Opportunities and Barriers to Contraception Access on College Campuses
April 03, 2023 | Brittany Lee
Access to comprehensive contraceptive care with as few logistical, financial, and stigma related barriers as possible increases positive health outcomes for individuals and their communities. When people can get their preferred method of birth control, rates of unintended pregnancy, preterm births, and short interval pregnancies all decrease. Additionally, contraceptive access is associated with increased financial and educational opportunities. Most importantly, access to contraceptive care gives people the ability to make decisions about what is best for their own sexual and reproductive health.
The positive health and social impact of improved contraceptive access is of particular value for college students, the majority of whom are of reproductive age and sexually active. Being able to get contraceptive care and reduce the risk of unintended pregnancy increases the likelihood that students achieve their educational goals and have a lower risk of negative maternal and infant health outcomes. As such, optimizing contraceptive care on college campuses can help ensure students have the resources and education to make informed decisions about their reproductive health.
Student health centers are a cornerstone of many colleges and universities, specifically those that serve students who live on campus since they are a hub for both healthcare and health education. Some institutions provide robust sexual and reproductive health services, including the full range of FDA-approved contraceptive methods. Contraceptive care at these health centers is dictated by state laws and university policies, while insurance coverage is determined by state and federal regulations and a student’s specific insurance policy.
Colleges with religious affiliations—or other institutional objections to birth control—or smaller colleges with fewer financial resources may not provide contraceptive care at student health centers. In these situations, students must choose between finding alternative locations of care, which can present challenges such as off-campus transportation and cost, or go without contraception, increasing their risk of unintended pregnancy.
Despite these potential barriers, there are innovative opportunities to provide high-quality contraceptive care on college campuses, while also reducing stigma to reproductive health and engaging a new generation of public health advocates.
Emergency Contraception for Every Campus (EC4EC), a program of the American Society for Emergency Contraception (ASEC), utilizes student leaders to advocate for vending machines that stock emergency contraception, condoms, and other sexual health products. The emergency contraceptive medication Levonorgestrel, commonly known as “Plan B,” primarily works by stopping or delaying the release of an egg from the ovary, preventing pregnancy. This medication has been available over the counter since 2013 but can be difficult for college students to get if their health center does not stock it, or if they cannot get it in a timely manner off campus, as it must be taken within 72 hours of unprotected sex or failed contraceptive use.
EC4EC helps address these issues as, depending on where they are located, vending machines can be available to students 24/7. However, this model requires support from the college administration to approve the program, facilities staff to upkeep its operation, and financial resources to purchase and maintain both the machine and the supplies. For campuses where vending machine distribution is not possible, EC4EC facilitates a peer-to-peer distribution model in which students supply free or low-cost emergency contraception in a confidential and discrete manner to their peers, typically coordinated through text messages.
Student leaders are the backbone of the EC4EC program, where they not only improve contraceptive care for their student body, but also build valuable skills in advocacy, coalition building, and navigating complex bureaucratic processes all while improving health outcomes of their community. Some states, such as New York, Illinois, and California, have proposed legislation that would require emergency contraception in vending machines on campuses at public universities, highlighting the role that states can play in improving access.
Improving Contraceptive Equity at Community Colleges
These distribution models are not feasible for contraceptive methods that require a prescription, such as oral contraceptives or intrauterine devices (IUDs), and not all academic institutions are willing and able to have vending machines on campus. Therefore, continued efforts among public health leaders should continue to prioritize contraceptive care among college students.
Students at community colleges are often left out of similar initiatives but can greatly benefit from increased contraceptive access. This population is more likely to be uninsured and low-income, significant factors that increase difficulty accessing contraceptive care. One study indicated that up to 10% of dropouts among female community college students were the result of unintended pregnancies, with other studies documenting a significant gap between desires to avoid pregnancy and contraceptive knowledge and use among community college students.
To reduce inequities in contraceptive care, community-based organizations, state agencies, and community colleges can partner to improve contraceptive access and identify solutions that are specific to their needs, while also increasing awareness of state and federal family planning services. BAE-B-SAFE, a program through Healthy Futures of Texas, is an example of this collaboration. The program helps reduce unintended pregnancies and sexually transmitted infections among community college students through peer educators who connect other students with free or low-cost sexual and reproductive health providers and deliver sexual health education.
Looking Forward
Although initiatives such as EC4EC and BAE-B-SAFE help meet a crucial need for college students, additional policy levers to improve contraceptive access more broadly can have an even greater impact on associated positive social and health outcomes. Continued support for Title X, a federal grant program for family planning services, as well as polices such as pharmacist prescribed contraception models and dispensing of 12-month of contraceptives at once, can connect more people to their preferred contraceptive method. Additionally, increased support for the reproductive health workforce, including clinical training on all methods of contraceptives and best practices for patient-centered contraceptive counseling, can help ensure that college students and others are able to obtain the birth control of their choice, wherever they receive care.