When a rape victim goes to the hospital for help, it’s crucial they receive comprehensive care. Part of that care includes receiving emergency contraception to prevent pregnancy resulting from the assault. Over the years, lawmakers across the United States have recognized the urgency in requiring medical facilities to provide EC to victims, with 13 states plus the District of Columbia enshrining that responsibility into law.

Yet multiple hospitals in those states have failed to provide victims with emergency contraception. In February, the Wisconsin Department of Health Services fined 22 hospitals, including SSM Health St. Mary’s in Madison — a repeat offender — for violating its Compassionate Care for Rape Victims Act, which mandates all hospitals offer sexual assault victims information about and access to emergency contraception. And in March, the Pennsylvania Bulletin released its annual list of healthcare facilities that cite “religious or moral belief” for failing to follow the state's administrative code dictating EC distribution to rape victims; 14 hospitals made the list this year.

Victims who are forced by hospitals to find emergency contraception on their own face major barriers to access. High cost and low availability can put the medication out of reach right away, if not entirely. Since EC is most effective within the first 72 hours after the assault, survivors face a higher risk of becoming pregnant the longer they wait to take the pill. And this, advocates say, can traumatize the victim further.

“To be sexually assaulted and then have to worry about things like sexually transmitted infections and pregnancy, on top of everything else,” says Julie Baisa, a sexual assault nurse examiner at Meriter Hospital in Madison, Wisconsin, less than a mile away from St. Mary’s. “If they’re not provided with [emergency contraception] or if they’re denied that, that can absolutely cause an increase in stress and anxiety to an already difficult situation.”

Meriter Hospital is the only facility in Madison that has a medical forensics program. According to Baisa, St. Mary’s and other hospitals in the area sometimes transfer sexual assault victims who present at their emergency units to Meriter because they doesn’t have the capacity to run a rape exam. Under the Wisconsin law, though, even facilities without a sexual assault nurse examiner (SANE) need to provide victims with information about and access to emergency contraception. According to the Wisconsin State Journal, the ER director at St. Mary's also cited the hospital's religious affiliation — it is Catholic — as a reason for not administering EC, in addition to its lack of forensics nurse examiners program.

But victims coping with the trauma of rape may not want to shoulder the burden of being examined or retelling their story at another facility. Or, if they live farther away from a hospital with a forensic program, may not have the means or want to travel. If they don’t have immediate access to emergency contraception and can’t finish medical treatment, they are left vulnerable to an unwanted pregnancy caused by their rapist.

That’s why “it’s really important that they be able to get access to the medications that they need and want,” Baisa says. “It’s the law.”

Hospitals that refuse EC at the time of care cause victims to jump through hoops, advocates say. Though emergency contraception is available over-the-counter, research shows that the medication isn’t as easy to obtain as it should be, especially for teenagers and young adults. Cost alone can deter young victims already dealing with trauma from getting EC; the average price of Plan B One-Step, for example, is nearly $50, while one-dose generics average about $10 less.