Iowa AG still sitting on funds to help sexual assault victims

Nurses from across Iowa share why they’re worried about the Republican AG denying payments for emergency contraception for sexual assault survivors.

Nurses across Iowa are worried that sexual assault survivors will have to shoulder a new burden. 

More than a year has passed since Iowa Attorney General (AG) Brenna Bird, an anti-abortion Republican, announced she was halting payments for emergency contraceptives from Iowa’s Sexual Assault Examination Payment Program while she conducts an audit of the program.

“I think we all feel pretty strongly that this is not a cost that we want to pass along to our patients,” said Katy Rasmussen, a nurse with the Sexual Assault Nurse Examiner (SANE) program, and the coordinator for the Johnson County Sexual Assault Response Team in Iowa.

In an interview with Iowa Starting Line, Rasmussen said she worries about finding the money so patients don’t have to pay for emergency contraceptives—which can be $40-50. 

“They have just experienced a trauma and a crime committed against them, and it is a necessary part of that medical forensic exam to provide them with emergency contraception,” she said.

The Iowa AG’s Sexual Assault Examination Payment Program pays the cost of a sexual assault victim’s medical exam, preventative medications for sexually transmitted infections and HIV. For 40 years, emergency contraception was also included, though it’s not required by Iowa law. 

However, after Bird was elected in 2022, the AG froze payments from the program to conduct an audit. 

Bird’s office said the audit is complete, but its release is awaiting “senior staff” approvals and additional “collaboration and work.” They haven’t indicated when payments will resume either.

The AG’s office did not respond to Starting Line’s request for comments about the audit or what’s causing the delay.

“Attorney General Bird is carefully evaluating whether this is an appropriate use of public funds.” Bird’s press secretary, Alyssa Brouillet, told the Des Moines Register.

The funds come from criminal fines paid by violators that go into the Crime Victim Compensation Program.

That uncertainty is what’s making SANE nurses nervous for patients, because there is no other statewide system in place. 

Rasmussen said free emergency contraception is still being provided to sexual assault survivors in Johnson County. But it comes at a loss to the provider facilities, or from creative funding measures that unsustainable long-term. 

In her case, the Johnson County Supervisors in September 2023 approved using $10,000 to purchase emergency contraceptives because other facilities would not. 

Other barriers

Johnson County isn’t the only area of Iowa in need. SANE nurses across the state told Starting Line they don’t know what would happen if the block on emergency contraception continues. But they said they won’t stop caring for patients.

“Where I work, they’re very passionate about our patients. And so, right now, they’re okay with paying it. I don’t know how long that’s going to last, but I’ve had doctors, nurses, pharmacists that have said if the hospital stops paying for it then [they will] chip in,” said Jessica Clayton, a SANE nurse at MercyOne in Mason City.

Because the area is less populated, the hospital doesn’t see as many sexual assault cases, Clayton said. Being able to provide the emergency contraception in the ER matters to their rural community, she added, because most residents don’t have easy access to pharmacies or resources. 

“It’s just easier for me to be able to just give [patients] all of their medication while they’re in the ER setting so that we know that they get them.”

When survivors show up to emergency rooms after their assaults, SANE nurses do a comprehensive medical exam. Clayton said the exam involves multiple steps—like providing an account of the assault to guide the exam, checking for injuries and documenting those found, running urine tests, and prescribing medication.

“The whole exam can take anywhere from—I think my shortest exam was maybe three, four hours, and my longest was about 12,” she said.

No part of the exam happens without explicit consent, and patients can refuse any step even if they’ve signed the consent forms.

In Central Iowa, the pharmacies Shannon Knudsen works with are continuing to bill the AG’s office.

“It has not been made illegal to prescribe, so we will continue to prescribe it,” she said.

Knudsen co-founded 515 FoReNsics, a partnership that coordinates and trains SANE nurses for Polk and Story counties. They respond to calls from all the hospitals in the Des Moines area.

Knudsen said she hasn’t heard of anyone in the state being denied the medication, but she considers herself fortunate to work in the Des Moines metro area, where there are more pharmacies.

“I do think we work really good as a team to find those connections and community resources, but I do worry that it will become more challenging,” she said.

Knudsen worries about patients thinking the medication is illegal, about providers refusing to prescribe it because of Iowa’s new Religious Freedom Restoration Act law, and about sexual assault survivors being forced to find and buy the medication for themselves.

Anti-abortion politicians like Bird often treat emergency contraceptives as if they’re abortion pills, which isn’t true. Emergency contraception pills prevent pregnancy primarily by delaying the release of an egg (ovulation), which is why taking it as soon as possible is important. It doesn’t have any effect on an egg that has already been fertilized.

“We all have biases…but in this work, you check them at the door and you take care of the patient and you meet their needs where they are,” she said. “Because it’s not about me, it’s about them.”