II 113th CONGRESS 2d Session S. 2876 IN THE SENATE OF THE UNITED STATES September 18, 2014 Mrs. Murray (for herself, Mrs. Boxer , Ms. Warren , Mr. Blumenthal , and Mr. Booker ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To establish a public education and awareness and access program relating to emergency contraception.

1. Short title This Act may be cited as the Emergency Contraception Access and Education Act of 2014 . 2. Findings Congress makes the following findings: (1) Each year 3,400,000 pregnancies, or one-half of all pregnancies, in the United States are unintended, and 4 in 10 of these unintended pregnancies end in abortion. (2) The Food and Drug Administration has declared emergency contraception to be safe and effective in preventing unintended pregnancy for women of reproductive potential and has approved certain forms of emergency contraceptive for unrestricted sale on pharmacy shelves to women of all ages. (3) Research indicates that emergency contraception reduces the risk of pregnancy by up to 95 percent and emergency IUD insertion reduces the risk by 99 percent. Although more effective the sooner it is taken, medical evidence indicates that emergency contraception can be effective up to 5 days after unprotected intercourse or contraceptive failure. (4) Emergency contraception is a responsible means of preventing pregnancy that works like other hormonal contraceptives by suppressing or delaying ovulation, which makes fertilization from unprotected intercourse unlikely if the medication is taken within 120 hours. Emergency contraception does not terminate an established pregnancy. (5) Most brands of emergency contraception consist of the same hormones found in other hormonal birth control. (6) The percentage of sexually experienced women aged 15 to 44 in the United States who have ever used emergency contraception increased from 4.2 percent in 2002 to 11 percent in years 2006 through 2010. (7) A recent study by the Guttmacher Institute demonstrates that the rate of teen pregnancy in the United States has reached a historic low, declining 51 percent since its peak in 1990. From 2008 to 2010, increasing proportions of women aged 18 and 19 reported becoming sexually active, yet fewer of them got pregnant during this time period than in previous studies. Research suggests that increasing rates of contraceptive use may be associated with the decline in teen pregnancy. (8) Despite an increase in use, significant disparities exist for young, urban, minority women who lack general knowledge about emergency contraception. In fact, 1 in 4 teens remain completely unaware of the method and its use. (9) Although the American College of Obstetricians and Gynecologists (ACOG) recommends that doctors routinely discuss emergency contraception with women of reproductive age during their clinical visits only half of obstetricians/gynecologists offer emergency contraception to all of their patients in need suggesting that greater provider and patient awareness and education is needed. (10) Nearly 1 out of 5 American women is a victim of rape. It is estimated that 25,000 to 32,000 women become pregnant each year as a result of rape, half of whom choose to terminate their pregnancy. The risk of pregnancy after sexual assault has been estimated to be 4.7 percent in adult survivors who were not protected by some form of contraception at the time of the attack. If used correctly, emergency contraception could help many of these rape survivors avoid the additional trauma of facing an unintended pregnancy. (11) Only 18 States and the District of Columbia require hospital emergency rooms to provide emergency contraception-related services to survivors of sexual assault. Of those, only 13 States and the District of Columbia require hospital emergency rooms to provide emergency contraception upon request to survivors of sexual assault. Nine States have adopted restrictions on emergency contraception, and six States explicitly allow pharmacists to refuse to dispense emergency contraception. (12) In light of their safety and efficacy, the American Medical Association, American Academy of Pediatrics, American Women’s Medical Association, Society for Adolescent Medicine, and the American College of Obstetricians and Gynecologists have endorsed more widespread availability of emergency contraceptives. (13) Healthy People 2020, published by the Office of Disease Prevention and Health Promotion (ODPHP), establishes a 10-year national public health goal of increasing the proportion of publicly funded health care providers who provide emergency contraception to their patients, and reducing the number of unintended pregnancies by 10 percent. (14) Public awareness campaigns targeting women and health care providers will help remove many of the barriers to emergency contraception and will help bring this important means of pregnancy prevention to women in the United States. 