Mississippi nurses who take care of sexual assault victims are worried that the state’s abortion ban could force them to stop offering emergency contraception – and they’re not getting any answers from the state’s chief legal officer.
Months ago, following the Dobbs ruling that allowed an abortion ban to take effect in Mississippi, a group of forensic nurses reached out to Attorney General Lynn Fitch’s office for guidance.
Michelle Williams, Fitch’s chief of staff, never answered their questions about abortion laws – including whether emergency contraception was legal.
When pressed by Mississippi Today, Williams said, “You can look at the law. You can decide whether or not it’s legal. But it is.”
Williams said she had responded to the first part of the email that asked about a project to update the state’s rape kits, which she considered “most relevant,” and then thought the conversation was finished.
The lack of response left the group of sexual assault nurse examiners concerned about potential legal consequences but determined to keep serving their patients.
“I’m going to continue to provide the emergency contraception as long as we have it available and give the education and resources that I always have,” said Alizbeth Eaves, one of the state’s few certified sexual assault nurse examiners and the trauma and SANE program manager at Ochsner Rush in Meridian. “But I am afraid that I’m going to be told, ‘That was against the law, and you’re in big trouble for it.’”
Through a records request, Mississippi Today obtained an email sent on July 18 by Shalotta Sharp, special projects coordinator at the Mississippi Coalition Against Sexual Assault, listing legal questions forensic nurses have about how the state’s new ban on abortion could affect their work.
Sharp, who has decades of experience as a certified sexual assault nurse examiner and is a long-time leader in the field in Mississippi, asked if emergency contraception is now outlawed. She also wanted clarification as to whether medical professionals can refer a patient to an abortion provider in another state.
“We are very thankful for any guidance and direction,” she concluded. “Thank you for your guidance and help!”
Williams responded that same day. She said she was on vacation but had proposed changes to crime victims compensation rules to review and should get back to Sharp soon. She did not acknowledge the other questions about the abortion law.
Sharp never heard from Williams after that. She had reached out to the attorney general’s office, she said, because the chief law enforcement officer is responsible for providing clarity about what the law actually requires.
“We certainly don’t want to be doing anything illegal,” she said. “But we also want what’s best for our patients.”
Mississippi Today told Sharp that Williams said emergency contraception is legal.
“If they’re saying that emergency contraception is not considered abortive, and it’s legal, literally that’s all I want to hear,” she said.
Under the updated rape kit the Attorney General’s Office produced in collaboration with the Mississippi chapter of the International Association of Forensic Nurses this year, the state continues to reimburse medical providers for “medication treatment for prevention of… pregnancy” for victims of sexual assault, regardless of whether the victim reports to law enforcement.
Only government entities, like counties, legislators and state agencies, can request official opinions from the attorney general, so Sharp’s email did not constitute a formal opinion request. Williams said the office can’t provide opinions outside that channel and that guidance for medical professionals comes from “any number of boards in the state.”
“We’ve been kind of left on read so to speak,” Eaves said. “It’s very frustrating that you’re going to have a trigger law in place and activate that trigger law without giving clear definitions and guidelines.”
Emergency contraception is recognized as part of the standard of care for victims of sexual assault by organizations like the American College of Obstetricians and Gynecologists. A copper intrauterine device is the most effective form and is about 99.9% successful at preventing pregnancy if placed within 120 hours of intercourse. Pills like ella and Plan B are also used in Mississippi hospitals.
Emergency contraception does not end a pregnancy– generally, it stops ovulation so an egg cannot be fertilized. But sometimes, the treatment can function by stopping a fertilized egg from implanting in the uterus.
“Where are we calling conception at?” Eaves said. “Because if we’re talking about when the sperm meets the egg, that could potentially take emergency contraception away.”
Some pro-life organizations consider the medication a form of abortion. The advocacy group Pro-Life Mississippi lists “Morning After Pill” on its website under “Types of Abortion.”
Attorneys general in other states have been willing to publicly clarify that emergency contraception is legal. In Missouri, a spokesperson for the office said state law — which bans abortion except in medical emergencies — did not prohibit Plan B after a local hospital said it would stop providing the medication because the “law is ambiguous.”
Mississippi’s ban on abortion defines abortion as “any instrument, medicine, drug or any other substance or device to terminate the pregnancy of a woman known to be pregnant.” During the period when emergency contraception is effective, pregnancy tests do not yet detect pregnancy.
“Obviously, when a person takes emergency contraception, she does not know she is pregnant and may well not be,” said Rob McDuff, a lawyer with the Mississippi Center for Justice, which represented the state’s last abortion clinic before it closed. “Emergency contraception continues to be perfectly legal.”
Forensic nurses interviewed by Mississippi Today said they are still providing emergency contraception to victims of sexual assault.
“We’re just prescribing it left and right,” said one nurse, who asked that her name not be used because she did not have permission from her employer to talk to the media.
But she’s worried about the future.
“That in itself is scary, that they (the Attorney General’s office) won’t just commit to saying, ‘Emergency contraception is okay,’” she said.
Eaves said the stakes of providing emergency contraception now feel higher than ever. If someone becomes pregnant following a rape, she is legally allowed to get an abortion in Mississippi only if “a formal charge of rape has been filed with an appropriate law enforcement official.”
That requirement makes Mississippi’s post-Dobbs abortion ban more restrictive than at almost any point in state history. When lawmakers added an exception to the state’s 1952 abortion ban for rape in 1966, they considered requiring a local chancery judge to first determine that a rape had occurred. But they rejected this idea because it would “require making the case a matter of public record and cause embarrassment to a wronged woman.”
Now, state leaders appear to have no such concerns.
Read the forensic nurses’ letter to the Attorney General’s Office:
9/14/22: This story has been updated to include a comment from Rob McDuff.