One year after the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization that overturned Roe v. Wade, ensuring access to emergency contraception on college campuses is more imperative than ever.
The American College Health Association, a health and wellness advocacy and research group representing over 700 institutions of higher education, issued guidelines in June for navigating reproductive healthcare at universities amidst a changing landscape for reproductive rights. The guidelines recommended low-cost and convenient emergency contraception placement across campuses and counseling from clinicians on emergency contraception options during all preventative screenings. Despite recommendations, emergency contraception access at campuses is not universal.
Kelly Cleland, the executive director of the American Society for Emergency Contraception (ASEC), said that while some student health centers provide ample services, some offer no reproductive healthcare whatsoever due to funding constraints or religious ideology.
“In the post-Dobbs era, the stakes for pregnancy prevention are higher than ever in states where abortion is banned or severely restricted,” Cleland said.
One year later, many students are taking emergency contraception matters into their own hands. Emergency Contraception For Every Campus (EC4EC), a project of ASEC, is a student-led initiative to make emergency contraception accessible and affordable. So far, the group has introduced vending machines with emergency contraception on at least 39 college campuses.
College students face unique barriers to accessing emergency contraception
Levonorgestrel, also known as the morning-after pill or the brand name Plan B, is sold over the counter and has no age limit, but access barriers persist for college students. A team of medical students in southwestern Pennsylvania found that about one-third of pharmacies in the area didn’t stock Plan B. Similarly, some student health centers don’t stock emergency contraception at all, and traveling off-campus can be difficult for students in rural areas without cars, Cleland said.
It’s important to note that if you take an emergency contraception pill with levonorgestrel like Plan B and you weigh more than 165 pounds, it won’t work as well. The emergency contraception brand Ella has a slightly higher weight limit than Plan B and is more effective, but a prescription is required for it and that can raise privacy concerns.
“Many students are on their parent’s health insurance, so for those who need to keep their contraceptive use confidential, it can be a problem that these charges are often detailed on the explanation of benefits that parents receive,” Cleland added.
Cost is another challenge for college students. Emergency contraceptives like Plan B and Ella can cost between $40-$68, which is out of reach for many students.
Unlike Plan B, oral contraceptives require a prescription. A progestin-only oral contraceptive may soon be available over-the-counter. A Food and Drug Administration (FDA) decision is expected this August. If approved it would be the first birth control pill to be available over the counter since oral contraceptives were introduced in the U.S. in 1960, and it has the potential to help reduce barriers for young people.
“Even schools that do provide sexual health services often have significant limitations, such as appointment requirements even for [emergency contraception], limited availability of appointments, and restricted hours,” Cleland said.
With emergency contraception, time is of the essence.
“We know that unprotected sex does not just happen during business hours, so students need access to [emergency contraception] whenever they need it, including nights and weekends,” Cleland said.
Though it can be taken up to five days after condomless sex, emergency contraceptive pills are most effective when taken within three days.
The rise of emergency contraception vending machines helps dismantle multiple barriers. Cleland explained that the first step is ensuring that the administration understands why vending machines are a critical need for students.
“Depending on the campus, sometimes this step is easy, and sometimes it’s a big challenge,” Cleland said. When the administration is on board, the next step is generally logistics.
Sometimes, colleges have contracts with existing vending machines, so it’s a matter of adding emergency contraception. Cleland explained that overall wellness machines can be helpful so that it’s not immediately clear what someone is buying.
Cost and placement are critical for meeting the needs of students.
“There’s no reason that [emergency contraception] in a vending machine needs to cost more than $8. That’s a price point that is generally still affordable for students and covers costs for the university,” Cleland said. “The machines should be in a part of campus that is central and accessible to all students, regardless of mobility issues.”
The process for getting emergency contraception boxes in a vending machine on campus varies based on the college. Because vending machine placement requires cooperation from colleges, students at conservative or religious institutions may not be successful. Broadly, Catholic colleges don’t provide contraceptives to students.
At some public universities, there’s also opposition to emergency contraception. Acting out of an abundance of caution in light of the state’s new anti-abortion law, last year public universities in Idaho warned staff not to refer students to abortion providers or tell them how to get emergency contraception. Colleges in the state also barred student health centers from dispensing emergency contraception.
EC4EC has two strategies for institutions that are resistant to making emergency contraception more accessible. The first is to advocate clearly and vocally with the administration for improved access to reproductive healthcare, which may make incremental change. The second strategy is through EC4EC’s peer-to-peer distribution model, where students take matters upon themselves.
“We help students get free or low-cost [emergency contraception], and provide them with information, materials, and a community of other student leaders who can help each other troubleshoot,” Cleland said.
Students at Washington, D.C.’s George Washington University led a movement this year to include emergency contraception in vending machines. Before the university added the venting machines, Individuals from the university created Foggy Bottom Plan B, where people in search of emergency contraception fill out an anonymous Google form and set up a meeting in a dorm room to receive it.
The campaign to prevent unplanned pregnancy, Power to Decide, launched a new initiative in January to address the sexual and reproductive health needs at historically Black colleges and universities (HBCUs), including providing free and low-cost birth control and emergency contraceptive access to students. The majority of HBCUs are in states with contraceptive deserts, where the number of health centers offering a full range of contraceptive methods is not enough to meet the needs of people of reproductive age who are eligible for publicly funded contraception.
“We are bringing young people on HBCU campuses to the table to develop, lead, and execute place-based engagement strategies to help increase knowledge and access to sexual and reproductive health services on their campus,” said JeNeen Anderson, the senior director of health equity at Power to Decide.
Anderson said that so far, North Carolina’s Fayetteville State University, Mississippi’s Tougaloo College, Alabama’s Tuskegee University, one of two campuses at the University of the Virgin Islands, and Xavier University of Louisiana are part of the program.
Cleland told Prism that students have a lot of power in advocating for sexual health services on campus.
“College students are at school to plan for their futures, and pregnancy can derail those plans,” Cleland said. “So pregnancy prevention has always been an important issue for many college students.”