3. Definitions In this Act: (1) Emergency contraception The term emergency contraception means a drug or device (as such terms are defined in section 201 of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 321 )), or drug regimen that— (A) is used postcoitally; (B) prevents pregnancy primarily by preventing or delaying ovulation, and does not terminate an established pregnancy; and (C) is approved by the Food and Drug Administration. (2) Health care provider The term health care provider means an individual who is licensed or certified under State law to provide health care services and who is operating within the scope of such license. Such term shall include a pharmacist. (3) Hospital The term hospital means— (A) a hospital as defined in section 1861(e) of the Social Security Act ( 42 U.S.C. 1395x(e) ); and (B) a critical access hospital as defined in section 1861(mm)(1) of such Act ( 42 U.S.C. 1395x(mm)(1) ). (4) Institution of higher education The term institution of higher education has the meaning given such term in section 101(a) of the Higher Education Act of 1965 (20 U.S.C. 1001(a)). (5) Secretary The term Secretary means the Secretary of Health and Human Services. (6) Sexual assault (A) In general The term sexual assault means a sexual act (as defined in subparagraphs (A) through (C) of section 2246(2) of title 18, United States Code) where the victim involved does not consent or lacks the capacity to consent. (B) Application of provisions The definition in subparagraph (A) shall apply to all individuals. 4. Survivors of sexual assault; provision by hospitals of emergency contraception without charge (a) In general Federal funds may not be provided to a hospital under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or to a State, with respect to services of a hospital, under title XIX of such Act (42 U.S.C. 1396 et seq.), unless such hospital complies with the conditions specified in subsection (b) in the case of— (1) any woman who arrives at the hospital and states that she is a victim of sexual assault, or is accompanied by someone who states she is a victim of sexual assault; and (2) any woman who arrives at the hospital whom hospital personnel have reason to believe is a victim of sexual assault. (b) Assistance for victims The conditions specified in this subsection regarding a hospital and a woman described in subsection (a) are as follows: (1) The hospital promptly provides the woman with medically and factually accurate and unbiased written and oral information about emergency contraception, including information explaining that— (A) emergency contraception has been approved by the Food and Drug Administration as an over-the-counter medication for all women without age restrictions and is a safe and effective way to prevent pregnancy after unprotected intercourse or contraceptive failure if taken in a timely manner; (B) emergency contraception is more effective the sooner it is taken; and (C) emergency contraception does not cause an abortion and cannot interrupt an established pregnancy. (2) The hospital promptly offers emergency contraception to the woman, and promptly provides such contraception to her at the hospital on her request. (3) The information provided pursuant to paragraph (1) is in clear and concise language, is readily comprehensible, and meets such conditions regarding the provision of the information in languages other than English as the Secretary may establish. (4) The services described in paragraphs (1) through (3) are not denied because of the inability of the woman or her family to pay for the services. (c) Effective date; agency criteria This section shall take effect upon the expiration of the 180-day period beginning on the date of the enactment of this Act. Not later than 30 days prior to the expiration of such period, the Secretary shall publish in the Federal Register criteria for carrying out this section. 5. Emergency contraception education and information programs (a) Emergency contraception public education program (1) In general The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall develop and disseminate to the public information on emergency contraception. (2) Dissemination The Secretary may disseminate information on emergency contraception under paragraph (1) directly or through arrangements with health agencies, professional and nonprofit organizations, consumer groups, institutions of higher education, clinics, the media, and Federal, State, and local agencies. (3) Information The information on emergency contraception disseminated under paragraph (1) shall include, at a minimum, the most current evidence-based and evidence-informed standards of care with respect to emergency contraception and an explanation of the proper, use, safety, efficacy, counseling and availability of such contraception. (b) Emergency contraception information program for health care providers (1) In general The Secretary, acting through the Administrator of the Health Resources and Services Administration and in consultation with major medical and public health organizations, shall develop and disseminate to health care providers information on emergency contraception. (2) Information The information disseminated under paragraph (1) shall include, at a minimum— (A) information describing the most current evidence-based and evidence-informed standards of care, proper use, safety, efficacy, counseling and availability of emergency contraception; (B) a recommendation regarding the use of such contraception in appropriate cases; (C) recommendation for health care providers working in emergency rooms to consult with survivors of sexual assault once clinically stable regarding options for emergency contraception and to provide any necessary follow-up care and referral services; and (D) information explaining how to obtain copies of the information developed under subsection (a) for distribution to the patients of the providers. (c) Authorization of appropriations There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of the fiscal years 2014 through 2018.