want it.
We analyzed greater than 35 million ER visits and recognized 112,716 survivors of current sexual assaults in 2019. Greater than 17,000 of the victims we recognized have been anticipated to pay out of pocket for his or her ER care; they have been charged a median of $3,673. Even privately insured survivors paid, on common, 14% of the full prices of their ER care (greater than $900), as a result of most personal protection carries copayments and deductibles, and lots of ERs are “out of community.” These are steep prices for most individuals, however significantly for the low-income ladies and ladies who most ceaselessly undergo sexual assaults.
I cared for my Texas affected person a number of weeks earlier than that state’s six-week abortion ban took impact, so she might select whether or not to terminate her being pregnant. That selection is not out there in Texas. Within the yr since Roe vs. Wade was overturned, legislators there and in eight different states — Alabama, Arkansas, Kentucky, Louisiana, Missouri, Oklahoma, South Dakota and Tennessee — have outlawed all abortions, even for pregnancies ensuing from rape.
“Rape exceptions” have been as soon as the norm in anti-abortion states, and even in at the moment’s brutal post-Roe setting, a number of Republican lawmakers can’t abdomen forcing rape survivors to hold the being pregnant for 9 months. The abortion bans in Idaho, West Virginia and Mississippi embody nominal exceptions for rape survivors. However to really get hold of an abortion in these states, victims are usually required to report the crime to the police and show they’ve acquired rape-related medical examinations.
These innocuous-sounding necessities disguise a tough fact. For a lot of survivors, getting medical care after rape comes with an not possible price ticket. Understanding they will’t afford a $3,600 medical invoice, they’ll by no means search care in any respect.
On the very least, the Violence Towards Ladies Act needs to be amended to make sure that state sufferer compensation funds cowl all important medical look after rape survivors, not simply forensic exams. And all states — together with these with abortion bans — ought to be certain that abortion care is definitely accessible for rape-related pregnancies.
However many victims of sexual violence don’t wish to disclose the assault, they usually want medical care too. Medicaid protection, which doesn’t drive victims to reveal assault, is a important lifeline for low-income victims of sexual violence.
But even states which have already expanded Medicaid nonetheless go away many uninsured and privately insured survivors susceptible to giant medical payments.
In California, for instance, many survivors of sexual violence with personal well being protection find yourself with medical payments amounting to a whole lot or hundreds of {dollars} as a result of excessive insurance coverage copayments or deductibles. In principle, victims can apply to the state’s Sufferer Compensation Board for help, however the course of is drawn out and bureaucratic. Systemic racism can be baked into the sufferer compensation system, since survivors with prior felony convictions, that are much more frequent amongst individuals of colour, are mechanically excluded from many states’ sufferer compensation packages, together with California’s. A common public insurance coverage program would be certain that all victims are in a position to afford care after an assault.
Our society has lengthy stigmatized victims of sexual violence and has by no means assured them the medical care and help they deserve. In post-Roe America, the mix of anti-abortion politicians and our unjust healthcare system compound rape victims’ struggling — including monetary insult to unimaginable damage.
Samuel Dickman is a doctor, researcher and the chief medical officer of Deliberate Parenthood of Montana.
