|Giving Patients What They Want and Need
“Last summer, in the course of one eight-hour shift, I took care of two girls— a 13-year-old and a 14-year-old. They were unrelated cases, but both had been raped sometime in the previous three months,” says Dr. Ralph Riviello. “Both came to the ER, feeling sick. Neither girl knew she was pregnant.” Riviello, director of clinical research for emergency medicine and the medical director for sexual assault services at Thomas Jefferson University in Philadelphia, has always been a proponent of providing women and teenagers with easy access to emergency contraception (EC), but that day cemented his commitment.
“These girls were not only dealing with the trauma of having been raped, but they now had to decide: should they terminate the pregnancy? Raise the child? Give the child up for adoption? Those are big questions for anyone—but a 13-year-old? One of them said that she had thought the rape was over—but now knew that it wasn’t.” It upset Riviello that had these girls had access to EC, they could have avoided having to make such difficult decisions in the aftermath of sexual assault. “Especially when a woman has been assaulted, EC can give her some control back. It’s an important part of empowering women,” Riviello says.
EC is empowering for all women, Riviello believes, not just rape victims. “EC gives women the ability to control their reproductive rights, it is safe and effective, and it should be available to women and teenagers whenever, wherever, and for whatever reason that they want it,” he says. Unfortunately, accessing EC is not easy—and the problem is not simply that a prescription is required to obtain it. “I’ve worked with physicians who won’t prescribe it at all. I’ve had nurses tell patients that we don’t give it, even though we have a policy to offer it to survivors of rape,” Riviello says.
Physicians’ personal feelings about EC should play no role in a woman’s ability to take care of her reproductive health, and Riviello is taking action to make sure that in his hospital EC gets into the hands of women who want it. “I want women to have options. They shouldn’t have to run all over Philadelphia looking for a doctor who will give them EC,” he says. He is writing a policy that requires physicians to give EC to any woman who requests it, regardless of the provider’s personal feelings. “The decision to use—or not use—EC should be left up to women themselves.” In fact, Riviello believes that doctors shouldn’t be involved in making decisions about EC at all, and that it should be made available over-the-counter.
Riviello joined the PRCH Board of Directors this year because it is the only voice in the U.S. for physicians who are pro-choice, and in favor of comprehensive reproductive health services for women. “We are a strong voice,” he says. And he has a strong message: “As doctors and patient advocates, it is our job to give our patients what they want and need. The women I see coming into the ER want and need EC.”