Sexual Assault Nurse Examiner and Emergency Contraception Access in Emergency Departments in the United States: A National Survey

Background: Despite the rise in sexual assault presentations in emergency departments (ED) in the United States, real-world access to sexual assault nurse examiners (SANE) and emergency contraception medication is unknown. We aimed to determine the real-world access of emergency sexual assault care by surveying EDs in the United States. Methods: EDs listed in the Centers for Medicare & Medicaid Services database were contacted telephonically by anonymous callers trained to collect responses from ED personnel. The study employed a cross-sectional survey to ascertain the availability of SANE and emergency contraception in EDs nationwide. Additional variables collected included regional demographics, urban status, hospital size, faith affiliation, academic affiliation, and existence of legislative requirements to offer emergency contraception to sexual assault patients. Findings: Of the 4360 eligible hospitals, 960 (22.0%) were contacted. SANE availability and emergency contraception access were reported to be available in 48.9% (95%CI: 45.5, 52.0) and 42.5% (95%CI: 39.4, 45.7) of hospitals, respectively. Emergency contraception access was a strong predictor of SANE availability. Hospitals reporting SANE availability were more likely to be large, rural, and academic affiliation. Hospitals reporting patient access to emergency contraception in the ED were more likely to be located in the Northeast, large, rural, academic affiliation, and in states with legislative requirements. Interpretation: Our results suggest that access to sexual assault services including emergent SANE and contraceptive medication in EDs remains poor with disparities. Geographic region, hospital size, and legislative status of the state are important predictors. Funding: None to declare. Declaration of Interest: None to declare.